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Central line arterial puncture — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsCentral line arterial punctureSCE Acute Medicine

A 58-year-old man is assessed on the acute medical unit. During attempted internal jugular central line insertion, bright pulsatile blood is aspirated and ultrasound suggests carotid cannulation with a dilator in situ. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: E — Leave the dilator or catheter in place and seek vascular advice

Leave the dilator or catheter in place and seek vascular advice is the best answer because large-bore arterial cannulation should not be removed blindly; vascular or interventional advice is needed. Give high-flow oxygen and prepare for airway support is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Pulling and pressing can cause stroke, expanding haematoma or airway compromise.

Reference: Association of Anaesthetists vascular access guidance