A recent experience I had at an all-CRNA hospital I cover. Here's what I sent to my fellow CRNAs in the department.

Dear x and x,

I wanted to make you both aware of a situation I encountered while placing a central venous line (CVL) in the ICU today.

I placed a CVL on a 80 male (PMHx CHF, PNA) for fluid resuscitation and antibiotic administration. The procedure was done in the standard fashion and without incident. A PCXR was taken at the bedside.

The CXR Report (attached, TeleRAS, Xray1) showed a possible retained wire d/t a linear density at the end of the catheter. The catheter was retrieved from the trash intact, and a second PCXR was taken (attached, Xray2), with the hope that the linear density was artifact. On the second xray, the linear density remained.

After a discussion with Dr. x, I decided to take the line out and replace it. A 3rd Xray was taken and was clear for any suspected retained parts. The line was replaced and the a PCXR confirmed placement, with no linear density seen.

I then asked the Xray tech to shoot an image of the removed catheter only. A clear radiographic tip was seen as it was in the patient.

So, I removed a perfectly good line from a patient, because myself, the radiologist, Dr. x, along with the ICU nurse, had never seen a tip like this before on a radiograph.

Please review the attached pictures. I've also attached pictures of the labels from the kit with the radiographic tip along with the CVL I placed afterwards (from ICU stock).

Also, please note that the description of the catheter on the two different Arrow kits were exactly the same. They each say, "Radiopaque Polyurethane with Blue Flextip" - but only one appears to have a the 5cm linear density like the first catheter I inserted.

Arrow Kit with Non-radiographic tip.jpgArrow kit with Radiographic Tip.jpgCathether with Radiographic tip.jpgTeleRAS.jpgXRay 1.jpgXray 2 2nd Closeup.jpgXray 2 Closeup.jpgXray 2.jpg