A question for OR nurses

Specialties Operating Room

Published

A family member recently had a brain tumor, a benign meningioma, removed and anesthesia place a central line. They obiviously had difficulty starting the line as there were 8 attempts on the R subclavian, 8 attempts on each jugular and it was eventually place on the L sublcavian after what appears to be 8 more sticks. Yes, I myself counted the stick marks, along with the attending Pulmonologist in the SICU. No chest x ray was done on him until after surgery when he went in to cardiac arrest. Surprise....he had bilateral pneumos! My theory is he was so acidotic from inadequate perfusion he arrested. My question is, do you normally get a chest xray after placing a central line in the OR? I am an ER nurse and we get the PCXR immediately after placing the line, what is the norm for the OR? Thank you.

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Definately.

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[color=darkslategray]not at my facility, though it can be requested, depending on the case. for my team (we do thoracic surgery) we do require postop cxr - some facilities do xrays on all pts. a lot depends upon facility policy.

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Specializes in Telemetry, OR, ICU.
A family member recently had a brain tumor, a benign meningioma, removed and anesthesia place a central line. They obiviously had difficulty starting the line as there were 8 attempts on the R subclavian, 8 attempts on each jugular and it was eventually place on the L sublcavian after what appears to be 8 more sticks. Yes, I myself counted the stick marks, along with the attending Pulmonologist in the SICU. No chest x ray was done on him until after surgery when he went in to cardiac arrest. Surprise....he had bilateral pneumos! My theory is he was so acidotic from inadequate perfusion he arrested. My question is, do you normally get a chest xray after placing a central line in the OR? I am an ER nurse and we get the PCXR immediately after placing the line, what is the norm for the OR? Thank you.

Yep, the surgeon will write an order for CXR to be done in PACU.

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I think waiting for the PACU before getting a chest xray is too long. Is this the standard?

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i think waiting for the pacu before getting a chest xray is too long. is this the standard?

[color=darkslategray]its my understanding that in certain places (mayo clinic comes to mind) that all their postop pts go through what looks like a "car wash" of an x-ray machine as they go to pacu - this is how they get away with not counting instruments/sponges, etc. it also takes care of the post-op cxr, too. much faster turnarounds, liability issues, etc. your mileage may vary. at my hospital, we get portable chests while the pt is in pacu.

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A family member recently had a brain tumor, a benign meningioma, removed and anesthesia place a central line. They obiviously had difficulty starting the line as there were 8 attempts on the R subclavian, 8 attempts on each jugular and it was eventually place on the L sublcavian after what appears to be 8 more sticks. Yes, I myself counted the stick marks, along with the attending Pulmonologist in the SICU. No chest x ray was done on him until after surgery when he went in to cardiac arrest. Surprise....he had bilateral pneumos! My theory is he was so acidotic from inadequate perfusion he arrested. My question is, do you normally get a chest xray after placing a central line in the OR? I am an ER nurse and we get the PCXR immediately after placing the line, what is the norm for the OR? Thank you.
CXR's are not done routinely on central lines placed in the OR by anesthesia. However, at least on the surface, this many attempts sounds excessive, but without knowing the patient's body habitus and anatomy, it's hard to say. With this many sticks, a CXR might have been prudent before proceeding with surgery. The pneumos don't surprise me given the number of sticks, but I would think problems would have shown up long before the end of the procedure.

The other question I would have is why did they need a central line to begin with?

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We do not get intra-op films for central lines...not even for difficult ones. We have also had a death from a swan-ganz catheter puncture. I'm not sure where the puncture occured but I assume it was proximal to the right atrium. I hope your family member recovers well!

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Thank you for all your input. This was done to the best father in law I could have ever asked for, and I feel his death could have been prevented with a simple CXR ASAP after the attempts for a central line.

I am not sure why the central line was place either, and I have reviewed the chart and cannot figure out why it was needed as he had a patent 18g prior to anesthesia.

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At my facility the post-op CXR is usually done in the unit, sometimes hours after line placed.

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Specializes in PACU, PICU, ICU, Peds, Education.

We generally have to remind anesthesia to order an x-ray in PACU. Often they don't tell us they started the line. We ask "is this new?" and they say, "Oh yeah, better get an x-ray." Of, course, the line has been in use for hours at this point.

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Yeah, like most of the other postings we do the check x-ray in the unit. Our guys feel that as we hook the line up to the monitor immediately they can tell by the reading where the line is. However they do the x-ray afterwards. If we put in a line for unit purposes only ,ie the patient is not actually coming to the OR we do the check immediately in the PACU.

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