Management of Vasopressor Extravasation Injuries

Joseph Esherick, M.D., FAAFP, FHM
More Articles – central lines, extravasation injuries, Featured, HPC Updates, norepinephrine, phenylephrine, vasopressors
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Peripheral vasopressor infusions are generally safe at low-moderate doses and for short durations, but you must watch the patient carefully for extravasation that can cause serious tissue injury. Traditionally, central lines were placed for administration of vasopressor infusions at any rate. We…
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Does the Location of the Central Line Tip Make a Difference?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – central lines, central venous catheters, Featured, HPC Updates
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Based on several studies, central line malposition occurs between 3.3-6.7% of the time.1  The historical recommendation is that malpositioned central lines should not be used for long periods of time, if at all.  The basis for these recommendations is based…
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The subclavian vein may be the preferred location over IJ and Femoral Locations for Central Line Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – central line complications, central line placement, central lines, Featured Procedure, HPC Updates
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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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Where Should I Place My Central Line?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – central lines, central venous catheters, DVTS, Featured, femoral lines, HPC Updates, IJ lines, Pneumothorax, subclavian line
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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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Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Anticoagulation, antiplatelets, central lines, Chest tube, chest tubes, coagulopathy, Featured, HPC update, Lumbar Puncture, Paracentesis, procedures, Thoracentesis
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This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
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Bleeding Risk of Central Line Insertion in Coagulopathic Patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Central line insertion, central lines, Central Venous Catheter, Featured, HPC Updates, thrombocytopenia
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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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The subclavian vein may be the preferred location over IJ and Femoral Locations for Central Line Placement

Joseph Esherick, M.D., FAAFP, FHM
More Articles – central line complications, central line placement, central lines, HPC Updates
More Tags – , , ,
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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Summary of Sepsis and Septic Shock Treatment in 2017

Joseph Esherick, M.D., FAAFP, FHM
More Articles – ARDS, Arterial Lines, central lines, hemodynamic monitoring, HPC Updates, Mechanical Ventilation, Sepsis, Septic Shock, vasopressors
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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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Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Catheter-related bloodstream infections, central line associated bloodstream infections, central lines, central venous catheters, Device-related infections, Vascular access
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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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