On the rare occasion I do a central line...
1. In medical patients, found jugular no easier than suclavian or femoral.
Unless very fat and sometimes femoral is difficult in these.
2. In trauma, of course, messing with then neck is WAY DOWN my priority list
and I will go for Subclavian (or femoral).
Against Subclavian:
- C-collar and co. in the way and have to be messed with.
- I was taught and got used to a slight head rotation away from side of
puncture - can't in trauma
- Gets in way of anaesthetist or airway person
- I personally believe subclavian lines are easier to dress and nurse. I
certainly very often stuffed up the dressing on the neck...
3. So now I've just become used to doing lines below the neck
4. However, if I'm in on a case, I will usually be leaving any sort of
plumbing like this to someone who cares, e.g. ITU/anaesthetics SHO/SpR
(depending on whom we've called for whichever case) and they're welcome to
it. They usually select neck for medical cases, but other sites in trauma.
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