Trick of the Trade: Bubble Study for Confirmation of Central Line Placement
The safe placement a central venous catheter (CVC) remains an important part of caring for critically ill patients.1 Over 5 million CVCs are placed each year in the United States. It is crucial to confirm that the central line is placed in the correct position in order to rule out potential complications of the procedure (e.g. pneumothorax) and begin administration of life-saving medications. Post-procedure chest radiographs (CXR) are the standard of care for CVC placements above the diaphragm. However, the annual cost to the U.S. healthcare system for CXRs after CVC placement is estimated to be over $500 million.2 Further, in a busy ED, the limited availability of portable radiography may pose a considerable time delay. Radiography may also be limited in resource‐poor and austere settings, particularly the prehospital and military environments. We review a faster, cheaper, and more accurate alternative for evaluating CVC placement: point of care ultrasound (POCUS).
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A 32 year old woman arrives in your emergency department after being in a motor vehicle collision where she was the seat-belted driver. She undergoes chest CT imaging despite a negative chest x-ray because of her ongoing anterior chest wall diffuse tenderness. You discover a small 10% pneumothorax (PTX), but no other associated thoracic injuries. Should you place a tube thoracostomy (chest tube)? Should this patient be admitted to the hospital? A 2019 Annals of Emergency Medicine paper by the NEXUS Chest research group tackles these questions.
Emergency Medicine (EM) residents are expected to be familiar with and competent in performing a wide number of procedures, including rare ones such as performing an escharotomy in a patient with severe burns. Unfortunately, there is a paucity of readily available simulation models to facilitate practice of this rare yet potentially life-saving skill.
Welcome to Leg Day #2 of the 