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With a new academic year starting, it is important to review some details on central lines
Complications of central lines (TLC-Triple lumen catheter)
- Pneumothorax (more common with subclavian)
- Arterial puncture (more common with femoral)
- Catheter malposition
- Subcutaneous hematoma
- Hemothorax
- Catheter related infection (historically more with femoral)
- Catheter induced thrombosis
- Arrhythmia (usually from guidewire insertion)
- Venous air embolism (avoid with Trendelenburg position)
- Bleeding
Avoiding infections: hand hygiene, chlorhexidine skin antisepsis, maximal barrier precautions, remove unnecessary lines, full gown and glove w/ mask and sterile technique.
Catheter position: 16-18cm for Right sided and 18-20 cm for Left sided. But can vary based on height, neck length, and catheter insertion site. Approximate length based on these factors.
Flow rates: Remember that putting in a central line does not necessarily improve your flow rates in resuscitation
16 G IV: 220 ml/min
Cordis/introducer sheath: 126 ml/min
18 G IV: 105 ml/min
16G distal port TLC: 69 ml/min
Ports (Can vary with type of catheter)
1. Distal exit port (16G)
2. Middle port (18G)
3. Proximal port (18G)
Arterial puncture: hold pressure for 5 mins and evaluate for hematoma formation (harder for subclavian approach)
Arterial cannulation: Has decreased due to ultrasound use but if you do cannulate an arterial site, don’t panic. Don’t remove the line. You can check a blood gas or arterial pulse waveform to confirm placement. Call vascular surgery for open removal and repair or endovascular repair. You could potentially remove a femoral arterial line and hold pressure but seek vascular advice regarding possible closure devices to use after removal.