Weird Central Line

[Inertia123]

Was doing a Right IJ on a patient who arrested 2/2 septic shock and got ROSC. Patient was getting NS under pressure bag in AC. Using u/s, was coming down a little off my mark so a pulled back and redirected. Got into the IJ and withdrew this weird, very dilute, pink kool-aid colored fluid. I was like wtf am I in the carotid!? Both myself and resident assisting me agreed that we both saw the tip of the needle in the IJ. Called attending over who instructed me to pull off the syringe and upon doing so, the dilute fluid began to shoot out, but NOT in a pulsitile way - very constant flow, like you turned on a hose or something. Anyway, we aborted the IJ and went for femoral which got return of sludgy, dark appearing blood.

Attending's theory was that the combined effect of pt getting peripheral NS under pressure bag combined with poor forward flow with early ROSC combined to create a high pressure in the central venous system and produced this this effect. Anyone ever encounter this before???

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[dotcb]

Never seen that before. May switch US view to longitudinal and see where tip is. You could also put in the wire and take a look at it. No harm done till you dilate. I may have just gone with it and placed the line. Whatever it was, doesn't sound arterial.

 

[Rendar5]

Was doing a Right IJ on a patient who arrested 2/2 septic shock and got ROSC. Patient was getting NS under pressure bag in AC. Using u/s, was coming down a little off my mark so a pulled back and redirected. Got into the IJ and withdrew this weird, very dilute, pink kool-aid colored fluid. I was like wtf am I in the carotid!? Both myself and resident assisting me agreed that we both saw the tip of the needle in the IJ. Called attending over who instructed me to pull off the syringe and upon doing so, the dilute fluid began to shoot out, but NOT in a pulsitile way - very constant flow, like you turned on a hose or something. Anyway, we aborted the IJ and went for femoral which got return of sludgy, dark appearing blood.

Attending's theory was that the combined effect of pt getting peripheral NS under pressure bag combined with poor forward flow with early ROSC combined to create a high pressure in the central venous system and produced this this effect. Anyone ever encounter this before???

I wonder ift here were something wrong with this patient that were causing an obstruction to the venous system. SVC syndrome?

 

[Inertia123]

I wonder ift here were something wrong with this patient that were causing an obstruction to the venous system. SVC syndrome?

Or maybe some kind of thrombus....I dunno....It was really weird and disconcerting....

 

[Bostonredsox]

Agree with dotcb I would have fed the wire and seen if you could follow it down the jugular on us.

 

[Janders]

Hell, I would find it reassuring that I was getting pink-tinged NS out of my CVL, considering there is a 99.999% change that peripheral IV is in the venous system...

The closest I've seen is an unfortunate man who exsanguinated from a burst HD fistula in the right arm. EMS got there, threw a tourniquet proximally on the upper arm, then placed 2x I/Os and started NS via pressure bags en route. CPR in progress. DOA. I loosed up the tourniquet, and the NS they were infusing can leaking out... barely pink. Sigh.