Aged 15-25 years (anonymity!!)
I agree that if you hit the artery with the introducer needle it seems
reasonable to try a bit of pressure abd try again, my case was complicated
by the fact that I had subsequently dilated the track and placed a (rather
wide) triple lumen line in it. It had been in for about 45 minutes before
we got the xray back. The concern was that we now had a "hole" rather than
just a "puncture".
Ordinarily we prefer internal jugular lines, a subclavian was chosen on
this occasion as he already had a chest drain in on both sides.
Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
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> From: john ryan <[log in to unmask]>
> To: [log in to unmask]
> Subject: Re: a pulling dilemma
> Date: 07 December 1998 03:34
>
> Canulating an artery seems to be so much more common with the subclavian
> than with the internal jugular route. I cut my central line teeth on
> subclavians rather than jugulars when I did a renal job for 6 months and
> replaced central lines for haemodialysis access every day. Initialy
> puncturing the subclavian artery was a common occurrence but the learning
> curve meant this decreased. We used to apply pressure for a few minutes
and
> try again when we would be successful. I dont remember any horrendous
> consequences and that was with a population who often had qualitatively
> dysfunctional platelets. Having said that I recall reading a paper from
an
> American journal a few years ago about extracting a catheter from a
> canulated subcalvian artery and thinking they had gone over the top so it
> would'nt surprise me if you tell us he had a major procedure to extract
the
> catheter.
>
> I guess we also have to think about the consequences of any procedure,
and
> would our management be the same in a 90 + year old pedestrian as it
would
> be with a 20 + year old. What age bracket was your patient in Simon ?
>
>
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