Central line errors
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Transcript of Central line errors
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Chris Jeziorkowski
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Personal experience Complications overview Individual complications
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385 Consecutive CVC placement over a 6 month period• 33% mechanical complication
22% failure to place 5% arterial puncture 4% catheter malposition 1% pneumothorax 1% subcutaneous hematoma <1% hemothorax <1% cardiac arrest
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Arrhythmias Vascular Injury Pulmonary Complications Guide Wires
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Ventricular dysrhythmias and bundle branch block • Cause by direct stimulation of endocardium• Prevented by limiting depth of guide wire
and catheter insertion to less that 16 cm
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Usually recognized by pulsatile blood flow and red appearance of blood• Can use US to confirm venous placement• Can get ABG and blood gas from your
sample to compare• Can transduce the pressure and observe
wave form
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Femoral artery injury can be contained with direct pressure for 15 minutes
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Air on aspiration may mean you violated the pleural space
Always get confirmatory chest x ray for subclavian and IJ lines
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Cases
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Inattention Inexperienced operator Inadequate supervision Overtired staff
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IR can remove guide wire
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Thoughts?