Central Venous Catheter (CVC) Complications
 • Arterial ...

Central Venous Catheter (CVC) Complications

 • Arterial puncture: Hold pressure x 10 mins; compress 1 inch inferior (IJ) or 2 inches superior (femoral) to puncture mark

 • Dilation / line placement in an artery: Consult vascular surgery BEFORE removing line; consider CT if pt stable

 • Pneumothorax (IJ & subclavian): Suspect if hypoxia, hypotension, difficult stick; obtain STAT CXR → thoracic surgery consult if PTX or hemoTX; if tension physiology (shock) → immediate decompression with 16G angiocath @ 5th ICS, mid-axillary line (enter above the rib)

 • Retroperitoneal bleed (femoral): Suspect if hematoma or hypotension; STAT CT / US → vascular medicine consult

 • Loss of wire or wire stuck in vessel: DO NOT use excessive force to pull out wire if it is stuck → leave in place, hold pressure to prevent exsanguination → STAT KUB / CXR if wire loss → vascular medicine consult

 • Air embolism: Hypoxia, chest pain, dyspnea, hypotension → can occur with insertion, removal, or while CVC is in place; administer 100% O2 (to speed air resorption); lay in Trendelenberg + left lateral decubitus position (to trap air in RV apex); STAT TTE (to assess for air in RVOT) → vascular medicine consult for potential aspiration of embolus

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MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf

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