It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line. However, available evidence doesn’t support this.
The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte.
Using the subclavian site for central venous catheterization reduced infections and DVT to a minimum, but tripled the risk of pneumothorax compared to the internal jugular (IJ) position. Using the femoral position eliminated pneumothorax risk, and was comparable to the IJ in infection risk, but significantly increased DVT risk.
Infusing Ringer’s lactate (RL) in a patient with hyperkalemia will actually lower his serum potassium level.
Most of our intoxicated patients are not vitamin deficient and don’t need supplementation. The real kicker is that we almost never really try to find out if the patient might be a chronic abuser and potentially at risk. We just hang the bag. Remember, everything we do in medicine has a potential downside. And if the patient really doesn’t need a banana bag in the first place, there is no benefit to balance that risk. The next time you ask for that little yellow bag, think again!
For decades now we’ve all been reciting the mantra that any sick or shocked patient needs: “2 large bore IVs” but do you know which IV cannula can deliver fluid to your patient the fastest?
Air embolism from IV tubing: In most cases, it will require at least 50 mL of air to result in significant risk to life, however, there are case studies in which 20 mLs or less of air rapidly infused into the patients circulation has resulted in a fatal air embolism.
