Triple knotting of a central venous catheter

Spontaneous Knot Formation in a Central Venous Catheter

Patient: Male, 63-year-old

Final Diagnosis: Spontaneous knot formation in central venous catheter

Symptoms: Central venous catheter whit any flow • associated with pain at the insertion site of the access

Medication: —

Clinical Procedure: Central venous catheterization

Specialty: General and Internal Medicine • Surgery

Knotting of a guidewire during internal jugular vein catheterization in an infant: A case report

Central venous catheterization has been frequently used in pediatric patients in wide variety of conditions. Several authors have described about various complication of central venous catheterization in pediatric patients and reported complication rates of 3% to 6%. Knotting of guidewire as a complication of central venous catheterization has been reported in adult patients, but knotting of guidewire has not been reported in infants. Therefore we report an infant who experienced a knotting of guidewire during internal jugular vein catheterization which was successfully removed without any adverse events. We suggest that knot formation is possible in infants and there should be a high suspicion if resistance is felt at the time of catheter advancement.

Continuing Controversy of Midclavicular Catheters

A review of 50 years of research on catheter tip placement indicates an overwhelming preference for the lower third of the superior vena cava as the appropriate tip location. Despite this evidence, there are still practitioners, physicians, and nurses who advocate tip placement within the axillo-subclavian-innominate vein (also referred to as the midclavicular). This article looks at the arguments presented by practitioners who support midclavicular tip placement. It also reviews some of the research from which the recommendations for superior vena cava placement are derived.

Removal of knotted intravascular devices. Case report and review of the literature

OBJECTIVE

to review published reports on knotted intravascular devices/catheters.

METHOD

report of two cases and systematic review of the literature.

RESULTS

a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113).

CONCLUSIONS

interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.