Season 9 Case 1

History: line placement for the OR. Does everything look ok?

Answer:

1)Malpositioned Left subclavian catheter (extends into R IJ)

2)Malpositioned Right jugular Swan-Ganz catheter (extends into hepatic vein)

Did you see both? You have to check every one!

Let go through them. Correct ones first.

ETT - tip below the thoracic inlet and >2cm above carina

GI tube - tip/side port below GE junction (hard to see but I think so)

Mediastinal drain

Right chest tubes x 2  (No pneumothorax)

What about that left subclavian catheter?

Tip extends up into the right jugular vein.

Ideal = tip at SVC-atrial junction.

Repositioning needed!

What about that right jugular Swan-Ganz catheter?

Coils in the right atrium then extends caudal with the tip in one of the hepatic veins

Ideal = extends through right atrium with tip in the right or left main pulmonary artery.

Repositioning needed!

Shortcut? Not that I know of. Check every tube/line on every image.

But remember, the more you do anything, the faster you get at it. Repetition breeds speed. Try and get faster by experience, not by shortcuts.