1: What is a central line?
By the time they get to the MICU, most people have a pretty good idea of what central lines are -basically great big IV lines that go into great big veins. We use central lines for all sorts of things,in all sorts of places, so it makes sense to go over the basics of what, where and why.
This is apparently the first central line ever, in a film from 1929. Dr.Werner Forsmann, over in Eberswald, Germany, had the suddeninspiration one day, I guess, that the thing to do was to thread aurological catheter up into his arm as far as he could, and then torun down to the x-ray room, where he had to fight his way past acouple of concerned colleagues to shoot a picture of himself…See it there – the white line? Where’s the end of the line – the tip?So Werner – is the line in good position?
1-1: How do I know if my line is in the right position?
Here’s how you tell. The tip is supposedto be in the SVC – if it’s as far as theRA, then it’s in too far.Right about here…No big mystery… but what if the blood inthe line is really bright? Hmm…
A good rule of thumb for any centralline that you put into a patient
,whether in the neck, the chest, or evenin a femoral site –
always, alwaystransduce it before you use it
. We’veseen a couple of femoral
lineslately that were placed in hypoxicpatients – so the blood return was dark,right? Wasn’t venous….do you want toinfuse pressors downstream from anarterial stick site towards a patient’s leg?Didn’t think so…So: should we use Werner’s line, or not?www.vh.org
1-2: How do I know if my line is central or not? And what does “central” mean, anyway?