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Kanchanasuttirak W, Lekhavat V, Kanchanasuttirak P. Long-Term Tunneled Hemodialysis Catheters: Achieving Efficiency Through Tip Position Optimization. Ann Vasc Surg 2024; 105:158-164. [PMID: 38582198 DOI: 10.1016/j.avsg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND This retrospective study assesses the influence of tunneled hemodialysis catheter tip location and lateralization on catheter-related complications, including dysfunction and catheter-related bloodstream infection. METHODS Using data from 162 patients who underwent catheter placement between January 2017 and December 2020, postoperative chest X-rays and clinical records were reviewed. Outcomes were assessed based on catheter removal duration and complication incidence. RESULTS Out of 177 catheter placements, 56 (32%) patients experienced complications during an average 530-day follow-up. Catheters placed in the superior vena cava (SVC) exhibited more severe complications with shorter dwell times compared with those in the pericavoatrial junction (pCAJ) or right atrium (RA). Moreover, complication rates were significantly higher (P < 0.01) in the SVC (1.91 per 1000 catheter days) compared with the pCAJ (0.54) or RA (0.47). Lateralization (right or left internal jugular vein) did not significantly affect the complication rates (0.60 vs. 0.58; P = 0.90). However, in subgroup analysis, a significantly higher complication rate was observed for catheters with tips inserted from the left side into the SVC than for those inserted from the right side (6.6 vs. 1.5; P < 0.01). CONCLUSIONS Catheters with tips in the SVC exhibited more severe complications than those in the pCAJ or RA, with left-side insertion of SVC-tipped catheters resulting in significantly higher complication rates compared with right-side insertion. These findings highlight the importance of optimal catheter tip positioning in long-term hemodialysis care to minimize complications and enhance patient outcomes.
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Affiliation(s)
- Wiraporn Kanchanasuttirak
- Faculty of Medicine Vajira Hospital, Department of Radiology, Navamindradhiraj University, Bangkok, Thailand
| | - Vitit Lekhavat
- Faculty of Medicine Vajira Hospital, Department of Radiology, Navamindradhiraj University, Bangkok, Thailand
| | - Pong Kanchanasuttirak
- Faculty of Medicine Vajira Hospital, Division of Vascular and Endovascular Surgery, Department of Surgery, Navamindradhiraj University, Bangkok, Thailand.
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Shah RP, Bolaji O, Duhan S, Ariaga AC, Keisham B, Paul T, Aljaroudi W, Alraies MC. Superior Vena Cava Syndrome: An Umbrella Review. Cureus 2023; 15:e42227. [PMID: 37605686 PMCID: PMC10439982 DOI: 10.7759/cureus.42227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is a medical emergency that encompasses an array of signs and symptoms due to obstruction of blood flow through the superior vena cava (SVC). It poses a significant healthcare burden due to its associated morbidity and mortality. Its impact on the healthcare system continues to grow due to the increasing incidence of the condition. This incidence trend has been attributed to the growing use of catheters, pacemakers, and defibrillators, although it is a rare complication of these devices. The most common cause of SVCS remains malignancies accounting for up to 60% of the cases. Understanding the pathophysiology of SVCS requires understanding the anatomy, the SVC drains blood from the right and left brachiocephalic veins, which drain the head and the upper extremities accounting for about one-third of the venous blood to the heart. The most common presenting symptoms of SVCS are swelling of the face and hand, chest pain, respiratory symptoms (dyspnea, stridor, cough, hoarseness, and dysphagia), and neurologic manifestations (headaches, confusion, or visual/auditory disturbances). Symptoms generally worsen in a supine position. Diagnosis typically requires imaging, and SVCS can be graded based on classification schemas depending on the severity of symptoms and the location, understanding, and degree of obstruction. Over the past decades, the management modalities of SVCS have evolved to meet the increasing burden of the condition. Here, we present an umbrella review providing an overall assessment of the available information on SVCS, including the various management options, their indications, and a comparison of the advantages and disadvantages of these modalities.
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Affiliation(s)
- Rajendra P Shah
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Olayiwola Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Center, Largo, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Anderson C Ariaga
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Bijeta Keisham
- Sinai Center for Thrombosis and Research, Sinai Hospital of Baltimore, Baltimore, USA
| | - Timir Paul
- Section of Interventional Cardiology, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, USA
| | - Wael Aljaroudi
- Department of Cardiology, Augusta University Medical College of Georgia, Augusta, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, USA
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3
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Ultrasound Imaging of the Superior Vena Cava: A State-of-the-Art Review. J Am Soc Echocardiogr 2023; 36:447-463. [PMID: 36754099 DOI: 10.1016/j.echo.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Greater interest in imaging the superior vena cava (SVC) in recent years has arisen because of increased focus on disorders of the right heart; the growing use of transvenous access lines, dialysis catheters, and device leads; and the emergence of right ventricular mechanical circulatory support systems via the transcatheter approach. As a low-pressure venous conduit in the right upper mediastinum, the SVC is prone to compression by various pathologic processes, to invasion by malignancies originating in nearby structures, and to complications arising from intraluminal device leads and indwelling catheters. Computed tomography and magnetic resonance venography are the modalities of choice for structural imaging of the SVC. Ultrasound allows a reasonable, yet less detailed anatomic assessment of this venous conduit. Spectral and color Doppler imaging by ultrasound are the most valuable noninvasive tools for the interrogation of SVC blood flow, a marker of the filling pattern of the right heart. Analysis of the velocity, duration, and direction of the Doppler waveforms and their phasic response to respiration makes it possible to distinguish normal from abnormal flow patterns and offers diagnostic insights into disorders that affect right heart function. The aims of this review are to demonstrate the added value SVC imaging provides during transthoracic and transesophageal echocardiographic studies, to outline its usefulness for the detection and evaluation of structural abnormalities, and to detail the role of spectral Doppler imaging in aiding the diagnosis of various disorders that affect the right heart.
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Auer J, Braun J, Lenk J, Gollrad J, Ro SR, Hamm B, de Bucourt M. Tunneled hemodialysis catheter insertion: Above, within, or below the right atrium-Where is the tip? Acta Radiol Open 2022; 11:20584601221122421. [PMID: 36134126 PMCID: PMC9483979 DOI: 10.1177/20584601221122421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background One major challenge when inserting a tunneled, cuffed central venous catheter (CVC) for hemodialysis under fluoroscopy is to accurately place the catheter tip by assessing its position in relation to the cardiac silhouette to approximate the right atrium (RA). Purpose To investigate whether a weighted mean calculated from published results for two two-dimensional landmark reference distances may be useful in assessing CVC tip positions in relation to the RA. Material and Methods Central venous catheter tip positions attained under fluoroscopic imaging during insertion using the cardiac silhouette as approximation were retrospectively related to two reference distances (carina to cranial RA border and craniocaudal RA extent), which were used to group catheter tip locations above (1), within (2), or below (3) the RA (henceforth referred to as landmark technique approximation, LTA). The LTA-derived catheter tip locations were validated by correlation with postinterventional computed tomography (CT) datasets acquired shortly after implantation (if available). Results Based on LTA, 45 catheter tips (10.6%) were above, 179 (42.2%) within, and 200 (47.2%) below the RA. Postinterventional CT (n = 57; 13.4%) visualized 26.3% above, 66.7% within, and 7.0% below the RA. Conclusion The LTA reference distances appear to lead to a rather low categorization of the CVC tips, or the tips have been placed rather low in the study population. Validation using postinterventional CT indicated an underestimation of the RA in the LTA. Patient characteristics with a higher risk of false estimation through LTA have been defined.
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Affiliation(s)
- Jonas Auer
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
- Jonas Auer, Department of Radiology,
Charité – University Medicine, Hindenburgdamm 30, Berlin 12203 Berlin.
| | - Joachim Braun
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Johannes Gollrad
- Department of Radiation Oncology
and Radiotherapy, Charité - University
Medicine, Berlin, Germany
| | - Sa-Ra Ro
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University
Medicine, Berlin, Germany
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Kim SK, Ahn JH, Lee YK, Hwang BY, Lee MK, Kim IS. Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks. J Clin Med 2022; 11:jcm11133692. [PMID: 35806977 PMCID: PMC9267543 DOI: 10.3390/jcm11133692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.
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Affiliation(s)
- Sun Key Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Bo Young Hwang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Min Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Il Seok Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
- Correspondence: ; Tel.: +82-10-4706-6356
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Sharifkazemi M, Rezaian G, Hosseininejad E, Arjangzadeh A. Three simple but interesting transthoracic echocardiographic road maps for proximal superior vena cava visualisation in healthy young adults. IJC HEART & VASCULATURE 2022; 39:101004. [PMID: 35321114 PMCID: PMC8935520 DOI: 10.1016/j.ijcha.2022.101004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 12/01/2022]
Abstract
Background Although much is known about the technical aspects of inferior vena cava visualization, it is much less about its counterpart: the superior vena cava (SVC). The aims of this study therefore, were to describe in detail the different possible two dimensional echocardiographic SVC visualization techniques in healthy young adults and to provide a series of values for its dimensions and Doppler signals. Methods The proximal SVC visualization through the three transthoracic windows was initially established in several adult patients, with or without cardiovascular implantable devices. Subsequently a group of 70 completely healthy adults (35 males and 35 females) were studied to determine the values of SVC dimensions and its pulse Doppler signal characteristics. The visualization windows included: a) Modified apical 5-champber view, b) Modified parasternal short axis view of great vessels and c) Modified subcostal view. The SVC dimensions were measured 3–5 cm above the RA-SVC junction at the end of both hold cardiac and respiratory cycles (systole, diastole and inspiration/expiration, respectively). The peak pulse Doppler velocities were only measured at the end-held expiration. Results The largest end systolic proximal SVC dimensions at the end of the expiration and inspiration ranged from 8 to 14.0 mm (11 ± 2 mm) and 8.0–14.0 mm (11 ± 2 mm) respectively, and the highest S wave velocity ranged from 0.5 to 0.7 m/s (0.6 ± 0.0 m/s). Conclusion This study has provided a detailed technical description for transthoracic proximal SVC visualization in a group of 70 healthy adults and has furnished sets of values for its dimensions and Doppler signal parameters.
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Affiliation(s)
- Mohammadbagher Sharifkazemi
- Corresponding author at: Department of Cardiology, Nemazee Hospital, Nemazee Square, Shiraz 71846141478, Iran.
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Baehner T, Rohner M, Heinze I, Schindler E, Wittmann M, Strassberger-Nerschbach N, Kim SC, Velten M. Point-of-Care Ultrasound-Guided Protocol to Confirm Central Venous Catheter Placement in Pediatric Patients Undergoing Cardiothoracic Surgery: A Prospective Feasibility Study. J Clin Med 2021; 10:jcm10245971. [PMID: 34945270 PMCID: PMC8706795 DOI: 10.3390/jcm10245971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Central venous catheters (CVC) are commonly required for pediatric congenital cardiac surgeries. The current standard for verification of CVC positioning following perioperative insertion is postsurgical radiography. However, incorrect positioning may induce serious complications, including pleural and pericardial effusion, arrhythmias, valvular damage, or incorrect drug release, and point of care diagnostic may prevent these serious consequences. Furthermore, pediatric patients with congenital heart disease receive various radiological procedures. Although relatively low, radiation exposure accumulates over the lifetime, potentially reaching high carcinogenic values in pediatric patients with chronic disease, and therefore needs to be limited. We hypothesized that correct CVC positioning in pediatric patients can be performed quickly and safely by point-of-care ultrasound diagnostic. Methods: We evaluated a point-of-care ultrasound protocol, consistent with the combination of parasternal craniocaudal, parasternal transversal, suprasternal notch, and subcostal probe positions, to verify tip positioning in any of the evaluated views at initial CVC placement in pediatric patients undergoing cardiothoracic surgery for congenital heart disease. Results: Using the combination of the four views, the CVC tip could be identified and positioned in 25 of 27 examinations (92.6%). Correct positioning was confirmed via chest X-ray after the surgery in all cases. Conclusions: In pediatric cardiac patients, point-of-care ultrasound diagnostic may be effective to confirm CVC positioning following initial placement and to reduce radiation exposure.
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Affiliation(s)
- Torsten Baehner
- St. Nikolaus-Stiftshospital Andernach, Ernestus-Platz 1, 56626 Andernach, Germany;
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Marc Rohner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Nadine Strassberger-Nerschbach
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (M.R.); (I.H.); (E.S.); (M.W.); (N.S.-N.); (S.-C.K.)
- Correspondence: ; Tel.: +49-228-287-14116
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8
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Morales MM, Anacleto A, Ferreira Leal JC, Greque VG, Souza AS, Wolosker N. Saccular Superior Vena Cava Aneurysm: Case Report and Comprehensive Review. Ann Vasc Surg 2020; 72:666.e23-666.e32. [PMID: 33333194 DOI: 10.1016/j.avsg.2020.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022]
Abstract
Saccular superior vena cava aneurysms (SVCAs) are one of the rarest causes of mediastinal masses. Seventy years after the first published case report, to the best of our knowledge, fewer than 30 cases have been described in the literature. This article provides an overview of the peculiarities regarding diagnosis and treatment performed in these cases and addresses the protocol adopted in our case report. We present a saccular aneurysm resected through median sternotomy, under cardiopulmonary bypass and superior vena cava reconstruction using a bovine pericardial patch.
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Affiliation(s)
- Marcia Maria Morales
- INVASE-Hospital Beneficência Portuguesa de São José do Rio Preto, Hospital Israelita Albert Einstein, Vascular and Endovascular Surgery Division, São Paulo, SP, Brazil.
| | - Alexandre Anacleto
- INVASE-Hospital Beneficência Portuguesa de São José do Rio Preto, Hospital Israelita Albert Einstein, Vascular and Endovascular Surgery Division, São Paulo, SP, Brazil
| | - Joao Carlos Ferreira Leal
- Hospital Beneficência Portuguesa de São José do Rio Preto Cardiothoracic Surgery, São José do Rio Preto, SP, Brazil
| | - Valdir Gilmar Greque
- Departament of Cardiology, Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto, Departament of Radiology, São José do Rio Preto, SP, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Vascular and Endovascular Surgery Division, São Paulo University Medical School, São Paulo, SP, Brazil
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Hillner B, Rehmenklau-Bremer L, Wrase C, Fuchs H, Herold T, Beyer L. Superior vena cava syndrome. VASA 2020; 49:437-448. [PMID: 33103626 DOI: 10.1024/0301-1526/a000908] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The superior vena cava syndrome (SVCS) is caused by compression, invasion, and/or thrombosis of the superior vena cava and/or the brachiocephalic veins. Benign SVCS is separated from malignant SVCS. SVCS comprises a broad clinical spectrum reaching from asymptomatic cases to rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. Symptoms are correlated to the acuity and extent of the venous obstruction and inversely correlated to the development of the venous collateral circuits. Imaging is necessary to determine the exact underlying cause and to guide further interventions. Interventional therapy has widely changed the therapeutic approach in symptomatic patients. This article provides an overview over this complex syndrome and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Saban Elitok
- Clinic for Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Andreas Ruttloff
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Sabine Reinhold
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Jessika Nielitz
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Julia Steindl
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | | | | | - Christian Wrase
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Heiko Fuchs
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Thomas Herold
- Radiology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
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10
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Lead-related superior vena cava syndrome: Management and outcomes. Heart Rhythm 2020; 18:207-214. [PMID: 32920177 DOI: 10.1016/j.hrthm.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Superior vena cava (SVC) syndrome includes the clinical sequalae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important nonmalignant causes of this syndrome. There are little data on the effectiveness of venoplasty and lead extraction in the management of these patients. OBJECTIVE The objective of this study was to report the findings associated with the use of balloon angioplasty and lead extraction in the management of 17 patients with lead induced SVC syndrome. METHODS Data collected from January 2003 to July 2019 identified 17 cases of SVC syndrome at our tertiary center. Their outcomes were compared to a control group of patients without SVC syndrome. A P value of <.05 was considered statistically significant. RESULTS Of the 17 patients, 13 (76%) underwent transvenous lead extraction and venoplasty. Three patients (18%) were treated with venoplasty alone, and 1 patient (6%) underwent surgical SVC reconstruction. In 10 patients (59%), transvenous reimplantation was necessary. Symptom resolution was achieved in all 17 patients and confirmed at both 6 and 12 months' follow-up. There was no significant difference in the rate of complications associated with transvenous lead extraction for SVC syndrome vs control. CONCLUSION In patients with SVC syndrome, venoplasty and lead extraction are safe and effective for resolution of symptoms and maintaining SVC patency.
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11
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Wei S, Liu J, Li X, Song Z, Dong M, Zhao H, Zhao Q, Chen G, Chen J. A retrospective stenting study on superior vena cava syndrome caused by lung cancer. Thorac Cancer 2020; 11:1835-1839. [PMID: 32438532 PMCID: PMC7327698 DOI: 10.1111/1759-7714.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Superior vena cava syndrome (SVCS) is a common condition predominantly caused by lung cancer. The presence of symptoms of SVCS, such as elevated intracranial pressure and laryngeal edema, indicates an unfavorable prognosis for lung cancer patients. Superior vena cava (SVC) stenting is the first‐line treatment for SVCS. In this study, we retrospectively analyzed SVCS cases treated with stenting in our center to explore the safety and effectiveness of stenting in the treatment of SVCS. Methods We reviewed 16 patients with SVCS caused by lung cancer who were treated at our center with endovascular stenting between 2016 and 2018. Patient information such as age, sex, type of lung cancer, obstruction condition, complications, survival time, and postoperative treatments are summarized. Results There were no treatment‐related complications in the perioperative period in any of the patients. Examination at postoperative day 2 indicated that the accompanying SVCS symptoms had improved in all patients. The median survival of patients treated along with combined postoperative chemotherapy and antivascular targeted therapy reached seven months (1–18 months). Conclusions SVC stenting is effective as a first‐line treatment modality for patients with SVCS caused by lung cancer. In combination with other treatment modalities, it can significantly alleviate symptoms and reduce complications, and thus it plays an important role in the treatment of patients with SVCS caused by lung cancer.
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Affiliation(s)
- Sen Wei
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Dong
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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12
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Optimal Prediction of the Central Venous Catheter Insertion Depth Targeting the Cavoatrial Junction. World J Surg 2020; 44:2170-2174. [PMID: 32144470 DOI: 10.1007/s00268-020-05449-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Central venous catheters should be positioned at the cavoatrial junction or the right atrium. If catheters are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the length between the clavicular notch and the carina, the catheter tip can be placed near the carina. Based on this, we aim to make a formula to place a catheter tip near the cavoatrial junction. METHODS This prospective nonrandomized interventional study included patients who needed a central venous catheter from June 2017 to July 2018. The location of the cavoatrial junction was identified using a fluoroscopic technique. The following variables were measured: L1, the length between the needle insertion point and the clavicular notch; L2, the length between the clavicular notch and the carina; and α, the length between the carina and the cavoatrial junction. RESULTS A total of 70 patients were enrolled. The mean age was 65.5 ± 11.6 years, and 62.9% were male. The mean L1 and L2 were 7.6 ± 1.4 and 7.0 ± 1.4 cm, respectively. The mean α was 4.4 ± 1.5 cm (95% CI 4.1-4.8), and it was not affected by demographic factors, such as sex, age, height or weight. CONCLUSIONS Central venous catheters in adult patients can be placed near the cavoatrial junction using a simple formula: the distance between the insertion point and the clavicular notch + the distance between the clavicular notch to the carina + 4.4 cm.
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Vertemati M, Rizzetto F, Cassin S, Zerbi P, Giordano A, Cariati M, Gallieni M. Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients. Clin Anat 2020; 33:1120-1129. [PMID: 31891199 DOI: 10.1002/ca.23549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Most hemodialysis patients start renal replacement therapy with a central venous catheter (CVC). The left internal jugular vein (LIJV) is the second-choice vein for CVC positioning, after the right IJV. However, to reach the right atrium, the CVC must pass through the left brachiocephalic vein (LBV), which also drains blood from the left arm through the subclavian vein. The purpose of this study is to describe how the anatomy of the central venous system and in particular that of the LBV affects vascular access in hemodialysis patients. MATERIALS AND METHODS Three-dimensional (3D) virtual model reconstructions of the central thoracic veins of three hemodialysis patients were obtained from contrast-enhanced computed tomography scans acquired in the venous phase. The images were exported as DICOM files and loaded on open-source software for visualizing and analyzing the medical imaging (3D Slicer, Windows version 4.8.1). RESULTS As expected, the 3D reconstructions showed that the LBV has a tortuous path with three main angulations that could be associated with external compression and stenosis. These could determine the difficulties and increased risks of venous injury during CVC placement, and an increased risk of medium to long-term catheter-associated vein thrombosis and stenosis. CONCLUSIONS The anatomical features of the LBV indicate that the path of a CVC from the LIJV to the right atrium is tortuous and can easily be complicated by vein injury, negatively affecting the creation of future arterio-venous vascular accesses in the left arm.
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Affiliation(s)
- Maurizio Vertemati
- Institute of Human Anatomy, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy.,CIMaINa (Interdisciplinary Centre for Nano structured Materials and Interfaces), Università degli Studi di Milano, Milan, Italy
| | - Francesco Rizzetto
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Simone Cassin
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Antonino Giordano
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maurizio Cariati
- Department of Radiology, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maurizio Gallieni
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
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14
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Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
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Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
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Ding X, Ding F, Wang Y, Wang L, Wang J, Xu L, Li W, Yang J, Meng X, Yuan M, Chu J, Ge F, Dong W, Xue M. Shanghai expert consensus on totally implantable access ports 2019. J Interv Med 2019; 2:141-145. [PMID: 34805890 PMCID: PMC8562251 DOI: 10.1016/j.jimed.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Totally implantable access ports (TIAPs) are used for patients with poor peripheral vascular support requiring central venous access. In recent years, TIAPs have been gradually accepted and promoted by patients, doctors, and nurses owing to their advantages of convenient carrying, a long maintenance period, low complications, and a high quality of life for patients. Currently, medical personnel that handle TIAP implantation and management in China are from different areas of healthcare, including surgery, internal medicine, radiology, nurse anesthesia, vascular access, etc., and many only handle TIAP as a part of their duties. Therefore, the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person, resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units. Based on this, we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.
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Affiliation(s)
- Xiaoyi Ding
- Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Fang Ding
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
| | - Yonggang Wang
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
| | - Liying Wang
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jianfeng Wang
- Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Lichao Xu
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wentao Li
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jijin Yang
- Changhai Hospital Affiliated with The Second Military Medical University, Shanghai, 200433, China
| | - Xiaoxi Meng
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
| | - Min Yuan
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, 200083, China
| | - Jun Chu
- Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University, Shanghai, 200025, China
| | - Feng Ge
- Zhongshan Hospital Affiliated with Fudan University, Shanghai, 200032, China
| | - Weihua Dong
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
| | - Mei Xue
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shanghai Cooperation Group on Central Venous Access Vascular Access Committee of the Solid Tumor Theranostics Committee, Shanghai Anti-Cancer Association
- Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China
- Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
- Changhai Hospital Affiliated with The Second Military Medical University, Shanghai, 200433, China
- Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China
- Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, 200083, China
- Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University, Shanghai, 200025, China
- Zhongshan Hospital Affiliated with Fudan University, Shanghai, 200032, China
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16
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Dahou A, Levin D, Reisman M, Hahn RT. Anatomy and Physiology of the Tricuspid Valve. JACC Cardiovasc Imaging 2019; 12:458-468. [DOI: 10.1016/j.jcmg.2018.07.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
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17
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Dual-Propeller Cavopulmonary Pump for Assisting Patients with Hypoplastic Right Ventricle. ASAIO J 2019; 65:888-897. [PMID: 30688694 DOI: 10.1097/mat.0000000000000907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Various congenital heart defects (CHDs) are characterized by the existence of a single functional ventricle, which perfuses both the systemic and pulmonary circulation. A three-stage palliation procedure, including the final Fontan completion, is often adopted by surgeons to treat patients with such CHDs. The completion Fontan involves the creation of a total cavopulmonary connection (TCPC), commonly accomplished with an extracardiac conduit. This TCPC results in nonphysiologic flow conditions that can lead to systemic venous hypertension, reduced cardiac output, and ultimately the need for heart transplantation. A modest pressure rise of 5-6 mm Hg could correct the abnormal flow dynamics in these patients. To achieve this, we propose a novel conceptual design of a dual-propeller pump inside a flared TCPC. The TCPC dual-propeller conjunction was examined for hydraulic performance, blood flow pattern, and potential for hemolysis inside the TCPC using computational fluid dynamics (CFD). The effect of axial distance between the two propellers on the blood flow interference and energy loss was studied to determine the optimal separation distance. Both the inferior vena cava (IVC) and superior vena cava (SVC) propellers provided a pressure rise of 1-20 mm Hg at flow rates ranging from 0.4 to 7 lpm while rotating at speeds of 6,000-12,000 rpm. Larger separation distance provided favorable performance in terms of flow interference, energy loss, and blood damage potential. The ability of a dual-propeller micropump to provide the required pressure rise would help to augment the cavopulmonary flow and mimic flows seen in normal biventricular circulation.
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18
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Jarineshin H, Sharifi M, Kashani S. Comparing the conventional 15 cm and the C-length approaches for central venous catheter placement. J Cardiovasc Thorac Res 2018; 10:221-226. [PMID: 30680081 PMCID: PMC6335980 DOI: 10.15171/jcvtr.2018.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/16/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: The present guidelines recommend placing the catheter tip in the superior vena cava (SVC) above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the Central venous catheter (CVC) at the suggested vascular zone. Methods: This was an interventional study on two hundred patients undergoing Coronary artery bypass surgery (CABG) operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a C-length method was applied for measuring the depth of catheter tip placement from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used. Results: In the first group (15 cm) 100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was +4.22±2.10 cm. In the second (C-Length) group 52% of the catheters were below C-line with an average distance of +0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone of placement (P<0.001). Conclusion: The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.
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Affiliation(s)
- Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Maryam Sharifi
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Saeid Kashani
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
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Ahn JH, Kim IS, Yang JH, Lee IG, Seo DH, Kim SP. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres' formula or a radiological landmark-based approach: a prospective randomized single-centre study. Br J Anaesth 2018; 118:215-222. [PMID: 28100525 DOI: 10.1093/bja/aew430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography. METHODS Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (n=93) or the R group (n=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA-SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view. RESULTS The distance from the skin insertion point to the RA-SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; r=0.821, P<0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; r=0.517, P<0.001], with z=3.96 (P<0.001). More tips were correctly positioned in the R group than in the P group (74 vs 93%, P=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable. CONCLUSIONS Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp KCT0001937.
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Affiliation(s)
- J H Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Woncheon-Dong, Yeongtong-Gu, Suwon, Gyeonggi-Do 443-721, Republic of Korea
| | - I S Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - J H Yang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - I G Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - D H Seo
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - S P Kim
- Department of Cardiovascular Surgery, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Republic of Korea
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20
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Gao Y, Liu Y, Zhang H, Fang F, Song L. The safety and accuracy of ECG-guided PICC tip position verification applied in patients with atrial fibrillation. Ther Clin Risk Manag 2018; 14:1075-1081. [PMID: 29922068 PMCID: PMC5995413 DOI: 10.2147/tcrm.s156468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Tip position verification of peripherally inserted central catheters (PICCs) is essential to the use of the catheter. Postprocedural chest X-ray as the “gold standard” practice for PICC tip confirmation can lead to a significant delay for patient IV therapy, cost more, and lead to radiation exposure for both patients and staffs. Intracavitary electrocardiogram (IC-ECG)-guided PICC placement which provides real-time tip confirmation during the insertion procedure has been widely used. However, safety and accuracy of ECG for abnormal surface ECG patients, such as patients with atrial fibrillation (AF), have not been reported. Objective To determine the safety and accuracy of IC-ECG technique for PICC tip position verification among the patients with AF. Patients and methods A prospective cohort study was conducted in a teaching and tertiary referral hospital with more than 3,600 beds in Qingdao, People’s Republic of China. Adult patients with diagnosis of AF who need a PICC for infusion from June 2015 to May 2017 were enrolled in the study. For every included patient with AF, ECG was used to detect the PICC tip position during catheterization and X-ray was done to confirm the tip position as the “gold standard” after PICC insertion. The effectiveness and accuracy of ECG-guided catheter tip positioning and chest X-ray confirmation were compared. Results Totally, 118 AF patients with 118 PICCs were enrolled (58 male and 60 female, age range 50–89 years old). There was no catheterization-related complication. When the catheter entered the lower 1/3 of superior vena cava, the amplitude of f wave reached the maximum. There was no statistical difference between X-ray PICC tip position verification and IC-ECG PICC tip position verification among patients with AF (χ2=1.31, P=0.232). Utilizing the cutoff point of f wave change ≥0.5 cm, a sensitivity of 0.94, a specificity of 0.71, a positive predictive value of 0.98, and a negative predictive value of 0.42 were observed. The area under the receiver operating characteristic curve was 0.909 (95% CI: 0.810–1.000). Conclusion The ECG-guided technique represents a safe and accurate technique to verify the position of PICC tip in patients with AF and could potentially remove the requirement for postprocedural chest X-ray among the patients with AF.
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Affiliation(s)
- Yufang Gao
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Yuxiu Liu
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.,Department of Community Nursing, School of Nursing, Weifang Medical University, Weifang, People's Republic of China
| | - Hui Zhang
- Hospital Management Office, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Fang Fang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Lei Song
- Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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21
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Excellent inter-observer agreement between radiologist and nurse: tracheal carina-based identification of peripherally inserted central catheter tip position. J Vasc Access 2018; 19:28-33. [PMID: 29027181 DOI: 10.5301/jva.5000799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: Accurate identification of position of a central venous catheter tip is important to reduce catheter-related complications. Nevertheless, inter-observer bias limits the accuracy of traditional method for determining tip position on chest x-ray (CXR) images. The aim of this study was to explore a simple and objective method for assessing position of peripherally inserted central catheter (PICC) tip on CXR image. Methods: Tracheal carina was used as the landmark to identify positions of catheter tips. The central vein (CV) was located between 3 cm above and 4 cm below tracheal carina. The vertical distance from catheter tips to tracheal carina was measured independently by a nurse and re-assessed by a radiologist. Inter-observer agreement was expressed as percentage in agreement and kappa coefficient. Results: Six hundred and twelve CXR images of catheters taken from 612 patients were included. The inter-observer agreement between nurse and radiologist was 97.88% (kappa = 0.934) for all catheter tips evaluated, and 98.40% (kappa = 0.923) for catheter tips with regard to CV, innominate vein, and right atrium. Most discrepancies (9/13) between observers occurred when catheter tips were positioned in a border region between different anatomical parts. Conclusions: Inter-observer agreement between nurse and radiologist is excellent. Our results demonstrate that the measurement of distance between catheter tip and tracheal carina performed by a nurse provide a convenient and reliable way to determine position of PICC tip. Our study also suggests that nurses can be trained to handle PICCs, especially when properly located catheters are applied in critically ill patients during emergency setting.
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Kwon HJ, Jeong YI, Jun IG, Moon YJ, Lee YM. Evaluation of a central venous catheter tip placement for superior vena cava-subclavian central venous catheterization using a premeasured length: A retrospective study. Medicine (Baltimore) 2018; 97:e9600. [PMID: 29480861 PMCID: PMC5943868 DOI: 10.1097/md.0000000000009600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system. To evaluate the placement of the tip of the CVC in subclavian central venous catheterizations using the C-length, we reviewed the medical records and chest radiographs of 122 adult patients in whom CVC catheterization was performed (from January 2012 to December 2014) via the right subclavian vein using the C-length. The tips of all subclavian CVCs were placed in the SVC using the C-length. No subclavian CVC entered the right atrium. Tip placement was not affected by demographic characteristics such as age, sex, height, weight, and body mass index. The evidence indicates that the C-length on chest radiographs can be used to determine the available insertion length and place the right subclavian CVC tip into the SVC.
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Zhang X, Lu Z, Hu Y, Xue M, Dai H. Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic. Worldviews Evid Based Nurs 2017; 14:163-167. [PMID: 28178399 DOI: 10.1111/wvn.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Xiaoju Zhang
- Assistant Nursing Director, Nursing Department, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenqi Lu
- Director of Nursing, Nursing Department, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Hu
- Professor of Nursing, Nursing School of Fudan University, Shanghai, China
| | - Mei Xue
- Head Nurse, Outpatient Chemotherapy Center, Fudan University Shanghai Cancer Ceter, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongqin Dai
- PICCs Insertion Nurse, Vascular Access Care Outpatient Clinic, Fudan University Shanghai Cancer Ceter, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Zhang Z, Zhang L, Xie F, Wang B, Sun Z, Kong S, Wang X, Dong N, Wang G, Lv Q, Li Y, Li L, Xie M. Echocardiographic diagnosis of anomalous pulmonary venous connections: Experience of 84 cases from 1 medical center. Medicine (Baltimore) 2016; 95:e5389. [PMID: 27858923 PMCID: PMC5591171 DOI: 10.1097/md.0000000000005389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We sought to evaluate the value of echocardiography in the diagnosis of different types of anomalous pulmonary venous connections (APVCs) and summarize the diagnostic experience. A total of 84 patients with APVC were confirmed by surgery (n = 82) or computerized tomography angiography (CTA) (n = 2) in the last 6 years (2008-2014) at the Wuhan Union Hospital. The total anomalous pulmonary venous connection (TAPVC) cases account for 60.7%, and partial anomalous pulmonary venous connection (PAPVC) cases account for 39.3% among the 84 cases that were identified. The 51 TAPVCs were classified by the Darling method-type I (41.1%), type II (52.9%), type III (1.9%), and type IV (3.9%). The most common drainage path of type I was common pulmonary drainage to the left innominate vein via vertical vein, and the coronary sinus drainage was the most common path in type II. Compared with surgical or CTA results, the sensitivity and specificity of echocardiography in the diagnosis of APVCs were 97.6% and 99.9%, respectively. The echocardiography misdiagnoses were mainly seen in PAPVCs. Of the TAPVCs and PAPVCs correctly diagnosed by echocardiography, the diagnostic accuracy of classification were 94% and 100%, respectively. Echocardiography has specific value in diagnosing and classification of APVC, especially the supracardiac and cardiac TAPVCs. Multiplane scan views and color Doppler improve the display of drainage pathway.
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Affiliation(s)
- Ziming Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Xie
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Kong
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinfang Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Mingxing Xie, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: ); Ling Li, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: )
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Mingxing Xie, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: ); Ling Li, Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Ave, Wuhan 430022, China (e-mail: )
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Duncan C, Trerotola SO. Outcomes of a Percutaneous Technique for Shortening of Totally Implanted Indwelling Central Venous Chest Port Catheters. J Vasc Interv Radiol 2016; 27:1034-7. [PMID: 27338498 DOI: 10.1016/j.jvir.2016.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Central venous port catheters that are too long are typically removed or revised. The subcutaneous position of port reservoirs precludes standard over-the-wire exchange techniques, and a method of percutaneous revision using an intravascular loop snare technique has been previously described. A retrospective review was conducted of 38 procedures that were performed at a single academic institution between 2005 and 2015. Technical success was 100%, without immediate or delayed complications with follow-up until port removal or death in 94% of patients. Percutaneous revision is an effective method for shortening too-long port catheters, allowing uninterrupted use of the port.
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Affiliation(s)
- Christopher Duncan
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Interventional Radiology, and Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Bream PR. Update on Insertion and Complications of Central Venous Catheters for Hemodialysis. Semin Intervent Radiol 2016; 33:31-8. [PMID: 27011425 PMCID: PMC4803506 DOI: 10.1055/s-0036-1572547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed.
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Affiliation(s)
- Peter R. Bream
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Nephrology, Department of Internal Medicine, Vascular and Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Simple Formula to Place Central Venous Catheter Tip at T6 After Surgical Cutdown in Neonates. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00032.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this paper was to develop a generally applicable formula to estimate correct catheter length after surgical cutdown in right internal jugular vein (RIJV) in neonates. The carina has been utilized as an anatomic landmark indicating superior vena cava-right atrium junction (SVC-RA) for the optimal placement of the central venous catheter (CVC) tip position. However, this landmark may not be accurate in neonates. Recent researches noted that the sixth vertebral body (T6) could better serve as a new landmark of SVC-RA in neonates and smaller children. We prospectively performed RIJV cutdown. For a controlled and reproducible surgical procedure, the venous entry site was consistently taken as the point where the omohyoid muscle crosses the RIJV. On intraoperative infantogram, the vertical distance between the venous entry site and T6 was measured and the catheter was inserted to this length. A linear regression model was investigated using the following variables to elicit the best prediction model for catheter length: gestational age, postconceptional age, birth weight, and weight at operation. Weight at operation best correlated with the measured CVC length (R2 = 0.916, P = 0.00), and the following linear equation was derived: estimated CVC length (mm) = 9 × [weight at operation (Kg)] + 30. There was no statistically significant difference between measured and estimated CVC length. With this formula, the optimal catheter length could easily be estimated when considering RIJV cutdown.
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Sonavane SK, Milner DM, Singh SP, Abdel Aal AK, Shahir KS, Chaturvedi A. Comprehensive Imaging Review of the Superior Vena Cava. Radiographics 2015; 35:1873-92. [DOI: 10.1148/rg.2015150056] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Weekes AJ, Keller SM, Efune B, Ghali S, Runyon M. Prospective comparison of ultrasound and CXR for confirmation of central vascular catheter placement. Emerg Med J 2015; 33:176-80. [PMID: 26446313 DOI: 10.1136/emermed-2015-205000] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/17/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To prospectively compare ultrasound (US) versus CXR for confirmation of central vascular catheter (CVC) placement. Secondary objective was to determine the incidence of pneumothorax (PTX) and compare US with CXR completion times. METHODS Investigators performed the US saline flush echo test, and evaluated each anterior hemithorax for pleural sliding with US after subclavian or internal jugular CVC placement. MEASUREMENTS AND MAIN RESULTS 151 total (135 in the emergency department, 16 in the intensive care unit) patients after CVC placement, mean age 62.1±15.6 years and 83 (55%) female patients. The rapid atrial swirl sign ( RASS) was ultrasound finding of an immediate appearance of turbulence entering the right atrium via superior vena cava after a rapid saline flush of the distal CVC port. RASS was considered 'negative' for CVC malposition. US identified all correct CVC placements. Four suboptimal CVC tip placements were detected by CXR. US identified three of these misplacements (McNemar exact p value >0.99). There were no cases of PTX or abnormal pleural sliding by either CXR or US. Median times for US and CXR completion were 1.1 (IQR 0.7) minutes and 20 (IQR: 30) minutes, respectively, median difference 23.8 (95% CI 19.6 to 29.3) minutes, p<0.0001. CONCLUSIONS PTX and CVC tip malposition were rare after US-guided CVC placement. There was no significant difference between saline flush echo and CXR for the identification of catheter tip malposition. Benefits of US assessment for complications include reduced radiation exposure and time delays associated with CXR.
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Affiliation(s)
- Anthony J Weekes
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Stephen M Keller
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Bradley Efune
- Department of Emergency Medicine, Good Shepherd Medical Center, Longview, Texas, USA
| | - Sama Ghali
- Department of Emergency Medicine, Chandler Medical Center, Lexington, Kentucky, USA
| | - Michael Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
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30
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Song YG, Byun JH, Hwang SY, Kim CW, Shim SG. Use of vertebral body units to locate the cavoatrial junction for optimum central venous catheter tip positioning. Br J Anaesth 2015; 115:252-7. [PMID: 26170349 DOI: 10.1093/bja/aev218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Central venous catheter (CVC) placement plays an important role in clinical practice; however, optimal positioning of the CVC tip remains a controversial issue. The objective of this study was to evaluate the use of vertebral body unit (VBUs), to locate the cavoatrial junction (CAJ), for optimal CVC tip placement based on chest radiography (CXR) using the carina as a landmark. METHODS 524 patients who underwent coronary computed tomographic angiography (CTA) and CXR were included. The position of the CAJ was identified using VBUs, and the efficacy of VBUs for locating the CAJ with the carina as a landmark was analysed using multiple regression analysis. A VBU was defined as the distance between two adjacent vertebral bodies, including the inter-vertebral disk space. RESULTS The mean (sd) distance from the carina to the superior CAJ was 54.3 (9.7) mm on CTA; the mean distance in VBUs at the level of the carina was 21.4 (1.7) mm on CTA and 22.6 (2.1) mm on CXR. The mean CAJ position was 2.5 VBUs below the carina on CTA and 2.4 VBUs below on CXR with 95% limits of agreement between -0.6 and +0.3. CONCLUSIONS The position of the CVC tip in relation to the carina can be described using the thoracic spine as an internal ruler, and the position of the CAJ in adults was reliably estimated to be 2.4 VBUs below the carina. CLINICAL TRIAL REGISTRATION KCT0001319.
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Affiliation(s)
- Y G Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - J H Byun
- Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - S Y Hwang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - C W Kim
- Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - S G Shim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
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Evaluation of the Correct Position of Peripherally Inserted Central Catheters: Anatomical Landmark vs. Electrocardiographic Technique. J Vasc Access 2015; 16:394-8. [DOI: 10.5301/jva.5000431] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to verify as early as possible the correct positioning of the peripherally inserted central catheter (PICC) tip in order to reduce complications due to possible malpositioning. The ECG-guided technique proved to be reliable, easy to carry out, straightforward, low-cost and allows us to recognize an incorrect or a suboptimal positioning throughout the procedure. The purpose of this study is to compare two methods used during the PICC insertion so as to prevent catheter malpositioning; the first study estimates the catheter length by the landmark method (based on cutaneous anatomical landmarks, CALs) with the addition of the postprocedural verification of tip location by chest X-Ray (CxR), whereas the second method of intraprocedural tip location is based on the observation of the morphological variations of the P wave (ECG-guided technique) with the addition of the postprocedural verification by CxR. Methods From 2010 to 2012, 90 PICCs were positioned, 48 using the anatomical landmarks and 42 using the ECG technique. Results Twenty-five percent of the catheters positioned with the anatomical landmark technique did not reach the correct position of the tip in SVC; of these, 6.25% were placed in an aberrant position and others in a suboptimal position. Of the 42 PICCs positioned with the ECG technique, only in three cases (equal to 7.14%), a suboptimal position of the tip was observed, whereas there was no case of aberrant positioning. Conclusions The ECG technique represents an accurate, low-cost and safe technique to verify the correct positioning of the tip. The use of the ECG allowed a more correct positioning in terms of catheter tip-carina distance and catheter tip-tracheobronchial angle, and in no patient was it necessary to place a catheter again.
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Proper Tip Position of Central Venous Catheter in Pediatric Patients. J Vasc Access 2015; 16:399-402. [DOI: 10.5301/jva.5000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/20/2022] Open
Abstract
Background In this study, we analyzed the thin-section pulmonary computed tomographic (CT) angiogram scans of pediatric patients to determine the normative length of superior vena cava (SVC) and the distance between carina and cephalad of SVC or cavocatrial junction. Methods Consecutive child patients, under 13 years of age in whom the central catheters were inserted under ultrasound guidance from December 2004 to April 2005 were evaluated retrospectively. Results In the 14 cases, the mean age was 7.2 ± 4.21 years. The mean length and diameter of the SVC in the pediatric patients were 45.6 ± 23.03 and 13.7 ± 3.62 mm, respectively. The distance from the carina to the cavoatrial junction was 22.0 ± 9.98 mm. The mean distance from the superior margin of the SVC to the carina was 23.7 ± 16.70 mm. The mean distance from the carina to the catheter tip was 38.9 ± 18.60 mm. In no case was the cavoatrial junction cephalad with respect to the carina. Carina to cavoatrial junction junction was significantly associated with age, height, and weight, respecitively (r = 0.750; p = 0.005, r = 0.763; p = 0.004; r = 0.777; p = 0.003). Conclusions The carina is a good landmark for the upper border of the cavoatrial junction. Length of carina to cavoaterial juction was associated with age. The rates of malposition and re-intervention and the patient's exposure to radiation can be reduced by using ultrasound during the catheter insertion.
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Sundaram B, Kuriakose JW, Stojanovska J, Watcharotone K, Parker RA, Kazerooni EA. Thoracic central venous evaluation: comparison of first-pass direct versus delayed-phase indirect multidetector CT venography. Clin Imaging 2015; 39:412-6. [PMID: 25724223 DOI: 10.1016/j.clinimag.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/14/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose was to compare first-pass and delayed-phase thoracic computed tomography (CT) venography for the evaluation of suspected central thoracic venous pathology. MATERIAL AND METHODS CT images and medical records of all patients who underwent thoracic CT venography over a 5-year period were retrospectively reviewed. Both first-pass (18s) and delayed-phase (60s) venous images were obtained in all patients. The images were reviewed in random order by three readers using a semiquantitative visual grading scheme for image quality, including artifacts and the uniformity of venous enhancement. In addition, enhancement was quantitatively evaluated. The presence and type of venous pathology, and overall diagnostic confidence were recorded and compared. Reference verification was performed when available. RESULTS Eighteen patients formed the study group, mean age 49.5years and 28% male. Dual-arm injection was successful in 72% of exams. All readers reported more streak artifacts on first-pass imaging than delayed imaging (72%-94% vs. 27%-44%, respectively; P<.05). First-pass imaging had significantly higher measured enhancement across all central venous segments than delayed imaging (mean HU range 212-906 HU vs. 173-414 HU; P<.05) but also had significantly more heterogeneous enhancement (mean S.D. range 75-1058 HU vs. 67-378 HU; P<.05). For overall diagnosis, reader agreement, accuracy, and confidence levels were higher for delayed-phase images (P<.05). CONCLUSION Indirect thoracic CT venography using delayed-phase imaging alone may be sufficient for evaluating clinically suspected central venous abnormality.
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Useful Equation for Proper Estimate of Left Side Peripherally Inserted Central Venous Catheter Length in Relation to the Height. J Vasc Access 2014; 16:42-6. [DOI: 10.5301/jva.5000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Direct measurement of venous length is easy to cause contamination during bedside insertion of peripherally inserted central venous catheter (PICC). It is necessary to provide an equation for proper estimate of catheter length in case of bedside insertion of PICC in relation to patient height. Methods For 165 PICC cases through left arm vein in 151 adult patients (male: female = 72:79), the cubital crease to carina length (CCL) was calculated as follows: CCL = (distance from cubital crease to puncture point) + (length of PICC inside body) – (distance from carina to catheter tip on post-procedural chest radiograph). We analyzed the relationship between CCL and height with regression analysis and suggest a new equation of CCL based on height. Results The mean CCL through the left arm vein was 47.1 ± 2.6 cm in male and 44.0 ± 2.9 cm in female. CCL was significantly correlated with patient height. Equation of CCL (cm) based on height was as follows: CCL = height* 0.19 + 14. Conclusions The equation of our study would provide a new equation for proper estimation of catheter length in case of bedside insertion of left arm PICC in relation to height and be helpful for optimal positioning of catheter tip of PICC.
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Weekes AJ, Johnson DA, Keller SM, Efune B, Carey C, Rozario NL, James Norton H. Central vascular catheter placement evaluation using saline flush and bedside echocardiography. Acad Emerg Med 2014; 21:65-72. [PMID: 24552526 DOI: 10.1111/acem.12283] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Central venous catheter (CVC) placement is a common procedure in critical care management. The authors set out to determine echocardiographic features during a saline flush of any type of CVC. The hypothesis was that the presence of a rapid saline swirl in the right atrium on bedside echocardiography would confirm correct placement of the CVC tip, similar to the accuracy of the postplacement chest radiograph (CXR). METHODS This was a prospective convenience sample of emergency department (ED) and intensive care unit (ICU) patients who had CVCs placed. Investigators used subcostal or apical four-chamber echocardiography windows to evaluate the onset and appearance of turbulent flow in the right atrium when the distal port of the CVC was flushed with 10 mL of saline. Onset was rated as "immediate" (within 2 seconds), "delayed" (2 to 6 seconds), or "absent" (did not appear within 6 seconds). Appearance was rated as "prominent," "speckling," or "absent." Digital video review was used later to objectively determine precise timing of turbulence onset. The rapid atrial swirl sign (RASS) was defined as the echo appearance of turbulence entering the right atrium immediately (within 2 seconds) after the saline flush of the CVC distal port. The observance of RASS ("positive") was considered "negative" for CVC malposition. Echocardiographic results were compared to CVC tip locations within predetermined zones on the CXR. Superior vena cava (SVC) region was considered the optimal CVC tip position for subclavian and internal jugular CVC. Left CVC tips within the mid left innominate vein were also considered appropriately placed. RESULTS A total of 142 patients enrolled, yielding 152 CVCs. Two CVCs were excluded from analysis due to incomplete data. Both CXR and echocardiographic images for 107 internal jugular CVCs and 28 subclavian CVCs were available for analysis. Saline flush echo evaluations were also performed on 15 femoral CVCs. Either 16-cm triple-lumen or 20-cm PreSep CVCs were used. CVC malposition was discovered on CXR in four of 135 (3.0%) of the subclavian and internal jugular CVCs. RASS for subclavian and internal jugular CVC evaluations versus CXR results for CVC tip malposition yielded 75% sensitivity, 100% specificity, positive predictive value (PPV) 100% (95% confidence interval [CI] = 29.24% to 100%), and negative predictive value (NPV) 99.24% (95% CI = 95.85% to 99.98%). Mean (±SD) time for onset of saline flush turbulence was 1.1 (±0.3) seconds for subclavian and internal jugular CVC tips within the target CXR zone. CONCLUSIONS The rapid appearance of prominent turbulence in the right atrium on echocardiography after CVC saline flush serves as a precise bedside screening test of optimal CVC tip position.
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Affiliation(s)
- Anthony J. Weekes
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - David A. Johnson
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - Stephen M. Keller
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - Bradley Efune
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | - Christopher Carey
- The Department of Emergency Medicine; Carolinas Medical Center; Charlotte NC
| | | | - H. James Norton
- Biostatistics Facility; Carolinas Medical Center; Charlotte NC
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Venugopal AN, Koshy RC, Koshy SM. Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature. J Anaesthesiol Clin Pharmacol 2013; 29:397-400. [PMID: 24106371 PMCID: PMC3788245 DOI: 10.4103/0970-9185.117114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.
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Costa P, Bueno M, Alves AMA, Kimura AF. Incidence of Nonelective Removal of Percutaneously Inserted Central Catheters According to Tip Position in Neonates. J Obstet Gynecol Neonatal Nurs 2013; 42:348-56. [DOI: 10.1111/1552-6909.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Impact of phase of respiration on central venous catheter tip position. J Vasc Access 2013; 14:383-7. [PMID: 23599138 DOI: 10.5301/jva.5000135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the impact of the phase of respiration on CVC tip position using cross-sectional imaging. METHODS We retrospectively analyzed the CT scans of 24 consecutive patients (eight men and 16 women, mean age 56.3 years, range 18-79) who underwent a CT scan protocol that includes both imaging of the thorax in inspiration and expiration. Only patients with a central venous catheter and absence of any substantial pulmonary pathology that might affect lung volumes were included. Measurements of the catheter tip location and central venous structures were obtained from inspiratory and expiratory phase images in each patient and compared using the paired <i>t</i> test. RESULTS The length of the SVC and superior mediastinum were significantly longer during inspiration compared to expiration (9 mm and 7 mm respectively, P<0.001 for both). The distance between the superior and inferior cavo-atrial junction did not change significantly with respiration. The catheter tip location moved on average 9 mm (range 0-25 mm) cephalad during inspiration compared to expiration (P=0.001) in relation to the superior cavoatrial junction. The amount of catheter tip movement correlated significantly with the degree of diaphragmatic excursion with respiration (R=0.58). During inspiration, the cavo-atrial junction was on average 11 mm inferior to the right cardiomediastinal angle observed on radiography, but was nearly identical during expiration (R=0.78, P<0.001). CONCLUSIONS The central catheter tip position varied significantly with respiratory motion, with a mean excursion of 9 mm. The right cardiomediastinal border demonstrated a strong correlation with the actual location of the superior cavo-atrial junction in expiration, but not in inspiration.
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Hong JB, Shin EH, Kim YK, Park JS, Kim JY, Jeon YS, Cho SG, Hong KC. Measurement of Length between Bronchial Carina and Superior Vena Cava-right Atrial Junction for Optimal Positioning of Central Venous Catheters in the Korean Adult Population. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jung Bum Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Eun Ho Shin
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Young Kyun Kim
- Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Sun Park
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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Vernick WJ, Oware A. Early Diagnosis of Superior Vena Cava Obstruction Facilitated by the Use of Cerebral Oximetry. J Cardiothorac Vasc Anesth 2011; 25:1101-3. [DOI: 10.1053/j.jvca.2010.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 11/11/2022]
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Central venous line placement in the superior vena cava and the azygos vein: differentiation on posteroanterior chest radiographs. AJR Am J Roentgenol 2011; 196:783-7. [PMID: 21427325 DOI: 10.2214/ajr.10.4681] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine, first, the accuracy with which radiologists reading posteroanterior chest radiographs differentiate whether a central venous line is in the superior vena cava or the azygos vein and, second, the circumstances in which radiologists may omit the lateral view to determine the position of a central venous line. MATERIALS AND METHODS Twenty-four radiologists evaluated 60 posteroanterior chest radiographs to determine the position of a central venous line in the superior vena cava or azygos vein. Investigators evaluated the appearance of the central venous lines to refine rules for determining central venous line position on a frontal radiograph and omitting the lateral view. RESULTS The accuracy of posteroanterior radiography for determining central venous line position was 90% at one study location and 85.5% at the other. No central venous line in the azygos vein extended more than 10.9 mm caudal to the cephalic edge of the right main bronchus. No central venous line in the superior vena cava had a down-the-barrel or curved appearance at the caudal edge. CONCLUSION For central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus and having no down-the-barrel or curved caudal appearance, categorization was nearly 100% accurate. Therefore, if desired to save radiation exposure and cost, it may be feasible to omit lateral views in radiography of patients with central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus in whom the caudal edge does not have a down-the-barrel or curved appearance.
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Abstract
OBJECTIVE To review venous anatomy and physiology, discuss assessment parameters before vascular access device (VAD) placement, and review VAD options. DATA SOURCES Journal articles, personal experience. CONCLUSION A number of VAD options are available in clinical practice. Access planning should include comprehensive assessment, with attention to patient participation in the planning and selection process. Careful consideration should be given to long-term access needs and preservation of access sites. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are uniquely suited to perform a key role in VAD planning and placement. With knowledge of infusion therapy, anatomy and physiology, device options, and community resources, nurses can be key leaders in preserving vascular access and improving the safety and comfort of infusion therapy.
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Affiliation(s)
- Gail Egan Sansivero
- Department of Radiology, Division of Vascular and Interventional Radiology, Albany Medical College, Albany, NY 12208, USA.
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Chen PT, Ting CK, Wang YC, Cheng HW, Chan KH, Chang WK. Practical Preprocedure Measurement to Estimate the Required Insertion Depth and Select the Optimal Size of Tunneled Dialysis Catheter in Uremic Patients. Semin Dial 2010; 23:431-9. [DOI: 10.1111/j.1525-139x.2010.00712.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee JB, Lee YM. Pre-Measured Length Using Landmarks on Posteroanterior Chest Radiographs for Placement of the Tip of a Central Venous Catheter in the Superior Vena Cava. J Int Med Res 2010; 38:134-41. [DOI: 10.1177/147323001003800115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Central venous catheterization (CVC) is a common procedure but catheter misplacement is a frequent complication and can be lethal. Most CVCs are inserted at a recommended mean depth of 15 cm from the skin puncture site. Chest radiographs are used to confirm the positioning of CVCs, with the carina regarded as a reliable landmark for tip placement. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured on posteroanterior chest radiographs. To test the accuracy of C-length based CVC placement, 637 adult patients scheduled to undergo elective major abdominal procedures and neurological surgical procedures requiring CVC were randomized to undergo either the 15-cm guided method or the C-length guided method for placement of the CVC tip into the superior vena cava (SVC). All the CVC tips in the C-length group were successfully placed in the SVC. These findings indicate that the pre-measured C-length using two landmarks can be used to determine the insertion length and to place the CVC tip successfully into the SVC.
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Affiliation(s)
- JB Lee
- Department of Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - YM Lee
- Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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