Central Lines

1. Percutaneous puncture should be attempted in the following order:

a. Femoral.

b. Internal jugular.

c. Subclavian.

2. Experience with a particular route of access, however, is also an important determinant. The femoral vein is the preferred site in emergency situations because it is relatively easy to cannulate, has fewer complications, and does not interrupt CPR. The complication rate for cannulation of the internal jugular or subclavian vein is higher when attempted by an inexperienced clinician.

E. Cutdown. If peripheral venous, central venous, and intraosseous cannulations are unsuccessful, venous cutdown may be attempted to gain vascular access.

VI. Problem Case Diagnosis. An intraosseous cannula was placed in this ill-appearing child who was in decompensated shock. BP stabilized and perfusion improved after administration of a 20 mL/kg normal saline bolus.

VII. Teaching Pearl: Question. In what scenarios should intraosseous cannulas be avoided?

VIII. Teaching Pearl: Answer. Avoid if patient has an overlying skin infection, a bone fracture, or at the site of previous infiltration.

0 0

Post a comment