Patient with hx ESRD on dialysis and multiple previous central catheters. Needs central line. #POCUS as shown. Go ahead and place the line? Poll in thread. #FOAMed #FOAMus #MedTwitter #EmergencyMedicine @mtabbut @RJonesSonoEM @SLWerner_EM @NephroP @siddharth_dugar
Place the line here?
Answer: This patient with chronic thrombus at the shown location. Best to look for a different location.
Note the echogenic material adherent to the wall of the internal jugular vein. Characteristics of chronic thrombi include narrowed lumen, non-compressible echogenic material adherent to the vessel wall.
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