A patient with persistent, severe ileus, who is unable to tolerate enteral feeding for more than a week in the setting of necrotizing pancreatitis has a central line placed for initiation of total parenteral nutrition (TPN). Chest radiograph is shown below.
Which of the following steps should be performed before starting TPN in this patient?
A. Advance the central line by 2 cm.
B. Pull back the central line by 2 cm.
C. Insert a chest tube on the right.
D. Consult a vascular surgeon.
答案解析：
将中心静脉导管插入动脉。尽管超声引导的进步降低了意外动脉插管的风险，但动脉插管和气胸等并发症仍有发生。因此，必须对术后胸片进行密切评价。一个病例系列证明，简单地拉动意外放置的动脉管路并施加压力，而不进行手术评价，可能导致并发症增加。因此，考虑手术探查或血管内修复的及时外科咨询是适当的。该胸片未显示需要放置胸管的任何病理。
正确答案：D
补充内容：ICU常用的导管位置图谱_全景看重症
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