1. Line Complications Dalhousie University Critical Care Lecture Series

5. Normal CXR

7. Mechanical Complications

16. Left Subclavian Artery

19. Prevention of Mechanical Complications

24. IJ Insertion Method Transverse orientation Longitudinal orientation

25. Check Vein for Patency Thrombus Vein should be free of clot and freely compressible when pressure is applied with the probe

26. Transverse Orientation- “Finger Wiggle” Finger on one side of probe Acoustic shadow of finger on same side of image

27. Orientation- “Mock Poke”

28. Orientation- “Mock Poke” Acoustic “shadow” of the needle over the vein

32. IJ Insertion Method After flash of blood, syringe is removed and a guidewire is advanced to 20cm The needle is then removed, leaving the guidewire in place

33. IJ Insertion Method Position of guidewire in relation to neck anatomy Make a small skin stab at wire insertion site. Note control of guidewire with both hands

34. IJ Insertion Method Dilate. If awake, tell the patient “you’re going to feel some pressure.” Advance the catheter over the wire. NEVER let go of the wire . Grab it when it comes out the brown port

37. Insertion Site-Femoral Vein is medial to femoral artery In anatomic position (legs apart), axis of vein is as pictured: toward umbilicus Note the inguinal ligament!

39. Image and Orientation

40. Infectious Complications

41. Infectious Complications Prevention

42. Management of Line Infections

45. What’s Wrong With These Pictures?

47. ETT in too far

48. Chest tube in poor position

49. Left mainstem intubation

50. Feeding tube in lung

51. Feeding Tube in RLL

52. Subclavian going In wrong direction

53. Carotid Artery Insertion

55. Hematoma After Subclavian Artery Puncture NG ETT

57. CT insertion Subclavian Line NG Down Left Mainstem!!!!

58. ETT Subclavian Crossing Through innominate