Saturday November 25, 2006
Q; What is the main purpose of trendelenburg position during upper body central line insertion? (choose one)
1. To increase blood flow to vessels.
2. To increase ease of anatomical landmarks.
3. To prevent venous air embolism
4. To counteract hypotension by sedative medicines if used.
Answer : To prevent venous air embolism
Venous Air Embolism is a rare but potentially fatal complication of central line insertion in upper body area and could be prevented with trendelenburg position (atleast 15 degrees), given no orthopnea. In case, Venous Air Embolism is suspected during line procedure with symptoms of sudden occurrence of cardiopulmonary dysfunction like hypotension, hypoxia or churning murmur over left sternal border ( "millwheel murmur" ) - following 7 immediate maneuvers are essential:
1. Clamp the line (do not withdraw) - to prevent further air.
2. Rotate patient to left lateral decubitus position - to decrease air leaving through RV outflow tract.
3. Enhance (or do if not done yet) Trendelenburg position - to help air trap in the apex of the ventricle.
4. Increase oxygen to 100% - Supplemental oxygen reduces the size of embolus. (Avoid High PEEP as it may increase the risk of paradoxical emboli).
5. Advance the catheter little, unclamp the line and aspirate from the 'distal port' to attempt to remove air. (PA-catheter is not as effective as triple lumen catheter in aspirating air).
6. If hypotension occurs - start IVF wide open and add pressor if needed (catecholamines are prefered).
7. Continue supportive treatment till air is absorbed or further management for complications like paradoxical emboli or hyperbaric oxygen therapy is planned.
Refrences: Click to get abstract/article
1. An Infrequent but Life-Threatening Complication of a Simple Procedure - Journal of Intensive Care Medicine, Vol. 17, No. 2, 92-94 (2002)
2. Venous Air Embolism - emedicine.com
3. Gas Embolism - NEJM, feb. 2000, Volume 342:476-482
4. Venous air embolism: a review. J Clin Anesth 1997;9:251-257
Q; What is the main purpose of trendelenburg position during upper body central line insertion? (choose one)
1. To increase blood flow to vessels.
2. To increase ease of anatomical landmarks.
3. To prevent venous air embolism
4. To counteract hypotension by sedative medicines if used.
Answer : To prevent venous air embolism
Venous Air Embolism is a rare but potentially fatal complication of central line insertion in upper body area and could be prevented with trendelenburg position (atleast 15 degrees), given no orthopnea. In case, Venous Air Embolism is suspected during line procedure with symptoms of sudden occurrence of cardiopulmonary dysfunction like hypotension, hypoxia or churning murmur over left sternal border ( "millwheel murmur" ) - following 7 immediate maneuvers are essential:
1. Clamp the line (do not withdraw) - to prevent further air.
2. Rotate patient to left lateral decubitus position - to decrease air leaving through RV outflow tract.
3. Enhance (or do if not done yet) Trendelenburg position - to help air trap in the apex of the ventricle.
4. Increase oxygen to 100% - Supplemental oxygen reduces the size of embolus. (Avoid High PEEP as it may increase the risk of paradoxical emboli).
5. Advance the catheter little, unclamp the line and aspirate from the 'distal port' to attempt to remove air. (PA-catheter is not as effective as triple lumen catheter in aspirating air).
6. If hypotension occurs - start IVF wide open and add pressor if needed (catecholamines are prefered).
7. Continue supportive treatment till air is absorbed or further management for complications like paradoxical emboli or hyperbaric oxygen therapy is planned.
Refrences: Click to get abstract/article
1. An Infrequent but Life-Threatening Complication of a Simple Procedure - Journal of Intensive Care Medicine, Vol. 17, No. 2, 92-94 (2002)
2. Venous Air Embolism - emedicine.com
3. Gas Embolism - NEJM, feb. 2000, Volume 342:476-482
4. Venous air embolism: a review. J Clin Anesth 1997;9:251-257
posted by icupearls.org archive | 8:30 PM
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