Would you use a sub-clavian heading towards the head?

Specialties MICU

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Would love to get some feed back.

How many have, when the central line has taken a wrong turn towards the head instead of the heart, then had orders to use that line?

What, if you have used that line, have you run through it?

Would you feel comfortable running vasopressors though it?

Specializes in ICU.

I came onto a shift once where a lady had an IJ infusing propofol and fluids. The nurse said the doctor okayed it. Her neck was swollen, she was out of control, and increasing the propofol did nothing. I was suspicious and asked the intensivist to please check the x-ray again. He said that it was fine and I could use it. Half hour later, her neck was more swollen. I started some peripherals and switched the drips over and she immediately calmed down. When I pressed on her swollen neck, propofol oozed out of the insertion site. I was so mad. I dragged the intensivist into the room and he admitted that he hadn't really looked at the x-ray, but just went with what the night intensivist had said. The poor lady had been getting all this stuff infusing into her neck for hours. Anyway, a little different from your dilemma, but I'm just saying that docs don't always look closely when they should. Grrr.

Specializes in Cardiac.
If I had a PICC line or any other central line that flipped up into the pt's IJ I would definitely not use it to infuse pressors, however I would not pull the PICC as this can be easily fixed.

The PICC nurse can easily pull the PICC back aseptically around 5cm and re-advance it.

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Our PICC nurses refuse to readvance an already existing line. They will pull it back, but not advance. So if it's in the IJ we gotta pull it...

Specializes in ICU, ER, EP,.

Absolutely not, have had surgeons adamantly demanding it's ok to use them. Unless I'm in a code and that's my only access, nope.

Great question, this does happen and our docs don't seem to have a problem with it:no:

Specializes in ER.

I would ask for an order to pull it back and call it a midline before I'd infuse pressors towards the brain. Otherwise I vote with peripherals, and lots of them. Also make an incident report and go up the chain of command.

Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.

I've had surgeons give an order to use it without a CXR... because "it's in the right spot... you don't have to check mine".... if you can believe that!

Specializes in Post Anesthesia.

Yep, had the same thing happen and got the same order several times in my many years of practice. Used it- no other choice, but was never comfortable with it. In theory the flow is toward the heart so you should be able to infuse anything but my concern is how much fluid rate can I put in a subclavian large bore line pointing up the IJ without backing up in the vein and increasing intarcranial pressure? I just hoped the EJ could pick up the extra flow.

Specializes in Infusion Nursing, Home Health Infusion.

This would be considered a malpositioned line. Do you happen to know what the catheter was made of (ie. silicone or polyurethane). One thing you could have tried is to sit the patient up (if able (high Fowlers) ) and performed a power flush with a 10 ml syringe. Rapidly flush with a couple of syringes of 10 ml normal saline. Re Xray to see if the catheter flipped down. If not re-insertion will be needed. I would site a good PIV and give the vasoppressors through them. If for any reason you could not obtain peripheral access,it would be acceptable to give l;ife savibg medications through this line until another more suitable line can be placed. carefully document,all of your efforts to obtain a suitable central line access.

Specializes in ICU.

Heck no!!!:eek:

In a word...No. That doc needs to get off his/her tushie and replace that line.

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