There wasn't any great logic, it was what I was told to do!!!
I now also prefer IJ lines
Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
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> From: Robert Anthony COCKS <[log in to unmask]>
> To: acad-ae-med-request <[log in to unmask]>
> Cc: acad-ae-med <[log in to unmask]>
> Subject: RE: a pulling dilemma
> Date: 09 December 1998 17:17
>
>
> Simon
>
> Been there, done that too ! I think anyone who has done enough central
> lines has experienced an arterial puncture at some time (particularly
with
> resuscitations when there is no systolic blowback straight away) One
reason
> why I went over to internal jugular lines in preference.
> Excuse my ignorance, but with reference to your second mail, why is the
> presence of bilateral chest drains an indication to use subclavian rather
> than internal jugular route?. I don't quite get the logic of that one,
but
> it is 10 years since my attachment to ICU !
>
> Rob Cocks, HK
> ----------
> From: acad-ae-med-request
> To: acadae messages
> Subject: a pulling dilemma
> Date: Tuesday, January 05, 1999 12:43PM
>
> I recently (but not too recently) had a patient with chest trauma who
left
> us in a bit of a clinicla dilemma.
>
> Hx.
> Pedestrian
> Blunt chest trauma to right side chest resulting in #2,3,4,5, ribs, flail
> segment, large pulmonary contusion and tension pneumothorax.
>
> The mechanism was a direct blow from a passing vehicle, there was no
other
> trauma. The left side of the chest appeared fine (on 3 x-rays and
> clinically)
>
> Tension was drained and the patient was observed, however after about 15
> hours he became tired and was intubated and ventilated on ITU. 10 minutes
> later airway pressures up, SBP down, pulse up, sao2 down (34%!!!!!!).
Both
> sides of the chest were then decompressed, tension on the left relieved
> leading to resolution of symptoms. Interestingly, because he was
ventilated
> on SIMV with a large contusion (plus collapse) on the left breath sounds
> were heard well on the right despite there being a large tension
(potential
> trap for the unwary - if in doubt and things are going badly wrong
consider
> decompressing both sides).
>
> Anyway, I placed a right subclavian triple lumen central line. This was
> easily done (performed >200 in past) with nothing different from usual,
> (bright red blood but ventilated on 80% at this point), non-pulsatile
flow
> on cannulation of the vessel.
>
> However, Check XRay shows triple lumen line in left subclavian artery -
> bugger!
>
> So the questions:
> 1. Do you just pull the line out, press and hope? (or do something
> different?)
> 2. Some people claim to transduce the intoducer needle routinely to avoid
a
> arterial puncture - is this over the top?
>
> I can let you know what happened later.
>
> Simon Carley
> Anaesthetics / Intensive Care
> Stepping Hill Hospital
> Stockport
> England
> [log in to unmask]
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