failed central line...

The technique of inserting a central catheter had been improvised since 20 years ago. I had heard that one of it was utilizing color Doppler to locate the vein before puncture. But as a man of action working in ED, I preferred the traditional way to visualize the anatomy and proceed with the puncture. 90 % of the time, I am par to my standard. But yet, from time to time, I will tripped over by my own shoe lace..

This patient is an elderly male suffered from latent  Tuberculosis. He had presented to our OPD and ED with multiple complaint after starting his medication. However, he was hypotensive on this presentation. He was not tachycardic though. I decided to flush him with fluid via a central line before I start the dopamine drip. The catheterization process gone smooth before the guide wire insertion part; obstruction was noted when the wire was passed beyond the 15cm line. I retracted the wire and reinserted it. Still I faced the obstruction at the 15cm mark. I redrawn the wire and did a blood drawing trial and it was smooth. I proceeded with the wire insertion part (still 15cm..) and inserted the catheter. Everything was smooth and fluid was flushing with no problem…

I grinned when I saw the follow up xray. I ordered a full run of 2000cc of fluid and removal of the catheter after the flushing.

This is the first time, I inserted the catheter into the subclavian vein; I had multiple insertions into the internal jugular vein and I am familiar with the “obstruction” encounter during those insertions. Well, it still serve it function anyway…