Central Line Insertion

Question 1

What is central line insertion?

Answer 1

Placement of a catheter into a large vein to administer medication or fluids, obtain diagnostic tests, and monitor specific medical conditions.

Question 2

What are the potential complications associated with central line insertion?

Answer 2

Mechanical, infectious, and thrombotic complications.

Question 3

What factors contribute to complications from central line insertion?

Answer 3

• Operator experience and skill
• Patient anatomy and condition
• Type and location of central line
• Sterile technique
• Duration of catheter placement

Question 4

What are the signs of an air embolism?

Answer 4

• Sudden onset dyspnea
• Hypoxia
• Hypotension
• Tachycardia
• Potential loss of consciousness

Question 5

How does bleeding present clinically after central line insertion?

Answer 5

Depends on the volume and rate of blood loss, ranging from localized swelling and bruising to signs of hypovolemic shock.

Question 6

What are the manifestations of pneumothorax?

Answer 6

• Sudden dyspnea
• Decreased breath sounds on the affected side
• Subcutaneous emphysema
• Mediastinal shift in tension pneumothorax

Question 7

What local signs indicate an infection at the catheter site?

Answer 7

• Redness
• Swelling
• Purulent discharge

Question 8

What systemic signs can indicate a severe infection?

Answer 8

• Fever
• Chills
• Sepsis

Question 9

What is phrenic nerve palsy, and how does it present?

Answer 9

Presents as dyspnea and potentially elevated hemidiaphragm on radiographic imaging.

Question 10

List differential diagnoses for air embolism.

Answer 10

• Myocardial infarction
• Pulmonary embolism
• Severe sepsis

Question 11

What are other causes of localized swelling and bruising apart from bleeding?

Answer 11

• Hematoma
• Soft tissue injury

Question 12

What differential diagnoses should be considered for pneumothorax?

Answer 12

• Pleural effusion
• Lung consolidation
• Atelectasis

Question 13

What are other possible causes of systemic infection to consider when an infection is suspected?

Answer 13

• Cellulitis
• Localized abscess

Question 14

What investigations are used for diagnosing air embolism?

Answer 14

• CT pulmonary angiogram
• Transesophageal echocardiogram

Question 15

What clinical assessments are needed to investigate bleeding?

Answer 15

• Clinical assessment
• Possibly imaging and blood tests (FBC, coagulation profile)

Question 16

What imaging techniques are used to investigate pneumothorax?

Answer 16

• Chest X-ray
• CT scan

Question 17

What investigations are recommended for suspected infection?

Answer 17

• Blood cultures
• Local swab culture
• Complete blood count
• Inflammatory markers

Question 18

What investigations are used for phrenic nerve palsy?

Answer 18

• Chest X-ray
• Nerve conduction studies

Question 19

What is the management for air embolism?

Answer 19

• Oxygen
• Patient positioning (left lateral and Trendelenburg)
• Hyperbaric oxygen therapy if severe

Question 20

What is the initial management step for bleeding after central line insertion?

Answer 20

Apply pressure to the site.

Question 21

What is the management for pneumothorax?

Answer 21

• Oxygen
• Chest tube insertion

Question 22

What is the standard management for infection related to central line insertion?

Answer 22

• Antibiotics
• Catheter removal if indicated

Question 23

What supportive care is provided for phrenic nerve palsy?

Answer 23

Supportive care, possible surgical consultation.

Question 24

What causes immediate SOB and pleuritic chest pain after insertion of central line?

Answer 24

Pneumothorax

Question 25

What is the position for central line insertion to prevent embolus?

Answer 25

The Trendelenburg position is where the patient lies with the head tilted down 15 degrees and the feet elevated in the air. This allows gravity to assist the filling and distension of the upper central veins to reduce the risk of air entering the system

Question 26

What causes acute shortness of breath with chest tightness and normal breath sounds and no tracheal deviation?

Answer 26

Air embolus, which occurs if air is accidentally introduced into the central line during flushing, dressing change, or disconnection of the catheter hub