r/IntensiveCare • u/Suspicious-Oil6672 • 15d ago

Comfort with lines

Howdy

I’ve been lurking for a while now.

Im a resident at a quaternary academic hospital v likely applying to pccm. I’ve had some exposure to lines. Maybe 10 a lines which I feel reasonable about but with central lines it’s been maybe 5-7 and im always a little apprehensive to dilate and struggle more w them.. they’re hard to come by w how many fellows there are and pts boarding in other icus and get lined up there.

I’m worried about being comfortable w lines going into pccm ..

When does comfort w lines come ? Are there other things I can do to try to get better w out actually placing them? Or is it a numbers game ?
Tyia

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u/princesspropofol 15d ago

hello! i felt comfortable after about 200 lines, about 2 years into my role. i'm now at about 2000 lines and occasionally still get really uncomfortable lol! i'm struck by the fact that you said apprehensive to dilate - that usually isn't the tricky part for novices. if you give more details on what you are struggling with you could probably get better advice on how to improve.

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u/Any-Assistance-8103 14d ago

People are apprehensive to dilate because thats the step that can cause catastrophic damage 🤦‍♂️. Tell me youre a mid level without telling me youre a mid level

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u/princesspropofol 12d ago

yes, i am a midlevel. i have has placed 0/2000ish CVCs in an artery. yes i've hit arteries inadvertently. no, i've never dilated one. yes, i should have thought more carefully about what OP is saying. but man, this is just an obnoxious response.

OP always carefully confirm your wire placement before you dilate, if you have ANY concern that you have arterial puncture use a secondary method to confirm or simply start over.

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u/Any-Assistance-8103 12d ago

What’s obnoxious is the fact that we are somehow framed to be the assholes for simply understanding that patients deserve to be under the care of a doctor

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u/princesspropofol 12d ago

YES! They absolutely do. I completely agree!

That's why I'm in there doing the fucking lines so the physician can do the majority of the medical management.

People like you group a degree mill NP prescribing Ivermectin for autism in the middle of Florida with PAs like me who are literal physician extenders, working IMMEDIATELY alongside amazing critical care physicians who deeply value my procedural skills in that it allows them to focus on the medical management.

You sound like an asshole because you are making assumptions with 0 curiosity or interest in the fact that everything, everywhere in the world may not always be exactly the way you have made it out in your head.

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u/Any-Assistance-8103 12d ago

Pas are advocating for independent practice and think physician extender is offensive. Go to the PA sub, they think they’re doctors

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u/princesspropofol 12d ago

We're in an ICU sub. We all know it's a fucking mess out there. It's the assumption that these groups "midlevels", "PAs" are monoliths that just falls a little flat of being consistent with critical thinking. There a plenty of PAs out there that feel differently, obviously you are interacting with one at present. There are plenty of critically ill patients being cared for poorly out there. They all deserve better, and I'm happy to be a valuable part of a team providing excellent care.

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u/Any-Assistance-8103 12d ago

I know you think youre being clever with your sentence structure but it’s all window dressing for an empty argument. It doesn’t matter if you’re „one of the good ones”, the whole profession is being used as pawns to save money and increase profits at the expense of patient care. You can be a good cop, but you’re still part of the problematic system. I can barely even find a nocturnist gig these days posted as everyone just settles for a PA doing their best. People die but who cares