key: cord-0917349-xz4sd5zw
authors: Eid, Mustafa Mahmood
title: Reprint of: Jugular central line inserted into the hepatic vein of a COVID-19 patient
date: 2022-04-08
journal: Dis Mon
DOI: 10.1016/j.disamonth.2022.101375
sha: 8c71762290853a897046b58b55674b5fa239db6d
doc_id: 917349
cord_uid: xz4sd5zw

nan

Emergency Additionally, a chest x-ray should be done after subclavian and internal jugular vein insertion to confirm the placement and exclude complications like pneumothorax. (2)

A 73-year-old patient with a history of multiple comorbidities presented to the emergency department with shortness of breath, fever, cough, and generalized fatigue. He claimed that his breathing became worse over three days. He did a nasopharyngeal swab before two days for SARS-CoV-2, which appeared positive today. The patient's vital signs showed a blood pressure of 110/50 mmHg; a heart rate of 115 beats per minute; a respiratory rate of 42 breaths per minute; a temperature of 38.5 C; and an oxygen saturation of 78 % on room air. Thus, the patient was placed on a monitor, and a non-rebreather mask with 10-liter of oxygen was started.

Antipyretics, in addition to other supportive measures, were initiated. A set of blood tests and chest computerized tomography in addition to arterial blood gas analysis was arranged. As his condition did not improve, non-invasive ventilation was started in the emergency, and the intensivist was consulted. The intensivist decided to admit the patient to the intensive care unit for further management. Later on, the patient was intubated and connected to mechanical ventilation due to the patient's condition's lack of improvement. Additionally, a right internal jugular central venous catheter was inserted. A portable chest x-ray was arranged to check the catheter position before use. Meanwhile, the patient heart rate increased to 140 to 158 beats per minute, and his rhythm showed intermittent atrial fibrillation in the monitor. The chest X-ray confirmed that the catheter reached the right upper abdomen region and was located within the hepatic vein ( Figure 1) . Thus, the central venous catheter was adjusted and pulled up to be in the correct position. Nevertheless, increased heart rate and intermittent atrial fibrillation were persisted despite treatment with beta-blocker medication. A few hours later, another portable chest x-ray was arranged, which confirmed that the catheter tip is in an abnormally low position ( figure 2) . Consequently, the central venous catheter was repositioned and pulled up. The heart rate decreased, and the atrial fibrillation disappeared. Plus, echocardiography was arranged, which showed normal chambers of the heart with no structural defects.

True/ False Question:

Central venous line insertion should only be done with Ultrasound guidance?

1-True.

The correct answer is (2-False.)

Explanation: Ultrasound guidance can be beneficial in all approaches and is the recommended approach. However, when ultrasound guidance is not feasible for various reasons, such as the emergency nature of a procedure, lack of equipment, or a patient's anatomy in a situation where there is limited room for the ultrasound transducer in the subclavian approach while manipulating the needle, CVLs may be placed using anatomical landmarks without ultrasound.

(2)

I have no conflicts of interest to disclose. 

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