Losing 18 Inches of Wire In a Patient? As Inevitable as … Doomsday Itself

Sometimes a doctor must place a large-caliber catheter into one of the body’s biggest veins: the internal jugular in the neck, the subclavian in the chest, or the femoral in the thigh. These are “centrally-located” — in close to the torso — and the catheters accessing them are thus called central lines.

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View of finder needle passing the sternocleidomastoid muscle (SM) to puncture the internal jugular vein (IVJ). Note nearby lymph nodes and carotid artery. Image from this excellent article on using ultrasound for central line placement.

Never Say Never

Losing a foot and a half of wire inside a patient is the very definition of what medicine calls a “Never Event.” As the term implies, these select errors are hard to forgive.

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Guidewire protruding from man’s neck (left), and then seen on CT imaging (right) floating in central veins. Graphic from the New England Journal of Medicine.

The End of Civilization: Just Another ‘Never Event’

Enter COVID-19. At this writing the coronavirus has killed more than 90,000 Americans; fear of the virus and government-recommended control measures have combined to crash the economy, and soon we will see the deaths of despair that accompany every recession.

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Born in DC, studied at UNC-Chapel Hill, now living in Massachusetts. ER physician, EMS medical director, recovering journalist & Russia-watcher.

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