For American EMS - A different question...

[zippyRN]

The asepsis of the field is more than adequate for the patients that receive the central lines.

Sight prep is no more involved than that for a peripheral IV, and the infusion rate is significantly greater. The whole pupose of using central lines and IO's is to obtain vascular access in patients that you can't get a peripheral IV in. Cardiac arrest and multisystem trauma are just a couple of examples.

NO - standards of practice and so on - if a patient recieving a central line in the Anaesthetic room gets full prep, then they do so in the ED and in the field ... also if radiological confirmation of placement is required in hospital how do yyou justify placement and use without confirmation of placement in the field when there are other valid options which have reduced risks of sepeis and pneumothorax...

NO - Central lines do not provide faster / greater flow rates than well placed peripheral lines ( central lines don't feature in the alphabet soup fo courses for that very reason )

the placement of aproper central line is often the last action taken in the preparation of thecritical carepatient, long after the ABCs, placing a peripheral arterial line for IBP , urinary catherterisation and further imaging ...

it is very rarefor any kindof emergent or urgent critical care transfer to go with a central line ine in situ but all with have peripheral arterial access for IBP as well as standard monitoring and ETCO2...

An experienced provider, with the line prepped beforehand, will have central access in a similar time frame to IO access. We don't go through the triple lumen progression, so the time frame is much quicker. Just a big needle on a syringe, going into a central vein.

i may have this wrong but it sounds lie some people are calling EJ IVs a central line

[AZCEP]

zippyRN, I would welcome you to come ride with me in western AZ so you could see the differences in what we are discussing.

Even the central access that is achieved in many hospitals, locally, are not verified with radiology. The risk of sepsis and pneumothorax are greater with prehospital use of the procedure. I've already conceded this point. However, the patient that receives central access is not one that can be deemed a greater risk than benefit. These are done in the most critically ill/injured only. For these patients, whom cannulation is only achievable with smaller guage sizes, central access does provide greater flow rates.

Central lines are CONSIDERED after an airway is established, and vascular access has been deemed impossible through peripheral sites.

And, no, I am not considering an external jugular IV a central line. As I've indicated previously, we use subclavian and internal jugular routes, and femoral less often.

[zippyRN]

zippyRN, I would <snip>

Even the central access that is achieved in many hospitals, locally, are not verified with radiology.

that is a departure from an internationally accepted standard of care, which is odd given it's also a potentially chargeable item as well ...

The risk of sepsis and pneumothorax are greater with prehospital use of the procedure. I've already conceded this point. However, the patient that receives central access is not one that can be deemed a greater risk than benefit. These are done in the most critically ill/injured only. For these patients, whom cannulation is only achievable with smaller guage sizes, central access does provide greater flow rates.

i would suggest there are other routes to achieve larger peripheral access if you can get small peripheral access ( e.g. the filling of veins against a 'tourniquet' by placing a small line distally and the tourniquet proximally ...

plus of course EJ lines etc...

[BushyFromOz]

Oh god not again...

INstead of someone doing something a "different way" they are doing it the "wrong" way :roll:

[AZCEP]

As you may well have noticed, very few American providers are still allowed to use central vascular access. The availability of IO has all but eliminated the central line for EMS.

I will apologize to vs-eh? for horribly derailing his initial intent of gathering information about the American system, and it's differences from the Canadian. Hopefully, some of my American colleagues will be willing to chime in with how their systems work. Arizona's has been well discussed.

[NREMT-Basic]

Just as a point of interest and conversation: the med list for an Ontario PCP is identical to our EMT-B drug list with the exception of the last drug, which I readily admit not being familiar with. In IL we also include the obvious O2 as a "drug" allowed to be given with standing order.

[akroeze]

Just as a point of interest and conversation: the med list for an Ontario PCP is identical to our EMT-B drug list with the exception of the last drug, which I readily admit not being familiar with. In IL we also include the obvious O2 as a "drug" allowed to be given with standing order.

FYI Salbutamol = Albuterol

[Dustdevil]

I think a lot of people on this forum see EMS level as simply a set of procedures, a "what can I do", and that seems to define them. If an EMT-B sees/or thinks that they should/can do an IV, that "sets them apart", makes them "more educated". Or if an EMT-P administers Lopressor that they have "an edge", perhaps in a greater educational scheme.

This is flawed thinking. It is also ironic considering the vast majority of calls require only BLS. I sure most would agree that an educated BLS paramedic with a limited scope is far better FOR THE PATIENT, than an under-educated BLS paramedic with a greater scope.

What good is all the education you receive when you don't carry the drugs that can help treat patients?

Careful! You're falling for VS's trap!

We could turn that question around and ask, what good are all those drugs when you don't have the educational foundation necessary to appropriately utilise them? The knowledge base is necessary BEFORE the skills. Education is not something you go back and get after you start killing people with your skills.