ICU · Procedural

ICU procedures: central line, arterial line, chest drain, and bronchoscopy

Also known as Central venous catheterisation · Arterial line · CVC insertion · Chest tube · Bronchoscopy ICU

Core ICU procedures every intensivist must master: (1) CENTRAL VENOUS CATHETERISATION (CVC) — internal jugular (IJV), subclavian (SCV), femoral — ultrasound-guided (standard of care — reduces mechanical complications 70% — Karakitsos 2006, Critical Care), Seldinger technique, maximal sterile barrier, check CXR post. (2) ARTERIAL LINE — radial (Allen's test — controversial), femoral, brachial — continuous BP monitoring + arterial blood gas sampling, zero + square-wave test before trusting values. (3) CHEST DRAIN (tube thoracostomy) — 5th ICS anterior axillary line (BATLS/ATLS safe triangle), for pneumothorax/haemothorax/effusion/empyema — underwater seal, size 28-36 Fr for haemothorax (small-bore 8-14 Fr pigtail for simple air/effusion). (4) BRONCHOSCOPY (flexible) — diagnostic (atelectasis, haemoptysis, biopsy, BAL) + therapeutic (mucus plug removal, foreign body, lavage) — in intubated (via ETT ≥8 mm, sealed swivel adaptor) or non-intubated (sedation). COMPLICATIONS: CVC (pneumothorax, arterial puncture, haematoma, air embolism, infection — CRBSI); arterial line (ischaemia, infection, accidental intra-arterial injection); chest drain (pain, infection, subcutaneous emphysema, re-expansion pulmonary oedema, organ injury); bronchoscopy (hypoxaemia, bleeding, pneumothorax, laryngospasm). Central line bundle (Pronovost): hand hygiene + maximal barrier + chlorhexidine + optimal site + daily review.