> But how much time will a central line save you Matt? Apart from the
> additional time placing one, you've then only gained a small
> advantage in
> terms of patient circulation of the drug.
Well, they take only a few seconds to place using the cannula over needle
technique. After a few minutes of CPR, and with positive pressure
ventilation I'd reckon that blood return from the peripheries must be pretty
slight, so placing the drug into an intrathoracic vein should save a few
minutes at least (length of the cannula means you drop the drug just above
the right atrium)
> I'm not convinced the distance from
> antecubital fossa to
> great veins is that big a saving when you put it in this context.
>
I beg to differ here. Arm at atmospheric pressure and for the most part
lying on the trolley, so below the level of the heart; thoracic cavity at
positive pressure because of positive pressure ventilation plus someone
bouncing up and down on the sternum. Little output to push blood through
peripheral capillaries- and less of that going to the upper limbs. You're
trying to get fluids to flow up a pressure gradient. Not based on any great
evidence but seems logical to use the central vein.
Anyway, to return to my original point: assuming I'm going to persist in
doing this and following the resus council 2000 guidelines (and I quote:
'The central veins provide the optimal route as they allow drugs to be
delivered rapidly into the central circulation... Ultimately, the route
chosen will depend upon the skills and equipment available.'). Got the
skills for placing a central line about as fast as a peripheral line.
Problem is the kit. Anyone got any helpful suggestions (actually, am I the
only one putting central lines in?)
Matt Dunn
Warwick
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