meddick94  asked:

Hey, how are you doing? Got a question. You said you junior doctors start all the pIVs in the hospital. What about central lines? Do they let you do those?


Certain skills like cannulas and putting up drips, im or sc medications are part of our core skillset that we are expected to be signed off in our first year of being a doctor.

In reality, you’ll be expected to do thousands of cannulas and bleed thousands of patients, but nobody generally asks you to put up a drip except in a resuscitation situation (and nobody trains you to use the 564 different pump machines or syringe drivers in every hospital). So despite these being core skills we use some more than others.

In practice, it’s usually still our nurse colleagues who’ll start an IV medication and who will know important things like how to make up every different drug and how long it should be given over; I’ve seen the reference books, there are just so many ways you can give medications! But of course there are times when we have to administer meds ourselves so it is essential to be comfortable with different modalities of doing this.

Central lines are considered a more advanced skill, so they are something we are expected to be trained to do on the job in our junior doctor years. If you go into hospital medicine, then it’s a skill which is considered important by around registrar level. However a GP trainee on the hospital part of their rota, or a surgeon would not necessarily be trained in doing them at all.

We don’t always get a huge amount of formal training on how to do things, either. Though I suspect there’s more training on these kinds of procedures if you specialise in medicine or acute medicine, because it becomes a skill you’re expected to know by a certain level of seniority.

At a more junior level, a lot can depend on which placements you have done and how much you’ve been taught and observed on the jobs you have done. My colleagues who had placements in ITU saw tonnes and have done them, however I’ve only ever done them or arterial lines on models because my patient population on my placements very rarely required them.

Even before we officially specialise, our wide range of jobs means we all end up with different skills and weaknesses.

During quieter hours on the 7th day of each month, a 3.5 minute rave is held between Woodford and Buckhurst Hill. If you’re quick there’s just time to down a pint and dance to a song. Unfortunately since Boris Johnson decided to ban alcohol on the tube, such raves have been pushed underground.

While the Doctor might well be best known for fighting intergalactic aliens, much of his time is taken up with the day to day protection of the Central Line from extraterrestrial interference. It has come to light however that when trains pass too close to the Tardis there is a chance they may not end up at Woodford (via Hainault).


hospitalglam They messed up so bad. I stressed to them over and over and over all the issues I had last surgery. Yet still they did conscious sedation ignored , the order, and did not even don it correctly I was awake the entire time. I explained local anesthetic doesn’t work because of my connective tissues disorder and I feel everything.I told EVERYONE that. I felt them make every single incision I was sobbing and screaming in pain and they never stopped or added sedation. I’m in so much pain and I cannot stop sobbing and I have to be on oxygen it keeps dropping . And now I have to go do another surgery wish me luck! Love you my spoon community <3 this hospital glam is keeping me in better spirits thank you for this existing.


[image 1 shows me with short red hair with a purple flower crown, no makeup with my NJ feeding tube, in a hospital gown revealing my chest showing being hooked up to a IV through my port I have my hand touching my neck. You can see my IV pole behind me. The second image is the same but black and white with only the purple flowers in colour and no hand.

Chronically fabulous and rocking the hospital glam during my first infusion of Entyvio in my brand new port!

Providing access to Hogwarts, Harry Potter and Hogsmeade is platform 9 and ¾. While in JK Rowling’s book the platform might be accessed via King’s Cross, if you run quickly enough through the ticket barrier at Woodford (avoiding the angry London Underground staff) you might just find yourself in another world…

Central Lines

Central lines are large intravenous lines placed into veins such as the internal jugular vein (neck), subclavian vein (chest) or femoral vein (groin). They can be used to administer multiple medications, fluids and blood transfusions at the same time (depending on the number of lumens, which are the entry sites), take blood without the need for venepuncture, and for measurement techniques such as measuring central venous pressure.

Central lines are commonly used in oncology and haematology as patients are likely to require IV chemotherapy, fluids, electrolyte replacement, IV antiemetics, blood transfusions and daily blood tests.


PORT/Portacath: A small, usually circular, appliance that is inserted under the skin in the chest. It is connected to a line that enters a large vein. The appliance is made of a rubber type material that is usually “accessed” by inserting a needle attached to an IV line, secured with a dressing. The advantage of the PORT is that it can be kept in the body without being accessed for long periods of time, and therefore only accessed when required. 

Vas Cath: A type of central line that is usually used for dialysis in renal patients. It has at least two lumens - one to take blood from the body and one to return it. There may be a third lumen for the administration of IV fluids or medications.

Hickman’s Line: A type of tunnelled central line that is usually inserted into the jugular vein, with the exit site at the chest. It is usually used for chemotherapy in cancer patients, but can also be used for IV fluids and medications, to take blood, etc. Hickman’s Lines may be inserted for apheresis, such as stem cell collection.

PICC Line: A peripherally-inserted central catheter is inserted into a vein in the arm, and then advanced through into the the larger veins with the tip usually resting in the distal superior cava. They are thought to have lower rates of infection, and reduced likelihood of a pneumothorax upon insertion.


  • Know that the line is in the correct place before using it. Central lines will be xrayed once inserted to ensure they are placed correctly.
  • Know when the line’s dressing needs to be changed. Central line dressings should be done aseptically, and may be done every week (depending on the facility’s policy). Dressings should be changed if they are lifting, to prevent infection entering the area.
  • Make sure you look at the insertion site before using the line. Look for redness, ooze and swelling, feel for heat, and ask the patient if they have any pain. Pain should only be present initially from the insertion of the line. 
  • Don’t forget to lock the line with heparin when they are not connected to fluids. Some lines (e.g. apheresis Hickman’s Lines) require certain amounts of heparin, which should be written on the lumen.
  • If you don’t know how to use a central line, ask!!!

hospitalglam coming your way rheumatologist appointment today nothing left she can do for me but I love her office there’s never anyone in it and it has the perfect lighting. Floral glow in the dark cane and one of my favorite bows. That central line dressing change aesthetic tho

A Shepherd’s Pie is very easy to make, and, its topping of fluffy, creamy mashed potato covering succulent hot mince, vegetables and gravy oozes flavour! This isn’t just a Shepherd's Pie however. This is a well designed, shiny, self adhesive Shepherd’s Pie coming soon to a Central Line train near you.