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Kairidibo, Pandey AR, Dwivedi V, Prakash S, Rath A, Reena, Dwivedi K, Pandey R. "Rapid Atrial Swirl Sign": A Better Tool Than the Landmark Technique for Ensuring Correct Depth of Insertion of Central Venous Catheters. Cureus 2024; 16:e65211. [PMID: 39184717 PMCID: PMC11343511 DOI: 10.7759/cureus.65211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION Central venous catheters (CVCs) are widely used in the management and resuscitation of critically ill patients in emergency departments and intensive care units. Correct depth of insertion of the CVC line is important to ensure uninterrupted flow, avoid complications, and monitor central venous pressure. Transthoracic echocardiography, with contrast enhancement, has been proposed as an alternative to chest X-ray in detecting central venous line positioning with high accuracy. Nevertheless, this method is not widely used due to some previous conflicting results and the cumbersomeness of the procedure. MATERIAL AND METHODS After approval by the Institutional Ethics Committee, this prospective observational study was carried out in patients for whom a central venous line was warranted. The study was conducted in the Intensive Care Unit of a tertiary care hospital among 150 adult patients to compare the "Rapid Atrial Swirl Sign" (RASS) technique by transthoracic echocardiography and the landmark-based technique for ensuring accurate depth of central venous line placement. RESULTS In this study, we found that the mean depth of insertion of the CVC for the Echocardiography RASS group (E) was 12.84 cm, while for the Landmark technique group (L), it was 12.02 cm. There was a significant difference between these groups, with a p-value of <0.05. We found that the majority of patients (98.63%) in Group E had the catheter tip in Zones 1, 2, and 3, while only 66.6% of patients in Group L had the catheter tip in similar zones. The mean standard deviation for zones on chest X-ray was 1.8 for Group E and 2.26 for Group L, with a significant difference between these groups (p-value <0.05). CONCLUSION The RASS technique is superior to the landmark technique in ensuring the correct depth of the tip of the CVC. When confirmed by chest X-ray, it was found that most patients had the catheter tip in Zone 1, 2, or 3 using the RASS technique. This confirms that the RASS technique can minimize the requirement of resources and hasten the initiation of patient management in a timely manner, unlike the landmark technique, which requires chest X-ray confirmation before use.
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Affiliation(s)
- Kairidibo
- Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Arun Raj Pandey
- Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vandana Dwivedi
- Pharmacology, Maa Vindhyavasini Autonomous State Medical College (MVASMC), Mirzapur, IND
| | - Shashi Prakash
- Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Amrita Rath
- Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Reena
- Anesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Kanak Dwivedi
- Pharmacology, Hind Institute of Medical Sciences, Lucknow, IND
| | - Ritesh Pandey
- Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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Gayatri A, Panidapu N, Sen B, Palamattam DJ, Kerala VP, Kumar NP. Lancisi Sign due to Malpositioned Central Venous Catheter. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00360-4. [PMID: 38955615 DOI: 10.1053/j.jvca.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Annusha Gayatri
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nagarjuna Panidapu
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Barsha Sen
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Don Jose Palamattam
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Varma Praveen Kerala
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Neema Praveen Kumar
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
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Ibarra-Sifuentes HR, Sánchez-Serna JF, Castillo-Torres SA, Vera-Pineda R, Cuellar-Monterrubio JE, Pezina-Cantú CO, Alvizures-Solares SR, Ramírez-Ramírez MG, Avila-Velázquez JL, Guerrero-González EM, Sánchez-Martínez C. Non-tunneled catheter tip depth position in urgent hemodialysis: a randomized controlled trial. Minerva Urol Nephrol 2023; 75:116-123. [PMID: 34114785 DOI: 10.23736/s2724-6051.21.04222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The average accepted depth for non-tunneled catheters (NTC) insertion does not guarantee its correct position, so controversy exists. The aim of this study was to assess the effect of two NTC placement depths on the number of NTC complication episodes. METHODS We designed a triple blind, parallel group, randomized controlled trial in a single Hemodialysis Center in Mexico (Registry: ACTRN12619000774123). We included patients in urgent need of hemodialysis via internal right jugular vein NTC. The length of the NTC tip placement depth was randomized to second intercostal space (2ICS) or fourth intercostal space (4ICS), using physical landmarks. The primary outcome was to compare the composite number of NTC dysfunction, repositioning, and relocation episodes for 48 hours post-procedure. RESULTS One hundred and sixty-five patients were included, 86 and 79 patients to NTC placement in the 2ICS and 4ICS, respectively. All patients underwent intention-to-treat analysis. The incidence of the composite outcome was lower in the 2ICS group compared to the 4ICS group, 4 (4.6%) and 50 (63%) combined episodes, respectively (P<0.001). Compared to the 4ICS group, the 2ICS group presented a relative risk of 0.06 (CI: 0.02-0.21, P<0.001) and number needed to treat (NNT) of 2.1. No adverse events occurred, derived from the NTC placement. CONCLUSIONS NTC tip placement in the 2ICS compared to 4ICS decreases the incidence of the combined number of dysfunctions, repositioning and relocation episodes, with a NNT of 2 for its prevention.
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Affiliation(s)
- Héctor R Ibarra-Sifuentes
- Department of Internal Medicine, Instituto Mexicano del Seguro Social, Hospital General de Zona11, Piedras Negras, Mexico - .,Unit of Nephrology, Instituto Mexicano del Seguro Social, Hospital General de Zona11, Piedras Negras, Mexico - .,Department of Internal Medicine, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico - .,Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico - .,Unidad Norte School of Medicine, Autonomous University of Coahuila, Piedras Negras, Mexico -
| | - José F Sánchez-Serna
- Secretaría de Salud, Unit of Nephrology, General Hospital Chetumal, Chetumal, Mexico
| | - Sergio A Castillo-Torres
- Department of Internal Medicine, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico.,Unit of Neurology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Raymundo Vera-Pineda
- Unit of Cardiology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Jesús E Cuellar-Monterrubio
- Unit of Gastroenterology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Cesar O Pezina-Cantú
- Unit of Hematology, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Constitución Hospital, Monterrey, Mexico
| | - Sergio R Alvizures-Solares
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - María G Ramírez-Ramírez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - José L Avila-Velázquez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elisa M Guerrero-González
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Concepción Sánchez-Martínez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
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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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Weber MD, Conlon T, Woods-Hill C, Watts SL, Nelson E, Traynor D, Zhang B, Davis D, Himebauch AS. Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients. Pediatr Crit Care Med 2022; 23:192-200. [PMID: 34999641 PMCID: PMC8897221 DOI: 10.1097/pcc.0000000000002882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. DESIGN Single-center retrospective cohort study. SETTING Quaternary academic PICU. PATIENTS Children greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location. CONCLUSIONS The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
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Affiliation(s)
- Mark D. Weber
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Watts
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Eileen Nelson
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Danielle Traynor
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Bingqing Zhang
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit
| | - Daniela Davis
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S. Himebauch
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Ye P, Tan Y, Shi S, Liu L. Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children. Paediatr Anaesth 2021; 31:346-351. [PMID: 33336473 DOI: 10.1111/pan.14107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children. AIM We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children. METHODS This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. RESULTS Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658-0.908; p < .001). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium. CONCLUSIONS Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.
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Affiliation(s)
- Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shujun Shi
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24:527-530. [PMID: 32963434 PMCID: PMC7482340 DOI: 10.5005/jp-journals-10071-23478] [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] [Indexed: 11/23/2022] Open
Abstract
Background Central venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmia's, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications. Objective To compare Peres’ formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach. Materials and methods A total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups—Peres’ group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups. Results About 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups. Conclusion Radiological landmark formula is superior to Peres’ formula for measuring optimal depth of insertion of right internal jugular venous catheter. How to cite this article Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24(7):527–530.
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Affiliation(s)
- A R Manudeep
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - B P Manjula
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - U S Dinesh Kumar
- Deparatment of Cardiothoracic and Vascular Anaesthesia, JSS Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020; 24:498-499. [PMID: 32963427 PMCID: PMC7482338 DOI: 10.5005/jp-journals-10071-23510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020;24(7):498-499.
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Affiliation(s)
- Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Samerchua A, Kongwatmai K, Boonsri S, Pipanmekaporn T, Bunchungmongkol N, Sukhupragarn W, Visrutaratina P. A Comparison of the external anatomical landmark and the radiological landmark for obtaining the optimal depth of a right internal jugular venous catheter in pediatric cardiac patients. Paediatr Anaesth 2020; 30:490-497. [PMID: 32011044 DOI: 10.1111/pan.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The external anatomical landmark and the radiological landmark have been introduced to provide estimation of the depth of right internal jugular venous catheter during insertion. AIMS This study aimed to compare the accuracy, agreement, and reliability of the external anatomical landmark and the radiological landmark, confirmation being by transesophageal echocardiography. METHODS This prospective observational study was conducted in children ages 1-15 years. The catheter was placed at the superior vena cava and the right atrium junction guided by transesophageal echocardiography. The catheter depth derived from the transesophageal echocardiography, the external anatomical landmark, and the radiological landmark was recorded. The optimal zone of the catheter tip was 5 mm below and 10 mm above the superior vena cava and the right atrium junction. Accuracy was assessed by the difference between the transesophageal echocardiography and the external anatomical landmark or the radiological landmark. Agreement with Bland-Altman plots and correlation were tested. RESULTS Eighty participants, median age of 3 years, were enrolled. The median (IQR) differences between the depth of the transesophageal echocardiography and the external anatomical landmark or the radiological landmark were 0.30 (0, 0.70) and 0.10 (-0.20, 0.90) cm, respectively. Bland-Altman plots demonstrated good agreement between the depths. The catheter tips were located in the optimal zone more frequently with the external anatomical landmark than the radiological landmark (94.7% vs 64.5%). The external anatomical landmark showed a stronger correlation to transesophageal echocardiography than the radiological landmark (r = .95 vs .83). CONCLUSION Both the external anatomical landmark and the radiological landmark enabled accurate estimation of the central venous catheter depth close to the superior vena cava and the right atrium junction. The external anatomical landmark is of more potential use than the radiological landmark in clinical practice.
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Affiliation(s)
- Artid Samerchua
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kritanon Kongwatmai
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Settapong Boonsri
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanyong Pipanmekaporn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Wariya Sukhupragarn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pannee Visrutaratina
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Iacobone E, Elisei D, Gattari D, Carbone L, Capozzoli G. Transthoracic echocardiography as bedside technique to verify tip location of central venous catheters in patients with atrial arrhythmia. J Vasc Access 2020; 21:861-867. [DOI: 10.1177/1129729820905200] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Transthoracic echocardiography with bubble test is an accurate, reproducible, and safe technique to verify the location of the tip of the central venous catheter. The aim of this study is to confirm the effectiveness of this method for tip location in patients with atrial arrhythmia. Methods: Transthoracic echocardiography with bubble test was adopted as a method of tip location in patients with atrial arrhythmia requiring central venous catheter. If bubbles were evident in the right atrium in less than 2 s after simple saline injection, tip placement was assumed as correct. In cases of uncertain visualization of the bubble effect, the test was repeated injecting a saline–air mixture. Tip location was also assessed by post-procedural chest X-ray. Results: In 42 patients with no evident P-wave at the electrocardiography, we placed 34 centrally inserted central catheters and 8 peripherally inserted central catheters. Transthoracic echocardiography with bubble test detected two centrally inserted central catheter malpositions. In four patients with peripherally inserted central catheter, transthoracic echocardiography with bubble test was positive only when repeated with the saline–air mixture. When the transthoracic echocardiography was positive, the mean (±standard deviation) time for onset of the bubble effect was 0.89 ± 0.33 s in patients with centrally inserted central catheter and 1.1 ± 0.20 s in those with peripherally inserted central catheter; such time difference was not statistically significant (p > 0.05). Conclusion: Tip location of central venous catheter by transthoracic echocardiography with bubble test is feasible, safe, and accurate in patients with atrial arrhythmia. This method can also be applied in peripherally inserted central catheters; however, further studies may be needed to confirm its use in this type of catheters.
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Affiliation(s)
- Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Diego Gattari
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Luigi Carbone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
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Ju H, Sun X, Feng Y. Determination and prediction of the appropriate depth of right internal jugular vein catheterization via the middle approach in adults using transesophageal echocardiography. Echocardiography 2019; 36:1496-1500. [PMID: 31287568 DOI: 10.1111/echo.14416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hui Ju
- Department of Anesthesiology Peking University People's Hospital Beijing China
| | - Xiaochen Sun
- Department of Anesthesiology Peking University People's Hospital Beijing China
| | - Yi Feng
- Department of Anesthesiology Peking University People's Hospital Beijing China
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Abstract
Central venous catheters (CVC) are commonplace in the management of critically ill patients and serve a variety of purposes. Venous access is important for the administration of fluid and medications as well as blood procurement needed for lab analyses. However, not every critically ill patient requires a CVC. This article highlights the key considerations, pitfalls and evidence-based practices regarding the use pediatric central venous catheters.
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Affiliation(s)
- Ramin Jamshidi
- 1919 E Thomas Avenue, Pediatric Surgery, Clinic D, Phoenix Children's Hospital, Phoenix, AZ 85016, United States.
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14
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Chaskar V, Karnik PP, Dave NM, Garasia M. Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study. Turk J Anaesthesiol Reanim 2018; 46:116-120. [PMID: 29744246 DOI: 10.5152/tjar.2018.32748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients. Methods Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis. Results Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully. Conclusion Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.
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Affiliation(s)
- Vaishali Chaskar
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | | | - Nandini Malay Dave
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | - Madhu Garasia
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
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15
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Tempe D, Hasija S. Quest to determine the ideal position of the central venous catheter tip. Br J Anaesth 2017; 118:148-150. [DOI: 10.1093/bja/aew443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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