Endotracheal intubation and central venous catheter placement in lateral position in an emergency traumatic injury: an improvised attempt in crisis

Abstract

Endotracheal intubation and central venous catheter (CVC) insertion are generally performed on the patient in the supine position. In traumatic cases, manual in-line stabilization and Sellick’s maneuver make airway management difficult. CVC insertion in the lateral position is not reported in the literature. A 30-year-old male with a history of falls from height presented with iron rods pierced into the right hand and right leg. The patient was intubated with manual in-line stabilization and Sellick’s maneuver in a lateral position. Due to the technical difficulty on the right side, CVC was inserted on the left side in a lateral position. Needle orientation was modified as per the position of the patient, and the left arm was pulled during the CVC insertion. The most experienced anesthesiologists should attempt for the best outcome. Wherever available, CVC should be inserted under ultrasonic guidance. With the landmark technique, the three-dimensional orientation of the anatomy should be kept in mind while attempting CVC insertion in an abnormal position.