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FOAM Bits

Central Lines... Getting Rid of Old Fears!

13/8/2015

 
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Doctors get thought many things that must be done in one sort of way and we do many things because we were thought so! Sometimes it is important though to  question standard procedures especially as our knowledge grows rapidly over time.


It's only a couple of years ago many anaesthetists were thought to insert central lines 'blindly' by using anatomical landmarks. X-rays confirmed line placement, ideally in the lower part of the superior vena cava, and excluded complications like a pneumothorax. Line placement in the right atrium was said to cause cardiac perforation and accidental placement in the contralateral subclavian vein often led to re-insertions of new lines. But important questions remains: Is this all really true? What actually do we know?


PulmCrit.org looked into this issue and just posted an excellent little review. Their bottom line is:

  • The ideal placement of the central line tip is unknown. 
  • Placement of central lines within the right atrium appears safe, and is specifically recommended by some guidelines for hemodialysis catheters.
  • Central lines terminating in the brachiocephalic trunk or subclavian vein are probably fine to use for most critical care applications (other than, for example, measurement of central venous pressure or mixed venous oxygen saturation). 
  • A combination of lung ultrasonography, internal jugular vein ultrasonography, and cardiac ultrasonography with a microbubble injection usually allows immediate exclusion of pneumothorax and proof that the catheter is in a intrathoracic vein.  Ultrasonography may be superior to chest X-ray for confirmation of line placement. 

Read their post here

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Ana Stafford link
13/12/2023 14:35:48

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17/12/2023 16:42:41

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Comments are closed.

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