Bedside ICU procedures: ultrasound-guided central venous and arterial cannulation, thoracentesis and chest drains, lumbar puncture, paracentesis and pericardiocentesis, with coagulation thresholds, local anaesthetic safety and Indian context.
6 topics
- 01
Central venous catheter insertion
Site choice, real-time ultrasound, confirming venous placement before dilation, tip position and complications.
8 stepsAlgorithm1 dosesNew - 02
Arterial line insertion and troubleshooting
Radial cannulation with ultrasound, transducer set-up, zeroing, and the square-wave test.
7 steps1 dosesNew - 03
Thoracentesis and chest drain insertion
Ultrasound-guided pleural aspiration, interpreting pleural fluid, intercostal drain insertion and drain management.
7 stepsAlgorithm2 dosesNew - 04
Lumbar puncture in the ICU
When to scan first, anticoagulant timing, technique, opening pressure and CSF tests.
6 steps1 dosesNew - 05
Paracentesis (diagnostic and large-volume)
Site, safety in coagulopathy, essential tests, SAAG, SBP diagnosis and albumin after large-volume paracentesis.
6 steps2 dosesNew - 06
Pericardiocentesis
Echo-guided pericardial drainage for tamponade: approach, confirmation, drain management and when to go to surgery.
7 steps1 dosesNew
Drugs in this module
Doses written for this module's context. The same drug may read differently in another module.
Lidocaine (lignocaine)
Amide local anaesthetic
Lidocaine (lignocaine)
Amide local anaesthetic
- Indications
- Local infiltration for bedside procedures
- Adult dose
- Infiltration with 1% (10 mg/mL) or 2% solution. Maximum: 4.5 mg/kg plain (about 300 mg), 7 mg/kg with adrenaline (about 500 mg).
- Preparation (India)
- 1% and 2% vials (plain or with adrenaline 1:200,000).
- Cautions
- Local anaesthetic systemic toxicity (perioral tingling, tinnitus, seizures, arrhythmia, arrest); aspirate before injecting; avoid adrenaline-containing solutions at end-arterial sites.
- Monitoring
- Neurological symptoms and ECG during and after large-volume infiltration.
Lipid emulsion 20%
Antidote for local anaesthetic systemic toxicity
Lipid emulsion 20%
Antidote for local anaesthetic systemic toxicity
- Indications
- LAST with seizures, arrhythmia or cardiovascular collapse
- Adult dose
- > 70 kg: 100 mL bolus over 2-3 min, then 200-250 mL over 15-20 min. ≤ 70 kg: 1.5 mL/kg bolus over 2-3 min, then 0.25 mL/kg/min. Repeat bolus once or twice and double infusion rate if unstable; maximum about 12 mL/kg.
- Preparation (India)
- 20% lipid emulsion bags (parenteral nutrition products, e.g. 100 mL and 250 mL).
- Cautions
- Pancreatitis and lipaemic interference with labs; use with standard ACLS (reduced adrenaline doses ≤ 1 mcg/kg).
Intrapleural alteplase + dornase alfa
Fibrinolytic + mucolytic (intrapleural)
Intrapleural alteplase + dornase alfa
Fibrinolytic + mucolytic (intrapleural)
- Indications
- Pleural infection with poor drainage despite a chest drain
- Adult dose
- Alteplase 10 mg + dornase alfa 5 mg intrapleurally twice daily for 3 days (6 doses), each clamped for 1 h.
- Cautions
- Pleural bleeding; check coagulation and platelets; avoid with bronchopleural fistula.
Human albumin 20%
Colloid
Human albumin 20%
Colloid
- Indications
- Large-volume paracentesis (> 5 L)
- Adult dose
- 6-8 g albumin per litre of ascites removed (e.g. 8 L removed: 48-64 g).
- Preparation (India)
- 20% (20 g in 100 mL) and 5% vials; costly in India.
- Cautions
- Volume overload in cardiac disease.
Module references (16)
- 1
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Farkas J. The Internet Book of Critical Care (IBCC). EMCrit Project; continuously updated.
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