Central Line Kit
Whether you’re doing internal medicine for a year or 3 years, you’re bound to come across really sick patients. Usually, I can tell within the first 10 seconds what’s wrong with the patient when someone tells me, “hey, there’s a 95-year-old guy in the emergency department.” Alarm bells start going off in my head and the first thought that comes to mind is that this is going to be a train-wreck.
My initial diagnosis (as always in these situations): Old Age
People who are old are just bound to have tons of medical problems; bad hearts, bad lungs, bad kidneys, you name it and they don’t typically have just one, they have all 3. They come to the hospital requiring tons of help, usually with aggressive fluid resuscitation and medicines called pressors to help keep their blood pressure up and their brains perfused (afterall, no brain = no life).
As an intern, these cases are a little overwhelming. These patients are really sick and need lots of attention, but sometimes it’s left on you (the fresh out of med school doctor) to figure out how to treat these patients. Sure, there’s a protocol, there’s help, and there’s backup if you need it, but it still feels like your calling the shots…and it definitely gets your adrenaline pumping because you actually feel like someone’s life is truly hanging in the balance–like life and death is going to be based on the decisions you make in the next several minutes.
Of course, instead of thinking about all this and taking the time to analyze each problem and how to fix it, these situations require doing everything all at the same time…giving fluids, antibiotics, oxygen, pressors and whatever else may be needed because if you take your time to take each step and see how the patient does, you may be moving too slowly. Since I’m an intern, I definitely work slower, so I get only one task, and that’s usually to put in a central line (the special line you need so that you can give pressors). It involves putting a big needle in someone’s groin, neck, or underneath their clavicle and threading wires and other catheters into the vein so that the patient has good intravenous access.
I talk about this because for some reason or another, this week has been “old age” week. Lots of sick patient’s, lots of central lines. It’s not THAT complicated a procedure really. I’ve had training, I’ve watched tons of them done, but this week was the first time I had ever put one in myself. Wait, did I say one? I meant two! That’s right! And I nailed them…both! Sure, I had to poke someone’s leg about 7 times (inadvertently hitting the femoral artery…one of the largest arteries in the body….several times), but i put in a central line in the femoral vein and the subclavian vein (right under your collar bone)! I’m sure it sucked to be a patient in these situations because I was learning at their expense, but at the same time, they needed a line in and I was the only one that was sort of, kind of available to do it. The hardest part of it all is breathing/maintaining your core body temperature when you’re in a sterile gown, gloves, mask, cap, and sticking a big needle into one of the biggest veins in the body, then threading a wire into that vein so you can get this big catheter in. Your mask fogs up, you sweat, you start to itch (but you can’t scratch cause your hands are sterile), and if it’s your first time, it takes an eternity cause your hands just aren’t used to the procedure. (Not to mention I’ve been staying 2-3 hours later than I was supposed to so that I can put these lines in).
Anyway, the truth is it felt so rewarding to put in those central lines this week. I’m a prelim medicine intern, which means I’m only here for the year, and I was hoping to skirt by doing ZERO procedures. After being here for a while though, I realized I just wouldn’t feel like a real doctor unless I knew how to perform procedures. So after successfully completing two lumbar punctures last month, and now two central line placements, I can’t wait for the next one to come. It’ll probably still be scary, but it’s just so rewarding when you do it right.
Looks kinda like this when it’s all done:
Central Line in the Subclavian Vein
Didn’t cause a pneumothorax (meaning I didn’t poke a hole in the lung while blindly looking for the vein) and didn’t kill the patient, OR poke myself with the big needle.
Yes, those cabinets on top used to be completely bare. Now they’re just glowing with warmth!
