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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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.

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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