Critical Care Scenarios TIRBO #48: Choosing a line site
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Nov 15, 2023 Discussion on factors and best practices for selecting a line site for central line placement in critical care scenarios. Pros and cons of using an Internal Jugular (IJ) line, considerations for dialysis access, risks and complications associated with line placement, and importance of integrating procedural knowledge with clinical context for patient safety.
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Avoid IJ in Raised ICP
- Avoid internal jugular (IJ) vein placement in patients with elevated intracranial pressure.
- Small triple lumen catheters may have little effect, but larger catheters pose risks and alternative sites are preferred.
Right IJ for Dialysis Access
- Prefer the right internal jugular for dialysis catheters or introducer sheaths to ensure best catheter function.
- Avoid placing smaller lines in right IJ if dialysis or large catheters may be needed there later.
Subclavian Pros and Cons
- Subclavian site offers better dressing and lower infection risk but has higher mechanical complication rates.
- Avoid subclavian in ventilated patients due to increased pneumothorax risk and consider anatomy like pacemaker presence.