Download - Central line errors
Chris Jeziorkowski
Personal experience Complications overview Individual complications
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
Arrhythmias Vascular Injury Pulmonary Complications Guide Wires
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
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
Femoral artery injury can be contained with direct pressure for 15 minutes
Air on aspiration may mean you violated the pleural space
Always get confirmatory chest x ray for subclavian and IJ lines
Cases
Inattention Inexperienced operator Inadequate supervision Overtired staff
IR can remove guide wire
Thoughts?