06 May 2008  Tricks of the Trade           1. Few people really
NEED a central line in the ER (at least the ones where I work).
They need IV access, and once that's accomplished we can usually
stabilize patients who are going to be able to be stabilized.
In the absence of sepsis (in which case the benefit of the
oximetric IJ central venous catheter has been pretty clearly
established), most other indications are more for convenience
than necessity.      If the nurses can't get a peripheral IV,
I'll usually place an 18-20g EJ which is generally sufficient.
Failing that, I'll typically place a triple lumen or large bore
introducer in the femoral vein.      If the patient is sick
enough to require a central line, they aren't going to be
getting out of bed for a couple of days anyway.    2. The
supraclavicular one is often used in children over here.    3.
do you ever hit the artery?    4. I agree that most people can
be adequately resuscitated without a central line, although
unless I just absolutely don't