Here are some rules I emphasize when teaching central line placement, usually for IJ triple lumens and HD lines. Not a comprehensive guide, just some things I've seen trainees miss (including myself). I'm a fellow so I am by no means an expert and I'd love your input! [THREAD] Prep is everything. Room, bed, trash, table, etc. Make it easy! Move bed up, IVs and trash on opposite side of table--make space. Raise bed. Head down. Confirm ultrasound(US), image the length of vessel (for overt clots/stenoses). Clean hair, leads, tubes out of the way.

Burnout: a work-related constellation of signs/symptoms, often without prior psychiatric history. Marked by existential crisis, emotional exhaustion, and depersonalization. That’s academic. I described what it looks & feels like at @MassGeneralNews @acgme @TheIHI [THREAD] Early in intern year, I was caring for Mr. V, an elderly HD patient. 1mo earlier, he was living independently & working at HR block. Now, he was admitted with delirium. I couldn't figure out why. I couldn't fix it. Weeks went by. He floundered on the service, sicker by the day.