The subclavian vein may be the preferred location over IJ and Femoral Locations for Central Line Placement

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Chest Tube, Featured Procedure, Infections
More Tags – central line complications, central line placement, central lines, featured procedure, HPC updates
Where to place a central venous catheter is a decision driven mainly by individual preference. The limited evidence available has not established any site as superior; the subclavian position has been reported as being less infection-prone, but more likely to cause…
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In plane ultrasound-guided central line placement is preferred over out-of-plane technique

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, medical procedures
More Tags – central line, HPC updates, internal jugular line, subclavian line, ultrasound-guided procedures
A study from an urban EM residency program determined that in-plane ultrasound-guided central venous catheterization is superior to out-of-plane ultrasound-guided central line placement. This study was only a single center study that was a randomized crossover study of ER residents…
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Where Should I Place My Central Line?

Ultrasound-Guided Central Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Featured, Medical General, medical procedures
More Tags – central lines, central venous catheters, featured, femoral lines, HPC updates, IJ lines, subclavian lines
The internal jugular or subclavian veins have fewer combined mechanical or infectious complications for central venous catheter insertions compared with femoral vein CVC placements.  Numerous organizations have proposed guidelines or central line bundles that have advocated preferential use of the…
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Which cirrhotic patients are at high risk for bleeding during hospital procedures?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Featured Procedure, Hospital Procedures, Lumbar Puncture, medical procedures, Paracentesis, Thoracentesis
More Tags – Bleed risk, central line, HPC updates, paracentesis, Procedures in Cirrhotic Patients, thoracentesis
How do we assess a cirrhotic patients bleed risk prior to a planned bedside procedure?  Can our standard platelet count and coagulation studies, prothrombin time (PT/INR) and partial thromboplastin time (aPTT), accurately predict bleed risk in cirrhotic patients?  The quick…
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Ultrasound-guided Central Venous Access: Are Landmarks a Thing of the Past?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Emergency Procedures, Featured Procedure, medical procedures
More Tags – central line, central venous catheter, featured procedure, HPC updates, ultrasound, ultrasound-guided procedures
Point-of-care ultrasound is one of the most rapidly evolving areas of medicine.  In addition to becoming the “stethoscope of the future” for bedside diagnostic evaluations, ultrasound has improved the safety and efficiency of a wide range of procedures.  The use…
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Bleeding Risk of Central Line Insertion in Coagulopathic Patients

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Featured, Hematology, medical procedures
More Tags – central lines, featured, HPC updates, thrombocytopenia
The evidence base for the safety of ultrasound-guided central line placement with thrombocytopenia or in patients with a bleeding diathesis is not robust.  Nevertheless, based on the data available most procedural experts feels that an ultrasound-guided central venous catheter insertion…
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A Simple Checklist for Central Lines Saves Lives and Money

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Featured Procedure, medical procedures, Ultrasound-Guided Peripheral IV
More Tags – central line, checklists, HPC updates
Safety checklists have been adopted by numerous industries to prevent errors and save lives.  Checklists have been used for decades by industries as diverse as the aviation industry, construction companies, and professional chefs to prevent mistakes.  In medicine, checklists have…
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Extended cardiac monitoring is indicated for evaluation of cryptogenic strokes in elderly patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Medical General, medical procedures, Neurological diseases
More Tags – atrial fibrillation, cardiac monitoring, cryptogenic strokes, HPC updates, ischemic strokes, stroke
Prior studies have found that in patients with cryptogenic ischemic strokes, extended post-stroke cardiac monitoring detects intermittent atrial fibrillation (AF) in up to 20% of cases. Now, an industry-sponsored study from Germany randomized 400 patients all over 60 years old…
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Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Hematology, Infections, Mechanical Ventilation, medical procedures, Respiratory diseases
More Tags – ARDS, Arterial lines, central lines, hemodynamic monitoring, HPC updates, mechanical ventilation, sepsis, septic shock, vasopressors
Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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Accuracy of Urine Electrolytes to Assess Etiology of Acute kidney injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, medical procedures, Nephrology
More Tags – acute glomerulonephritis, acute interstitial nephritis, acute kidney injury, acute tubular necrosis, diuretics, HPC updates, prerenal azotemia
Both the fractional excretion of sodium (FENa) and the fractional excretion of urea (FEUrea) have an established role as part of the work-up for determining if acute kidney injury (AKI) is due to a prerenal or intrarenal cause. Although both…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, Central line insertion, Central line-associated bloodstream infections, Device-related infections, HPC updates, Vascular access
Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Catheter-related bloodstream infections, Central line-associated bloodstream infections, central lines, central venous catheters, Device-related infections, HPC updates, Vascular access
The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal.  Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs).  We now can appreciate that the…
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The Reasons Hospitalists Should Learn Hospital Procedures

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Central line, Chest Tube, Emergency Procedures, Endotracheal Intubation, FAST Exam, Glidescope Intubation, Hospital Procedures, King Tube, Lumbar Puncture, Medical General, medical procedures, Needle Decompression, Paracentesis, RUSH Exam, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – emergency procedures, hospital procedures, HPC updates, medical procedures, simulation-based procedural training
Hospitalists are in the ideal position to perform bedside procedures on their patients. They know every aspect about their patients and have had the opportunity to develop a good rapport and the trust of their patients. So, why are they…
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Transexamic Acid Reduces Transfusions and Mortality in Major Bleeding

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line, Ginecology, Hospital Procedures, medical procedures, Traumatology
More Tags – HPC updates, transexamic acid, trauma
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-hemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots). Now…
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Optimal Location for Needle Decompression For A Tension Pneumothorax

Hospital Procedure Consultants
More Articles – Central line, Emergency Procedures, medical procedures, Needle Decompression, Respiratory diseases, Thoracentesis, Ultrasound-Guided Peripheral IV
More Tags – HPC updates, needle decompression, needle decompression 5th intercostal space, needle insertion, needle thoracostomy placement, obstructive shock, pneumothorax
Needle decompression location Traditionally, needle decompression for the emergent treatment of a tension pneumothorax is the second intercostal space in the mid-clavicular line.  This remains an option for needle insertion when you are treating a tension pneumothorax.  This insertion point…
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