Annals for Hospitalists Inpatient Notes - Choosing a Central Line in the ICU—What's New and What's True?
Authors: Sushant Govindan, Steven Q. Simpson
Journal: Annals of Internal Medicine (2019)

Web Exclusives19 March 2019Annals for Hospitalists Inpatient Notes - Choosing a Central Line in the ICU—What's New and What's True?Sushant Govindan, MD and Steven Q. Simpson, MDSushant Govindan, MDKansas City Veterans Affairs Hospital, Kansas City, Missouri, and University of Kansas Department of Internal Medicine, Kansas City, Kansas (S.G., S.Q.S.)Search for more papers by this author and Steven Q. Simpson, MDKansas City Veterans Affairs Hospital, Kansas City, Missouri, and University of Kansas Department of Internal Medicine, Kansas City, Kansas (S.G., S.Q.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0447 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A 60-year-old man with a history of diabetes, hyperlipidemia, and prostate cancer is seen in the emergency department for 5 days of fever and purulent sputum. Vital signs are temperature 39.1o C, heart rate 110 beats/min, respiratory rate 22 breaths/min, SpO2 91% on 3 L/min of oxygen, and blood pressure 70/30 mm Hg. Serum lactate is 5 mmol/L. A chest radiograph shows a right lower lobe infiltrate. Bedside ultrasonography finds a hyperdynamic left ventricle and inferior vena cava variation. Cultures are obtained, antibiotics are initiated, and the patient receives 30 mL/kg of intravenous fluids. His heart rate subsequently decreases to ...References1. Climo M, Diekema D, Warren DK, Herwaldt LA, Perl TM, Peterson L, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2003;24:942-5. [PMID: 14700410] CrossrefMedlineGoogle Scholar2. Govindan S, Snyder A, Flanders SA, Chopra V. Peripherally inserted central catheters in the ICU: A retrospective study of adult medical patients in 52 hospitals. Crit Care Med. 2018;46:e1136-e1144. [PMID: 30247241] doi:10.1097/CCM.0000000000003423 CrossrefMedlineGoogle Scholar3. Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, et al; Michigan Appropriateness Guide for Intravenouse Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;163:S1-40. [PMID: 26369828]. doi:10.7326/M15-0744 LinkGoogle Scholar4. Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med. 2014;127:319-28. [PMID: 24440542] doi:10.1016/j.amjmed.2014.01.001 CrossrefMedlineGoogle Scholar5. Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis. 2014;59:96-105. [PMID: 24723276] doi:10.1093/cid/ciu239 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Kansas City Veterans Affairs Hospital, Kansas City, Missouri, and University of Kansas Department of Internal Medicine, Kansas City, Kansas (S.G., S.Q.S.)Disclosures: The authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0447.Corresponding Author: Sushant Govindan, MD, 4801 Linwood Boulevard, Kansas City, MO 64128; e-mail, sushant.[email protected]gov. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 19 March 2019 David H. Wesorick and Vineet Chopra Metrics 19 March 2019Volume 170, Issue 6Page: HO2-HO3KeywordsDecision makingHeart rateIntensive care unitsLactatesMedical risk factorsOxygenUltrasound imaging ePublished: 19 March 2019 Issue Published: 19 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...