Internal medicine pearls pdf

Diagram showing a tunneled central line inserted into the right subclavian vein. A dialysis two-lumen catheter inserted on the person’s left side. Internal medicine pearls pdf at the base of the neck indicate the insertion point into the left jugular vein.


For such indications, a Hickman line, a PICC line, or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as an entry point for pathogenic organisms. Additionally, the line itself may become infected with bacteria such as Staphylococcus aureus and coagulase-negative Staphylococci. Central line insertion may cause several complications.

The benefit expected from their use should outweigh the risk of those complications. In catheterization of the internal jugular vein, the risk of pneumothorax is minimized by the use of ultrasound guidance. For experienced clinicians, the incidence of pneumothorax is about 1.

All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus aureus and Staphylococcus epidermidis sepsis. Historically, a few CVC infections were considered an acceptable risk of placing central lines. However, the groundbreaking work by Dr.

Peter Pronovost at Johns Hopkins Hospital turned that perspective on its head. The IHI and CLABSI has identified proper hand washing by the performing provider, sterile draping over the person, thorough cleaning of the insertion site, and daily review for ongoing CVC need as key ways to decrease infection rate. Infection risks were initially thought to be less in jugular lines, but the decreased rate of infection is only seen in obese people.