Q: During inserting non-tunneled Central Venous Catheter (CVC) in ICU, it is recommended to infiltrate a large amount of local anesthesia into subcutaneous (SC) tissues.
Infiltrating skin and SC tissues with local anesthesia is needed prior to inserting CVC in ICU but large infiltration can cause two problems.
1. a large infiltration of local anesthesia in the SC tissue will distort anatomical landmarks (particularly making it difficult if no bedside ultrasound is available).
2. A large infiltration of local anesthesia in the SC tissue may compress vein making access more difficult, particularly in dehydrated patients.