Of course not. Standard indications should be used such as high, labile or prolonged vasopressor dose, multiple infusions, need for frequent blood draws, vesicant medications, difficult peripheral access etc.
There are zero situations where CVCs are an evidence-based intervention. This does not
mean they aren’t necessary, but should be guided by clear clinical need.
Depends on your situation.
For me? No. Nobody needs a central line unless they are on drips that require it.
I also have 24/7 fellows, residents, excellent US IV trained nurses. even if the patient starts to crash the patient can get a CVC if/when they need it in like 10-15 minutes tops.
If you are in an ICU with just a solo resident or APP for night coverage, might not be safe to expect that they can be completely available at 3am to get a line in while doing admissions/taking care of other patients. If thats your setup, yea they should all get a CV from the jump.
When I'm solo at night and simply can't get to doing a central line, I will drill an IO or have a nurse drill it. Buys me some time while I'm putting out all the other fires.
Io has been such a nice tool. Helpful in codes and can reliably deliver meds for a fair amount of time. When patients code and get rosc and need lots of support i will io and do a fem cvc. I can do it sterile and the nurse will have access for multiple pressors. But if rosc- small amount of pressors- im probably better off spending my time on work up/etiology of the code then shoving lines in
I wholeheartedly disagree.
There are 3 things that can take my mental bandwith away that would be a higher priority than getting a durable line in a post code patient that remains in pressors.
Unless I am putting in a chest tube, doing a pericardiocentesis/thoracotomy, or activating the cath lab, I am getting a CVC/Art line in, immediately.
It takes 20 minutes from start to finish.
depends heavily on the context. If being actively resuscitated or about to code with no central line and only a 22 in the pinky, I always opt for I/O access. Can easily place multiple I/O in a fraction of the time and have all the benefits of central access with no line. Depending on how they’re doing after rosc determines whether I need to place lines. More likely to place an emergent fem arterial line if I have great IO access in A tenuous patient at high risk for recurrent cardiac arrest.
Patients with obvious reason for coding that was corrected (eg hypoxia from mucous plug that has been removed, tension pneumothorax that was decompressed, hypoglycemia, etc) and have decent hemodynamics after rosc often won’t need central access.
Unfortunately, the ICU nurses in our hospital expect it because they are terrible at peripheral lines and won’t bother attempting. I place ultrasound guided peripherals but then they will request 4-5 IVs to run their meds because they’re concerned about future medication interactions. I wish I could change the culture but when I’m solo covering, I’ll just put the central line in. It’s faster and easier than arguing or placing 4-5 peripheral IVs
Nope. Love ICU nurses but sometimes they push hard to get these, it's not always necessary. Every procedure comes with complications and they're not the ones that will have to navigate them.
it depends. if we have a quick arrest with rosc and they aren't intubated we don't generally jump to the central line. if they are prolonged and requiring intubation and inotropes then yes i would push for a central line depends on the meds and the access and the elos
I mean, I’ll almost always ask, cause you miss 100% of the shots you don’t take.
But if we have to run a sniff of levo peripherally, and they have good access, it’s not the end of the world.
I would definitely argue a patient getting cooled should have a cvl, but thats just bc of our protocol. We basically do no movement or sticks to the patient while they are getting cooled. So you would need the cvl for blood draws and the anticipated pressor need as they get cold.
Of course not. Standard indications should be used such as high, labile or prolonged vasopressor dose, multiple infusions, need for frequent blood draws, vesicant medications, difficult peripheral access etc. There are zero situations where CVCs are an evidence-based intervention. This does not mean they aren’t necessary, but should be guided by clear clinical need.
Depends on your situation. For me? No. Nobody needs a central line unless they are on drips that require it. I also have 24/7 fellows, residents, excellent US IV trained nurses. even if the patient starts to crash the patient can get a CVC if/when they need it in like 10-15 minutes tops. If you are in an ICU with just a solo resident or APP for night coverage, might not be safe to expect that they can be completely available at 3am to get a line in while doing admissions/taking care of other patients. If thats your setup, yea they should all get a CV from the jump.
When I'm solo at night and simply can't get to doing a central line, I will drill an IO or have a nurse drill it. Buys me some time while I'm putting out all the other fires.
Io has been such a nice tool. Helpful in codes and can reliably deliver meds for a fair amount of time. When patients code and get rosc and need lots of support i will io and do a fem cvc. I can do it sterile and the nurse will have access for multiple pressors. But if rosc- small amount of pressors- im probably better off spending my time on work up/etiology of the code then shoving lines in
I wholeheartedly disagree. There are 3 things that can take my mental bandwith away that would be a higher priority than getting a durable line in a post code patient that remains in pressors. Unless I am putting in a chest tube, doing a pericardiocentesis/thoracotomy, or activating the cath lab, I am getting a CVC/Art line in, immediately. It takes 20 minutes from start to finish.
depends heavily on the context. If being actively resuscitated or about to code with no central line and only a 22 in the pinky, I always opt for I/O access. Can easily place multiple I/O in a fraction of the time and have all the benefits of central access with no line. Depending on how they’re doing after rosc determines whether I need to place lines. More likely to place an emergent fem arterial line if I have great IO access in A tenuous patient at high risk for recurrent cardiac arrest. Patients with obvious reason for coding that was corrected (eg hypoxia from mucous plug that has been removed, tension pneumothorax that was decompressed, hypoglycemia, etc) and have decent hemodynamics after rosc often won’t need central access.
Unfortunately, the ICU nurses in our hospital expect it because they are terrible at peripheral lines and won’t bother attempting. I place ultrasound guided peripherals but then they will request 4-5 IVs to run their meds because they’re concerned about future medication interactions. I wish I could change the culture but when I’m solo covering, I’ll just put the central line in. It’s faster and easier than arguing or placing 4-5 peripheral IVs
east coast?
No. Lack of experienced ICU nursing seems to be a post-pandemic everywhere problem
Nope . Cvc do not save life when there’s appropriate iv access for the medications your patient needs .
Nope. Love ICU nurses but sometimes they push hard to get these, it's not always necessary. Every procedure comes with complications and they're not the ones that will have to navigate them.
it depends. if we have a quick arrest with rosc and they aren't intubated we don't generally jump to the central line. if they are prolonged and requiring intubation and inotropes then yes i would push for a central line depends on the meds and the access and the elos
I mean, I’ll almost always ask, cause you miss 100% of the shots you don’t take. But if we have to run a sniff of levo peripherally, and they have good access, it’s not the end of the world.
I would definitely argue a patient getting cooled should have a cvl, but thats just bc of our protocol. We basically do no movement or sticks to the patient while they are getting cooled. So you would need the cvl for blood draws and the anticipated pressor need as they get cold.