Dr. Mike Niroumandpour
Dr. Lee had an 80 yr old male trach/peg come in with concern for sepsis who was hypotensive. Despite sufficient fluids patient was persistently hypotensive so the decision was made to place a central line. Trach collars make access to the IJ difficult and although there is recent literature in support of femoral lines being as sterile as the neck lines it is still TBHC ICU culture to change these out so the subclavian route seemed like a good option on this patient. These lines can be done just as easily as any other central line and with ultrasound we can visualize the lung and avoid hitting it with an in-plane technique. We can also get rid of the historical dogma that subclavian vasculature cannot be compressed because many times these vessels are superficial and easily compressible with the utlrasound probe. This line can be done infra- or supraclavicularly, the following is a great video.
Dr. Cathy Chen
Dr. Chen had a 62 yo asthmatic female who came in short of breath for 5 days. An xray showed white-out of the right lung with some tracheal shift and a CT scan showed the same along with mets. The patient started to decompensate so the decision was made to drain the fluid. Because of the improved visualization by ultrasound she opted with a thoracentesis instead of a chest tube. The CT scan and xray do not show the complicated fluid collection like the ultrasound does and these images led to a better therapy. Patient improved and was stabilized however ultimately did require a chest tube placed by Dr. Adebanke. Guidance again was optimized due to improved visualization by ultrasound.