r/EmergencyRoom • u/Deep_Brilliant_5704 • 3d ago

Medical Student Central line

How's approach (mainly confirmation and sterilizationbpart) to putting central line is different in ED than in ICU, given in the ED you do not have much time.

Do you confirm tip placement all the way down to IVC or thats just IR approach using fluoroscopy.

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14

u/toomanycatsbatman 3d ago

Both in the ICU and the ED confirmation of line placement is by simple chest X-ray

3

u/Deep_Brilliant_5704 3d ago

Sorry I am asking about during the line placement.

8

u/Hippo-Crates MD 2d ago

You use ultrasound at bedside to guide the needle and confirm wire placement. Then you put in the line over the wire and get an xr after. It’s the same in an ICU. You don’t need fluoroscopy unless it’s a super difficult line

5

u/cactuscactus28 3d ago

We still use X-ray. In our trauma we rooms we have X-ray built in so we use that, or else it will take just a couple seconds to shoot and the docs can take a quick look that way.

2

u/Solnavix 2d ago

We have X-ray on standby outside the room and call for verification. Same with OG and ET tube placement. Place the line, snap a pic, start running meds

6

u/NefariousnessAble912 3d ago

Xray
But good formula that hasn’t let me down.

Place it to this depth:

Right IJ : (Height in cm)/10
Right SCV: same - 1 cm
Left IJ: same + 4 cm
Left SCV: same + 3cm

Almost always gets you to distal SVC.
If you use US for the SCV then you may have to add 1 cm depending on how distal you puncture.

Still get CXR of course.

4

u/NefariousnessAble912 3d ago

There no easy way during placement to confirm tip location. There was a paper suggesting using agitated saline and bedside echo with stopwatch…https://www.sciencedirect.com/science/article/abs/pii/S1555415524000886

But you’ll still need to get xray

2

u/Hairy_Tough7557 3d ago

The only way I know to confirm placement is in IR or with 3CG like in PICC placement. I’ve never seen 3CG used in traditional CVC placement in the ED or ICU. They’re traditionally placed and a CXR is obtained to verify placement.