Bibliographic record
Abstract
The insertion of a central line is usually carried out in the supine position. We wish to report a case in which we inserted a Vascath™ in the prone position. A 58 year-old immuno-compromised man presented to our intensive care unit with respiratory failure due to pneumonia. He required intubation and ventilation. We were obliged to turn him prone to maintain oxygenation. He subsequently developed acute renal failure requiring continuous haemofiltration. We decided to insert a Vascath™ (Bard Instrument Company, Toronto) in the neck while maintaining the prone position. The right internal jugular vein was used as his head was turned in this direction. The patient was put in the anti-Trendelenberg position and all usual aseptic measures were used. We used the normal landmarks, a ‘seeker’ needle and the conventional approach to find the internal jugular vein. Subsequent placement of the Vascath™ was achieved using the Seldinger method without difficulty or complications. An assistant was needed to keep the skin folds separate, as the flexed neck position invariably brings the skin folds closer. Prone positioning of patient is commonly used in intensive care units in patients with respiratory failure. The onset of multiorgan failure often requires the insertion of central venous catheters for monitoring, inotropes or renal replacement therapy. Turning a patient from the prone to supine position is hazardous and may result in the displacement of the tracheal tube and vascular lines, and also requires a large number of people to manoeuvre the patient. The anatomical relationship of the internal jugular vein in relation to the carotid artery does not change in the prone position [1]. Anatomical landmarks are distorted but by palpating the carotid artery it is still relatively easy to identify the internal jugular vein with a ‘seeker’ needle. The NICE guidelines recommend the use of ultrasound to locate the internal jugular vein [2] and this could be particularly helpful in the prone position. Our patient demonstrates that it is possible to safely insert a central line in the prone position avoiding the need to turn the patient.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".