Central line dislodging?

[daniela095]

When transferring a patient onto a stretcher, the right internal jugular central line was tugged on the side because the lines attached to the ports got caught. Can the central line dislodge from this?

[Double-Helix, BSN, RN]

Yes, tension or pulling on the line can dislodge it.

[bugya90, ASN, BSN, LVN, RN]

Typically IJ is sutured in so it would require a pretty good pull to dislodge it but it can happen.

[iluvivt, BSN, RN]

It absolutely can! You can have what is called a secondary malposition with the tip no longer in an optimal anatomical location which is preferably in the low SVC or at the cavoatrial junction.You should examine the insertion site which may require that you remove the dressing and see if any has been pulled out or through a suture clamp.They are usually 20 to 24 cm long and vary by manufacturer. Even if you do not see a large amount externally visible you should get a chest xray since it could have whipped up if the tug was significant.You can also have the proximal lumen become extracellular on multi=staggered tip designs so also check a blood return on each lumen.

[AnnieOaklyRN, BSN, RN, EMT-P]

Yes, and if the line is still in the neck an X-ray should be done to recheck placement.

Annie

[JadedCPN, BSN, RN]

Yes, and if the line is still in the neck an X-ray should be done to recheck placement.

Annie

Absolutely this.

[MunoRN, RN]

Being "tugged on" while still remaining appropriates secured isn't going to cause an IJ central line to no longer be located in the vessel. Xrays are not benign and should only be used when there is a legitimate indication.

[AnnieOaklyRN, BSN, RN, EMT-P]

Being "tugged on" while still remaining appropriates secured isn't going to cause an IJ central line to no longer be located in the vessel. Xrays are not benign and should only be used when there is a legitimate indication.

I disagree unless they take the dressing down and measure, chest X-ray!

[MunoRN, RN]

I disagree unless they take the dressing down and measure, chest X-ray!

There's no rationale support for Xraying every time the tubing is "tugged", for many patients that would mean q 15minute CXRs, which would clearly cause more harm than any offsetting benefit.

[dudette10, MSN, RN]

Considering PICCs can move several centimeters just with arm movement, chest x-rays if sutures are in place, venous blood can be aspirated, and the patient experiences no untoward signs or symptoms seems like an awful lot of hullabaloo for nothing.

[iluvivt, BSN, RN]

That was was not supposed to be extracellular....it is extravascular....I think my phone changed it...so it's an extravascular tip placement on the proximal lumen.I have see this several times and it is often tricky to spot or figure out.

[iluvivt, BSN, RN]

If it's a significant tug....yes it can cause a secondary malposition especially if it was not deep enough,such as in the upper SVC .It does tend to happen more with pressure changes such as heavy coughing and vomiting and power injections and don't think beause its sutureed in or has a Securacath in place that you are safe !