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Abstract
Central venous catheters (CVC) are commonplace in the management of critically ill patients and serve a variety of purposes. Venous access is important for the administration of fluid and medications as well as blood procurement needed for lab analyses. However, not every critically ill patient requires a CVC. This article highlights the key considerations, pitfalls and evidence-based practices regarding the use pediatric central venous catheters.
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Affiliation(s)
- Ramin Jamshidi
- 1919 E Thomas Avenue, Pediatric Surgery, Clinic D, Phoenix Children's Hospital, Phoenix, AZ 85016, United States.
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2
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Hooda B, Singh S, Kiran S, Dwivedi D. Pressure infusion bag----"One size fits all" positioning tool for central venous access and brachial plexus blocks: A novel yet effective technique. Indian J Anaesth 2019; 63:414-415. [PMID: 31142891 PMCID: PMC6530288 DOI: 10.4103/ija.ija_802_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bhavna Hooda
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shalendra Singh
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - S Kiran
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Kong VY, Odendaal JJ, Weale R, Liu M, Keene CM, Sartorius B, Clarke DL. The correlation between ATLS and junior doctors' anatomical knowledge of central venous catheter insertion at a major trauma centre in South Africa. Injury 2018; 49:203-207. [PMID: 29137701 DOI: 10.1016/j.injury.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the ability of junior doctors (JDs) in identifying the correct anatomical site for central venous catheterization (CVC) and whether prior Advanced Trauma Life Support (ATLS) training influences this. DESIGN We performed a prospective, observational study using a structured survey and asked a group of JDs (postgraduate year 1 [PGY1] or year 2 [PGY2]) to indicate on a photograph the exact site for CVC insertion via the internal jugular (IJV) and the subclavian (SCV) approach. This study was conducted in a large metropolitan university hospital in South Africa. RESULTS A total of 139 JDs were included. Forty-four per cent (61/139) were males and the mean age was 25 years. There were 90 PGY1s (65%) and 49 PGY2s (35%). Overall, 32% (45/139) were able to identify the correct insertion site for the IJV approach and 60% (84/139) for the SCV approach. Of the 90 PGY1s, 34% (31/90) correctly identified the insertion site for the IJV approach and 59% (53/90) for the SCV approach. Of the 49 PGY2s, 29% (14/49) correctly identified the insertion site for the IJV approach and 63% (31/49) for the SCV approach. No significant difference between PGY1 and 2 were identified. Those with ATLS provider training were significantly more likely to identify the correct site for the IJV approaches [OR=4.3, p=0.001]. This was marginally statistically significant (i.e. p>0.05 but <0.1) for the SCV approach. CONCLUSIONS The majority of JDs do not have sufficient anatomical knowledge to identify the correct insertion site CVCs. Those who had undergone ATLS training were more likely to be able to identify the correct insertion site.
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Affiliation(s)
- V Y Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J J Odendaal
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - R Weale
- Department of General Surgery, Wessex Deanery, United Kingdom.
| | - M Liu
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - C M Keene
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - B Sartorius
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Roldan CJ, Paniagua L. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction. West J Emerg Med 2015; 16:658-64. [PMID: 26587087 PMCID: PMC4644031 DOI: 10.5811/westjem.2015.7.26248] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/15/2015] [Accepted: 07/17/2015] [Indexed: 01/22/2023] Open
Abstract
Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.
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Affiliation(s)
- Carlos J Roldan
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
| | - Linda Paniagua
- University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas
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Xing CY, Liu YL, Zhao ML, Yang RJ, Duan YY, Zhang LH, Sun XD, Yuan LJ, Cao TS. New Method for Noninvasive Quantification of Central Venous Pressure by Ultrasound. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003085. [DOI: 10.1161/circimaging.114.003085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chang-Yang Xing
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Yuan-Ling Liu
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Mei-Ling Zhao
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Rui-Jing Yang
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Yun-You Duan
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Lian-Hua Zhang
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Xu-De Sun
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Li-Jun Yuan
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Tie-Sheng Cao
- From the Departments of Ultrasound Diagnostics (C.-Y.X., Y.-L.L., M.-L.Z., R.-J.Y., Y.-Y.D., L.-J.Y., T.-S.C.) and Anesthesiology (L.-H.Z., X.-D.S.), Tangdu Hospital, Fourth Military Medical University, Xi’an, China
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Ultrasonographic comparison of two landmarks for the internal jugular vein: high versus conventional approach. Eur J Emerg Med 2015; 23:292-297. [PMID: 25734479 DOI: 10.1097/mej.0000000000000260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed and compared two landmarks (conventional vs. high approach) used in internal jugular vein (IJV) cannulation with respect to the degree of overlap with the carotid artery (CA) and the cross-sectional area (CSA) of the IJV using ultrasonography. PATIENTS AND METHODS Forty-eight adult patients were included. Using ultrasonography, the percentage overlaps with the CA and the CSA of both IJVs were measured in the supine and Trendelenburg positions using conventional and high approaches. With the conventional approach, the IJV is penetrated at the apex of Sedillot's triangle, formed by the clavicle and the sternal and clavicular heads of the sternocleidomastoid muscle. The high approach involves the midpoint between the sternal notch and the mastoid process. RESULTS The degree of overlap with the CA was 30.5 (7.5-69.4)% [median (interquartile range)] and 0.0 (0.0-25.4)% with the conventional and high approaches, respectively, for the right IJV (P<0.001) in the Trendelenburg position with 30° head rotation. The CSA of the right IJV was 1.22 (0.92-2.01) and 0.98 (0.79-1.72) cm with the conventional and high approaches, respectively (P<0.001), in the Trendelenburg position with 30° head rotation. IJV was more deeply positioned using the high approach than the conventional approach (P<0.001). CONCLUSION The high approach for IJV cannulation decreased both the degree of overlap with the CA and CSA of the IJV and increased the depth of the IJV from the skin compared with the conventional approach.
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Paraskevas G, Natsis K, Ioannidis O, Kitsoulis P, Anastasopoulos N, Spyridakis I. Multiple variations of the superficial jugular veins: case report and clinical relevance. ACTA MEDICA (HRADEC KRÁLOVÉ) 2014; 57:34-7. [PMID: 25006662 DOI: 10.14712/18059694.2014.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.
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Affiliation(s)
- George Paraskevas
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Natsis
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Orestis Ioannidis
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Kitsoulis
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Anastasopoulos
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Spyridakis
- Department of Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ahn EJ, Baek CW, Shin HY, Kang H, Jung YH. Phrenic nerve palsy after internal jugular venous catheter placement. Korean J Anesthesiol 2012; 63:183-4. [PMID: 22949992 PMCID: PMC3427817 DOI: 10.4097/kjae.2012.63.2.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eun Jin Ahn
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. Risk Manag Healthc Policy 2011; 4:27-39. [PMID: 22312225 PMCID: PMC3270925 DOI: 10.2147/rmhp.s10383] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed.
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Affiliation(s)
- Michael P Bannon
- Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota, USA
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