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Choi JH, Yoo JH, Chang WH, Park YW, Kim HJ, Oh HC. Intravascular guide wire aspiration in a patient on extracorporeal membrane oxygenation: A case report. Medicine (Baltimore) 2024; 103:e37638. [PMID: 38579027 PMCID: PMC10994507 DOI: 10.1097/md.0000000000037638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Guide wire aspiration during central venous catheter (CVC) insertion in a patient on extracorporeal membrane oxygenation (ECMO) is a very rare but dangerous complication. A guide wire aspirated inside the ECMO can cause thrombosis, the ECMO to break down or shut off, and unnecessary ECMO replacement. PATIENT CONCERNS A 58-year-old man was scheduled for venovenous ECMO for acute respiratory distress syndrome. After his vital signs stabilized, we inserted a CVC. During CVC insertion, the guide wire was aspirated into the ECMO venous line. INTERVENTION After confirming the guide wire inside the ECMO venous line, we replaced the entire ECMO circuit. OUTCOMES ECMO was maintained for 57 days, and weaning was successful but the patient died 5 days afterward. LESSONS Care must be taken when inserting a CVC using a guide wire in ECMO patients: the guide wire should not be inserted deeply, it should be secured during insertion, the ECMO venous cannula tip requires proper positioning, and ECMO flow should be temporarily reduced.
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Affiliation(s)
- Jae Ho Choi
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Won Ho Chang
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Young Woo Park
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Hyun Jo Kim
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Hong Chul Oh
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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Erdemir A, Rasa HK. Impact of central venous port implantation method and access choice on outcomes. World J Clin Cases 2023; 11:116-126. [PMID: 36687176 PMCID: PMC9846971 DOI: 10.12998/wjcc.v11.i1.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing, there is still no “gold standard” for the implantation technique.
AIM To identify the implantation technique that should be favored.
METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated. Patients were assigned into two groups according to the access method. The first group comprised patients whose jugular veins were used, and the second group comprised patients whose subclavian veins were used. Groups were evaluated regarding age, sex, application side, primary diagnosis, active follow-up period in the hospital, chemotherapy agents administered, number of complications, and the Clavien-Dindo severity score. The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test. The χ2 test was used to analyze the variables.
RESULTS There was no statistically significant difference between the groups regarding age, sex, side, number of chemotherapy drugs, and duration of port usage (P > 0.05). Only 2 patients in group 1 had complications, whereas in group 2 we observed 19 patients with complications (P < 0.05). No port occlusion was found in group 1, but the catheters of 4 patients were occluded in group 2. One port was infected in group 1 compared to three infected ports in group 2. Two port ruptures, two pneumothorax, one revision due to a mechanical problem, one tachyarrhythmia during implantation, and four suture line problems were also recorded in group 2 patients. We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.
CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.
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Affiliation(s)
- Ayhan Erdemir
- Department of General Surgery, Anadolu Medical Center, Kocaeli 41400, Turkey
| | - Huseyin Kemal Rasa
- Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
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Maddali DMM, Salim Al Aliyani DKR, Arora DNR, Sathiya MPM. Central Venous Catheter Tip Malposition Following Internal Jugular Vein Cannulation In Pediatric Patients With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2022; 36:2483-2487. [DOI: 10.1053/j.jvca.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
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Reichmann-Ariel D, Sadeh R, Galante O, Almog Y, Fuchs L. Central venous catheter insertion- guidewire migration ratio: Right heart to inferior vena cava. PLoS One 2021; 16:e0252726. [PMID: 34133420 PMCID: PMC8208537 DOI: 10.1371/journal.pone.0252726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Central Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study Galante et al. (2017) observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown. OBJECTIVE In this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration. METHODS This is a retrospective study in the medical intensive care unit among patients that have received CVC during the study years 2014-2020. The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well. RESULTS One hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC. CONCLUSION About a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.
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Affiliation(s)
| | - Re’em Sadeh
- Clinical Research Center, Soroka University Medical Center, Be’er Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
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Adrian M, Bengtsson P, Borgquist O, Bozovic G, Kander T. Minimal guidewire length for central venous catheterization of the right subclavian vein: A CT-based consecutive case series. J Vasc Access 2021; 23:375-382. [DOI: 10.1177/1129729821993983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein. Methods: One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15–16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit. Results: The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits. Conclusion: After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15–16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.
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Affiliation(s)
- Maria Adrian
- Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Sweden
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Pär Bengtsson
- Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Ola Borgquist
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, Lund, Sweden
- Department of Intensive and Peri-operative Care, Skåne University Hospital Lund, Lund, Sweden
| | - Gracijela Bozovic
- Department of Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, Lund, Sweden
- Department of Intensive and Peri-operative Care, Skåne University Hospital Lund, Lund, Sweden
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Sood V, Kumar V, Rathi M, Pattanashetty N, Ramachandran R. Fracture Embolism of In-situ Guidewire-Bewildering Aetiology of Protracted Pyrexia in a Patient with End Stage Renal Disease! Indian J Nephrol 2021; 31:54-56. [PMID: 33994689 DOI: 10.4103/ijn.ijn_330_19] [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: 09/29/2019] [Revised: 01/24/2020] [Indexed: 11/04/2022] Open
Abstract
Guidewire embolism during venous access for haemodialysis is not uncommon yet potentially avoidable iatrogenic complication. Unrecognised, long-standing in-situ guidewire may predispose to thrombosis and become a nidus for infection. This entity should always be borne in mind and considered as one of the differentials of unexplained pyrexia in patient on maintenance haemodialysis. In this context, we report a patient on maintenance dialysis who presented with fever of 6 weeks duration with no localising history and failed response to empirical antibiotics. On imaging, he was detected to have in-situ guidewire with fracture embolism into inferior vena cava and right external iliac vein and soon patient became afebrile following guidewire retrieval using gooseneck snare device, thereby retrospectively confirming causality.
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Affiliation(s)
- Vivek Sood
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navin Pattanashetty
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Langer NH, Hein L, Bestle MH. Intracranial entrapment of a haemodialysis catheter guidewire. BMJ Case Rep 2020; 13:13/8/e232535. [PMID: 32843444 DOI: 10.1136/bcr-2019-232535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man with chronic obstructive pulmonary disease was hospitalised due to pneumonia and pulmonary embolisms. After subsequently developing septic shock and acute renal failure, he required dialysis. A haemodialysis catheter was planned inserted into the right subclavian vein, the guidewire was introduced using the Seldinger technique. When the guidewire's 20 cm marker entered the introducer needle, it suddenly encountered resistance. Repeated attempts to remove the guidewire failed. Vital signs and haemodynamic parameters remained unchanged throughout the procedure. CT angiography revealed cranial displacement of the wire into the right internal jugular vein, with the tip of the wire just cranial to the jugular foramen in the right sigmoid sinus. Interventional radiological removal attempts were unsuccessful. Thoracic and neurosurgical interventions were considered impossible and the guidewire was left in place. Due to the pulmonary embolism and the foreign object in the patient, life-long anticoagulation was considered, with close monitoring of compliance with the patient's comorbidity and medication.
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Affiliation(s)
- Natasha Hemicke Langer
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark
| | - Lars Hein
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark
| | - Morten Heiberg Bestle
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Nordsjaellands Hospital, University of Copenhagen, Hillerod, Denmark
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Abstract
More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.
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Davies TW, Montgomery H, Gilbert-Kawai E. Cannulation of the subclavian vein using real-time ultrasound guidance. J Intensive Care Soc 2020; 21:349-354. [PMID: 34093738 DOI: 10.1177/1751143720901403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cannulation of the subclavian vein has many advantages when compared to other anatomical sites for central venous access. Difficulty in its ultrasonic visualisation, and the perceived consequent 'higher' complication rate, mean that this approach has fallen out of favour. This barrier, however, may now have disappeared. In this article, we discuss the indications, contraindications and complications associated with subclavian vein cannulation, and present an ultrasound-guided approach to infraclavicular subclavian cannulation.
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Affiliation(s)
- Thomas W Davies
- Department of Intensive Care, University College Hospital, London, UK
| | - Hugh Montgomery
- Department of Medicine, Centre for Human Health and Performance, University College London, London, UK
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Hagaman S, Matteo J, Kee-Sampson J, Bashir S, Le RT, Meyer TE. Pipe-Cleaning Plugged Portacaths: How to Unclog an Implanted Port After Development of a Fibrin Sheath. Vasc Endovascular Surg 2020; 54:233-239. [PMID: 31957599 DOI: 10.1177/1538574419900054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Industry has long fought the battle to design a vascular catheter that is less thrombogenic. Indwelling catheters provide long-term central venous access, but they develop fibrin sheaths as the vascular system recognizes them as foreign bodies. Peripheral catheters and central catheters can be changed over a guidewire when they form a fibrin sheath or otherwise malfunction. However, totally implantable venous access devices such as a port cannot be easily exchanged over a wire. Therefore, when a port malfunctions, thrombolytics are usually the only option attempted before the port is explanted and a new site is prepared for access. We present a minimally invasive technique demonstrating port salvage that does not require explant.
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Affiliation(s)
- Sean Hagaman
- Lake Erie College of Osteopathic Medicine, Bradenton Campus, Bradenton, FL, USA
| | - Jerry Matteo
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Joanna Kee-Sampson
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Saeed Bashir
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Rebecca T Le
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Travis E Meyer
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
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Trimble A, Ivanick N. Wire Placement into the Dural Venous Sinuses during Central Venous Catheter Placement. Am J Respir Crit Care Med 2019; 198:e1-e2. [PMID: 29579394 DOI: 10.1164/rccm.201711-2235im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aaron Trimble
- 1 Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Nathaniel Ivanick
- 2 Christus St. Vincent Regional Medical Center, Santa Fe, New Mexico
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Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted Central Venous Catheters. Case Rep Anesthesiol 2019; 2019:5134575. [PMID: 31428478 PMCID: PMC6679875 DOI: 10.1155/2019/5134575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.
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Samaha D, Clark EG. Common errors in temporary hemodialysis catheter insertion. Semin Dial 2019; 32:411-416. [PMID: 30950124 DOI: 10.1111/sdi.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-tunneled hemodialysis catheter (NTHC) insertion is an essential skill for nephrology practice and remains a requirement of training. However, improper insertion technique can increase the risk of potentially fatal infectious and mechanical complications. Evidence-based strategies can reduce the rates of such complications and should be integrated into practice and training. Ultrasound (US) guidance should routinely be used for NTHC insertion at the femoral and internal jugular sites (with avoidance of the subclavian site). Nephrologists should receive proper training in the use of US for line insertion. With respect to other aspects of the procedure, proper insertion technique readily prevents guidewire-induced arrhythmias. In addition, adherence to infection-control guidelines results in a sustainable reduction in bloodstream infections. All these aspects of NTHC insertion may be best taught and evaluated through a program that includes simulation-based mastery learning (SBML) training. As a separate issue, nephrologists (and intensivists) should be aware that a dysfunctional catheter should be replaced at a new site rather than being changed over a guidewire. This review of common errors related to NTHC insertion seeks to highlight evidence-based approaches to practice and training.
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Affiliation(s)
- Daniel Samaha
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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Jorge I, Pietrobom I, Góis A. Complete heart block during ultrasound-guided central venous catheterization. Intern Emerg Med 2018; 13:453-454. [PMID: 28913701 DOI: 10.1007/s11739-017-1748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Iago Jorge
- Department of Internal Medicine, Federal University of São Paulo, Rua Napoleão de Barros, 715, São Paulo, SP, CEP 04024-002, Brazil.
| | - Igor Pietrobom
- Department of Internal Medicine, Federal University of São Paulo, Rua Napoleão de Barros, 715, São Paulo, SP, CEP 04024-002, Brazil
| | - Aécio Góis
- Department of Internal Medicine, Federal University of São Paulo, Rua Napoleão de Barros, 715, São Paulo, SP, CEP 04024-002, Brazil
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Woodland DC, Randall Cooper C, Farzan Rashid M, Rosario VL, Weyker PD, Weintraub J, Bentley-Hibbert S, Kluger MD. Routine chest X-ray is unnecessary after ultrasound-guided central venous line placement in the operating room. J Crit Care 2018; 46:13-16. [PMID: 29627658 DOI: 10.1016/j.jcrc.2018.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Central venous catheters (CVC) can be useful for perioperative monitoring and insertion has low complication rates. However, routine post insertion chest X-rays have become standard of care and contribute to health care costs with limited impact on patient management. METHODS 200 patient charts who underwent pancreaticoduodenectomy with central line placement and early line removal were reviewed for clinical complications related to central line placement as well as radiographic evidence of malpositioning. A cost analysis was performed to estimate savings if CXR had not been performed across routine surgical procedures requiring central access. RESULTS In 200 central line placements for Whipple procedures, 198 lines were placed in the right internal jugular and 2 were placed in the subclavian. No cases of pneumothorax or hemothorax were identified and 30 (15.3%) of CVCs were improperly positioned. Only 1 (0.5%) of these was deemed clinically significant and repositioned after the CXR was performed. CONCLUSION Routine CXR consumes valuable time and resources (≅$155,000 annually) and rarely affects management. Selection should be guided by clinical factors.
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Affiliation(s)
| | | | | | | | - Paul David Weyker
- Kaiser Permanente South San Francisco, Department of Anesthesiology, Division of Critical Care Medicine, United States; Kaiser Permanente South San Francisco, Department of Anesthesiology, Division of Interventional Pain Management, United States
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Preventing Retained Central Venous Catheter Guidewires: A Randomized Controlled Simulation Study Using a Human Factors Approach. Anesthesiology 2017; 127:658-665. [PMID: 28806225 DOI: 10.1097/aln.0000000000001797] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retained central venous catheter guidewires are never events. Currently, preventative techniques rely on clinicians remembering to remove the guidewire. However, solutions solely relying upon humans to prevent error inevitably fail. A novel locked procedure pack was designed to contain the equipment required for completing the procedure after the guidewire should have been removed: suture, suture holder, and antimicrobial dressings. The guidewire is used as a key to unlock the pack and to access the contents; thereby, the clinician must remove the guidewire from the patient to complete the procedure. METHODS A randomized controlled forced-error simulation study replicated catheter insertion. We created a retained guidewire event and then determined whether clinicians would discover it, comparing standard practice against the locked pack. RESULTS Guidewires were retrieved from 2/10 (20%) standard versus 10/10 (100%) locked pack, n = 20, P < 0.001. In the locked pack group, participants attempted to complete the procedure; however, when unable to access the contents, this prompted a search for the key (guidewire). Participants discovered the guidewire within the catheter lumen, recovered it, utilized it to unlock the pack, and finish the procedure. A structured questionnaire reported that the locked pack also improved subjective safety of central venous catheter insertion and allowed easy disposal of the sharps and guidewire (10/10). CONCLUSIONS The locked pack is an engineered solution designed to prevent retained guidewires. Utilizing forced-error simulation testing, we have determined that the locked pack is an effective preventative device and is acceptable to clinicians for improving patient safety.
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Datta R, Purohit G, Agrawal J, Singh S. Pericardial tamponade: Rare complication of subclavian vein cannulation. Med J Armed Forces India 2017; 74:294-296. [PMID: 30093778 DOI: 10.1016/j.mjafi.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/10/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rashmi Datta
- Consultant, (Anaesthesiology & Critical Care), Base Hospital, Delhi Cantt & Army College of Medical Sciences, Delhi, India
| | - Gaurav Purohit
- Graded Specialist (Anaesthesiology), 153 GH, C/O 56 APO, India
| | - Jyotsna Agrawal
- Assistant Professor (Anaesthesiology), Base Hospital, Delhi Cantt & Army College of Medical Sciences, Delhi, India
| | - Shalendra Singh
- Classified Specialist (Neuro Anaesthesia & Critical Care), All India Institute of Medical Sciences, Delhi, India
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Hallas P. A novel technique for determining the correct length of tunneled catheters. Acta Anaesthesiol Scand 2017; 61:701-702. [PMID: 28485015 DOI: 10.1111/aas.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. Hallas
- Department of Pediatric Anestesia; Rigshospitalet; Copenhagen Ø Denmark
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Randomized comparison of three guidewire insertion depths on incidence of arrhythmia during central venous catheterization. Am J Emerg Med 2017; 35:743-748. [DOI: 10.1016/j.ajem.2017.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/22/2022] Open
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Tomar GS, Charan S, Mishra N, Kumar S. Missed Guide Wire in Inferior Vena Cava after Central Venous Cannulation. Anesth Essays Res 2017; 11:271-272. [PMID: 28298803 PMCID: PMC5341673 DOI: 10.4103/0259-1162.177185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gaurav Singh Tomar
- Department of Neuroanaesthesiology and Critical Care, Neuroscience Centre, AIIMS, New Delhi, India
| | - Sumit Charan
- Department of Anaesthesiology and Critical Care, Jeevan Anmol Hospital, New Delhi, India
| | - Neeraj Mishra
- Department of Anaesthesiology and Critical Care, Jeevan Anmol Hospital, New Delhi, India
| | - Shailendra Kumar
- Department of Anaesthesiology and Critical Care, AIIMS, New Delhi, India
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Yoshimura M, Nakanishi T, Sakamoto S, Toriumi T. Confirmation of optimal guidewire length for central venous catheter placement using transesophageal echocardiography. J Clin Anesth 2016; 35:58-61. [DOI: 10.1016/j.jclinane.2016.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign. Case Rep Crit Care 2016; 2016:1436924. [PMID: 27597903 PMCID: PMC4997017 DOI: 10.1155/2016/1436924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022] Open
Abstract
Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.
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Iatrogenic Transient Complete Heart Block in a Preexisting LBBB. Case Rep Crit Care 2016; 2016:9531210. [PMID: 27478653 PMCID: PMC4960327 DOI: 10.1155/2016/9531210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/26/2016] [Indexed: 11/24/2022] Open
Abstract
Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure.
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Abstract
Venous thromboembolism (VTE) is a common complication among patients in the intensive care unit. While anticoagulation remains standard therapy, vena caval filters are an important alternative when anticoagulation is contraindicated. To determine the safety and efficacy of vena caval filters in the treatment of VTE, a comprehensive review of the English-language medical literature was performed. Except for one randomized controlled trial, the literature supporting the use of vena caval filters consists almost exclusively of case series, which in many instances are limited by incomplete and short follow-up. While case series suggest that filters function effectively in the prevention of pulmonary embolism (2%-4% symptomatic pulmonary embolism [PE], fatal PE < 2%), recent higher quality studies indicate that filters may not provide significant additional protection to that provided by anticoagulation alone. Furthermore, filters are associated with a 2- fold increase in the incidence of recurrent DVT. Until randomized comparative studies are available, the safety and efficacy of all the available devices should be considered to be roughly equivalent. Since filters do not inhibit continued clot formation, all filter patients should receive anticoagulation for durations appropriate for their thrombotic disorder. Although extended anticoagulation may prevent thrombotic complications associated with filter placement, this strategy has yet to be experimentally tested. While many additional indications for vena caval filter use have been proposed (VTE in cancer patients, PE prophylaxis in trauma patients, etc), well-designed clinical trials demonstrating their efficacy in these situations are lacking. Further development of temporary/retrievable filters, which offer the potential to avoid the long-term complications of permanent filters, should be a research priority. Until additional data are available, vena caval filters should generally be restricted to patients with VTE who cannot receive anticoagulation.
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Affiliation(s)
- Michael B Streiff
- Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Ross Research Building, Room 1025, 720 Rutland Avenue, Baltimore, MD 21205, USA
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26
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Abstract
Venous thromboembolism (VTE) is a common cause of inpatient and outpatient morbidity and mortality. While anticoagulant therapy is considered the primary means of prevention and treatment of VTE, inferior vena cava filters (IVCFs) are often used as an alternative or adjunct to anticoagulation. With the advent of retrievable filters indications have liberalized, to include placement for primary prophylaxis in high-risk patients. However, this practice is based on limited evidence supporting their efficacy in preventing clinically relevant outcomes. Since indiscriminate use of IVCFs can be associated with net patient harm and increased health care costs, knowledge of the literature surrounding IVCF utilization is critical for providers to adopt best practices. In this review, we will provide an overview of the literature as it relates to specific clinical questions that arise when considering IVCF utilization in the prevention and treatment of VTE. Practice-based recommendations will be reviewed to provide the clinician with guidance on challenging clinical scenarios.
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Affiliation(s)
- Anita Rajasekhar
- University of Florida College of Medicine, Health Science Center, PO Box 100278, Gainesville, FL, 32610, USA,
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27
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Gupta KK, Nagpal N. Unusual but completely avoidable complication during central venous catheterization. Anesth Essays Res 2015; 9:241-3. [PMID: 26417134 PMCID: PMC4563956 DOI: 10.4103/0259-1162.156352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Central venous catheterization is generally a safe procedure, but several complications such as pneumothorax, arrhythmias, arterial puncture, infection, and thrombosis are known to occur even in the experienced hands. Complications related to guide wire are very rare and mostly relate to the expertise of operating person. We hereby report a rare but completely avoidable complication, that is, complete loss of the guide wire into the subclavian vein which was successfully retrieved by surgery.
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Affiliation(s)
- Kewal Krishan Gupta
- Department of Anaesthesiolgy and ICU, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Nitin Nagpal
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
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Martin DS, Cobb A, Meale P, Mitchell K, Edsell M, Mythen MG, Grocott MPW. Systemic oxygen extraction during exercise at high altitude. Br J Anaesth 2014; 114:677-82. [PMID: 25501722 PMCID: PMC4364061 DOI: 10.1093/bja/aeu404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Classic teaching suggests that diminished availability of oxygen leads to increased tissue oxygen extraction yet evidence to support this notion in the context of hypoxaemia, as opposed to anaemia or cardiac failure, is limited. Methods At 75 m above sea level, and after 7–8 days of acclimatization to 4559 m, systemic oxygen extraction [C(a−v)O2] was calculated in five participants at rest and at peak exercise. Absolute [C(a−v)O2] was calculated by subtracting central venous oxygen content (CcvO2) from arterial oxygen content (CaO2) in blood sampled from central venous and peripheral arterial catheters, respectively. Oxygen uptake (V˙O2) was determined from expired gas analysis during exercise. Results Ascent to altitude resulted in significant hypoxaemia; median (range) SpO2 87.1 (82.5–90.7)% and PaO2 6.6 (5.7–6.8) kPa. While absolute C(a−v)O2 was reduced at maximum exercise at 4559 m [83.9 (67.5–120.9) ml litre−1vs 99.6 (88.0–151.3) ml litre−1 at 75 m, P=0.043], there was no change in oxygen extraction ratio (OER) [C(a−v)O2/CaO2] between the two altitudes [0.52 (0.48–0.71) at 4559 m and 0.53 (0.49–0.73) at 75 m, P=0.500]. Comparison of C(a−v)O2 at peak V˙O2 at 4559 m and the equivalent V˙O2 at sea level for each participant also revealed no significant difference [83.9 (67.5–120.9) ml litre1vs 81.2 (73.0–120.7) ml litre−1, respectively, P=0.225]. Conclusion In acclimatized individuals at 4559 m, there was a decline in maximum absolute C(a−v)O2 during exercise but no alteration in OER calculated using central venous oxygen measurements. This suggests that oxygen extraction may have become limited after exposure to 7–8 days of hypoxaemia.
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Affiliation(s)
- D S Martin
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - A Cobb
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - P Meale
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - K Mitchell
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Mailpoint 810, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Anaesthesia and Critical Care Research Unit, GICU, Mailpoint 27, Level D, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - M Edsell
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Department of Anaesthesia, St George's Hospital, London, UK
| | - M G Mythen
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK
| | - M P W Grocott
- UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, 170 Tottenham Court Road, London W1 T 7HA, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Mailpoint 810, Sir Henry Wellcome Laboratories, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK Anaesthesia and Critical Care Research Unit, GICU, Mailpoint 27, Level D, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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29
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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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Kipling M, Mohammed A, Medding RN. Guidewires in clinical practice: applications and troubleshooting. Expert Rev Med Devices 2014; 6:187-95. [DOI: 10.1586/17434440.6.2.187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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Marano L, Izzo G, Esposito G, Petrillo M, Cosenza A, Marano M, Fabozzi A, Boccardi V, De Vita F, Di Martino N. Peripherally Inserted Central Catheter Tip Position: A Novel Empirical-Ultrasonographical Index in a Modern Surgical Oncology Department. Ann Surg Oncol 2013; 21:656-61. [DOI: 10.1245/s10434-013-3391-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Indexed: 12/20/2022]
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32
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Kale SB, Raghavan J. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection. Indian J Anaesth 2013; 57:390-3. [PMID: 24163455 PMCID: PMC3800333 DOI: 10.4103/0019-5049.118564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.
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Affiliation(s)
- Suresh Babu Kale
- Department of Cardiothoracic Surgery, Institute for Cardiac Treatment and Research, Southern Railway Headquarter Hospital, Perambur, Chennai, Tamil Nadu, India
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33
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Samanta S, Samanta S. Recurrent central venous malposition caused by severe lower airway distortion. Am J Emerg Med 2013; 32:101-2. [PMID: 24211285 DOI: 10.1016/j.ajem.2013.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Sujay Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Sukhen Samanta
- Department of Anesthesia&Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India
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34
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Rajasekhar A, Streiff MB. Vena cava filters for management of venous thromboembolism: A clinical review. Blood Rev 2013; 27:225-41. [DOI: 10.1016/j.blre.2013.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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35
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Huang YC, Huang JC, Chen SC, Chang JM, Chen HC. Lethal cardiac arrhythmia during central venous catheterization in a uremic patient: a case report and review of the literature. Hemodial Int 2013; 17:644-8. [PMID: 23461759 DOI: 10.1111/hdi.12030] [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] [Indexed: 02/01/2023]
Abstract
Double-lumen central venous catheter (CVC) is a rapid access technique for hemodialysis (HD) when an arteriovenous fistula or graft is not available. A variety of procedure-related complications have been reported, such as infection and pneumothorax, but serious cardiac complications are relatively less mentioned. We report a uremic woman with preexisting left bundle branch block who required emergent HD and received jugular double-lumen CVC insertion, which was complicated by short-duration ventricular tachycardia followed by complete atrio-ventricular block and bradycardia. Pharmacological management did not reverse heart rate and rhythm. External pacing was not applied because she remained hemodynamically stable in the course of HD. Heart rate returned to sinus rhythm with left bundle branch block 4 hours later and did not recur through the whole admission period. We speculate that the transient arrhythmia might have been induced by mechanical contact with the ventricular wall during the procedure with the guided metallic wire. In conclusion, physicians responsible for CVC catheterization should pay more attention to patients with preexisting cardiac arrhythmia to prevent such technical mistakes from transpiring.
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Affiliation(s)
- Ya-Chin Huang
- Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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36
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Complete heart block—an underappreciated serious complication of central venous catheter placement. J Electrocardiol 2012; 45:790-2. [DOI: 10.1016/j.jelectrocard.2012.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Indexed: 01/04/2023]
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Wu PH, Kuo MC, Li HH, Chen HC. A complication of double lumen hemocatheter guide wire entrapment in a hemodialysis patient. Hemodial Int 2012; 17:307-9. [PMID: 22574944 DOI: 10.1111/j.1542-4758.2012.00705.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Double lumen hemocatheter is commonly used for temporary hemodialysis patient and various complications have been documented but few reports of guide wire-related complications. We report a complication of double lumen hemocatheter guide wire entrapment in a 43-year-old female of type 1 diabetes mellitus and hemodialysis patient. She was admitted for left arteriovenous shunt dysfunction and right internal jugular vein hemocatheter chamber clotting was found while on hemodialysis, so a new hemocatheter was changed over guide wire. Guide wire was introduced without any resistance and the clotting hemocatheter was removed. During the procedure, the J-tipped guide wire could not be withdrawn and portable chest radiography revealed the J-tip of the guide wire was in the right ventricle near the region of tricuspid valve. Fluoroscopy was arranged and it also confirmed the J-tip was lying in the ventricle near the tricuspid valve where it was stuck. Snare catheter kit was inserted through the 10 Fr sheath and the cardiologist untied the knot by endovascular snare and removed the guide wire smoothly. This report emphasizes the importance of awareness on guide wire entrapment while inserting double lumen hemocatheter. When a guide wire became hard to withdraw, extracting an entrapped guide wire with fluoroscopy guide and snare catheter is a preferable and minimal invasive approach.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature. Case Rep Crit Care 2011; 2011:287261. [PMID: 24826318 PMCID: PMC4010052 DOI: 10.1155/2011/287261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/22/2011] [Indexed: 12/30/2022] Open
Abstract
Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
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39
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Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. Risk Manag Healthc Policy 2011; 4:27-39. [PMID: 22312225 PMCID: PMC3270925 DOI: 10.2147/rmhp.s10383] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed.
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Affiliation(s)
- Michael P Bannon
- Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota, USA
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40
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McGee WT, Mailloux PT, Martin RT. Safe placement of central venous catheters: a measured approach. J Intensive Care Med 2011; 26:392-6. [PMID: 21436169 DOI: 10.1177/0885066610392895] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To develop a simple method for safely placing central venous catheters (CVCs) outside the heart from the subclavian or internal jugular vein in compliance with Food and Drug Administration (FDA) and manufacturer guidelines. METHODS Patients requiring CVCs were enrolled into this prospective trial. Central venous catheters were inserted into the subclavian or internal jugular vein from either the right or left side to a depth of 15 cm. Chest radiographs were obtained immediately after insertion of the catheter to check tip placement and to evaluate for mechanical complications. RESULTS Operators successfully placed 201 of 210 (96%) CVCs outside the heart. Six of these required repositioning. Nine catheter tips were located in an intracardiac position. No cases of pneumothorax, hemothorax, or pericardial tamponade occurred. One case of delayed hydrothorax due to superior vena cava injury occurred. CONCLUSIONS Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines.
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Affiliation(s)
- William T McGee
- Critical Care Division, Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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41
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Abstract
The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.
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Affiliation(s)
- Omar Rahman
- Adult Intensive Care/Shock Trauma Unit, Geisinger Medical Center, Danville, PA 17822, USA.
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42
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Omar HR, Fathy A, Mangar D, Camporesi E. Missing the guidewire: an avoidable complication. Int Arch Med 2010; 3:21. [PMID: 20868508 PMCID: PMC2955561 DOI: 10.1186/1755-7682-3-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 09/25/2010] [Indexed: 11/10/2022] Open
Abstract
Central venous catheterization is an imperative tool in the critically ill patient to administer fluids, medications and for monitoring the central venous pressure. This procedure is associated with a variety of complications, some of which can be life threatening. In this brief report, we are addressing one of the rare complications of central venous catheterization which is missing the guidewire. We also described several precautions to avoid this complication as well as modifications in the guidewire to prevent its escape.
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Affiliation(s)
- Hesham R Omar
- Department of Cardiovascular Medicine, Cairo University Hospital, Cairo, Egypt.
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Carotid artery puncture, myocardial injury, and ventricular arrhythmia. South Med J 2010; 103:967-8. [PMID: 20689471 DOI: 10.1097/smj.0b013e3181eaa35d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matsushima K, Frankel HL. Bedside ultrasound can safely eliminate the need for chest radiographs after central venous catheter placement: CVC sono in the surgical ICU (SICU). J Surg Res 2010; 163:155-61. [PMID: 20599208 DOI: 10.1016/j.jss.2010.04.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 02/18/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Real-time ultrasound guidance of central venous catheter (CVC)/peripherally inserted central catheter (PICC) insertion improves safety and efficacy. We hypothesized that a more robust ultrasound surveillance technique incorporating thoracic, vascular, and cardiac views-the CVC sono-would avoid the need for chest radiography to realize cost and efficiency gains. METHODS We conducted a prospective data collection in a high-volume, urban, academic SICU. A single surgical intensivist, blinded to the results of chest radiography, performed all CVC sonos post-insertion. Catheter malposition was defined as location extrinsic to the superior vena cava and determined by a board-certified radiologist on chest radiography. CVC sono consisted of (1) mechanical complications screen (hemo-, pneumothorax), (2) intravenous tip screen, (3) intracardiac tip screen. The result of CVC sono was compared with chest radiography. RESULTS CVC sono evaluated 83 catheters (42 CVCs and 41 PICCs) and was considered technically adequate in 59 (71%). Incomplete studies were significantly more common in those with chest tubes (P = 0.02), but not in those with cervical collars (P = 0.07), an open abdomen (P = 0.28), or BMI > 40 (P = 0.33). Mean CVC sono time was 10.8 min, compared with chest radiography of 75.3 min (P < 0.001). No hemo-pneumothoraces developed. Presence of multiple indwelling central catheters (>1 CVC) trended for inaccurate CVC sono for catheter malposition (accuracy: 79% versus 93%, P = 0.11). CONCLUSION A novel ultrasound technique, CVC sono eliminated the need for chest radiography in most patients after CVC/PICC insertion, saving time and money. Those with multiple indwelling central catheters may still require post-insertion conventional chest radiography.
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Affiliation(s)
- Kazuhide Matsushima
- Department of Surgery, Division of Trauma, Acute Care, and Critical Care Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-850, USA.
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Goel S, Tandon M, Panigrahi B. Bedside technique to detect misplaced subclavian vein catheter in internal jugular vein. Ann Card Anaesth 2010; 13:71-2. [PMID: 20075542 DOI: 10.4103/0971-9784.58841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chakraborty A, Donoo FA, Roy Chowdhury S, Saha A, Ganguly S, Rupert E. Guidewire entrapment in a tricuspid valve apparatus. J Cardiothorac Vasc Anesth 2009; 24:898-9. [PMID: 20036155 DOI: 10.1053/j.jvca.2009.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Indexed: 11/11/2022]
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Huang CC, Chan CM, Chen JH, Chen WL, Wu YL. Emergency Femoral Central Venous Catheterization in an Elderly Patient Complicated by Distal Guidewire Migration. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(08)70052-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pikwer A, Bååth L, Davidson B, Perstoft I, Åkeson J. The Incidence and Risk of Central Venous Catheter Malpositioning: A Prospective Cohort Study in 1619 Patients. Anaesth Intensive Care 2008; 36:30-7. [PMID: 18326129 DOI: 10.1177/0310057x0803600106] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 2.5 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.
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Affiliation(s)
- A. Pikwer
- Departments of Anaesthesiology and Intensive Care Medicine, and of Diagnostic Radiology, Lund University, Malmö University Hospital, Malmö, Sweden
- Resident Anaesthesiologist, Department of Anaesthesiology and Intensive Care Medicine
| | - L. Bååth
- Departments of Anaesthesiology and Intensive Care Medicine, and of Diagnostic Radiology, Lund University, Malmö University Hospital, Malmö, Sweden
- Consultant Radiologist, Department of Diagnostic Radiology
| | - B. Davidson
- Departments of Anaesthesiology and Intensive Care Medicine, and of Diagnostic Radiology, Lund University, Malmö University Hospital, Malmö, Sweden
- Consultant Anaesthesiologist, Department of Anaesthesiology and Intensive Care Medicine
| | - I. Perstoft
- Departments of Anaesthesiology and Intensive Care Medicine, and of Diagnostic Radiology, Lund University, Malmö University Hospital, Malmö, Sweden
- Nurse Anesthetist and IT Technician, Department of Anaesthesiology and Intensive Care Medicine
| | - J. Åkeson
- Departments of Anaesthesiology and Intensive Care Medicine, and of Diagnostic Radiology, Lund University, Malmö University Hospital, Malmö, Sweden
- Associate Professor and Consultant Anaesthesiologist, Department of Anaesthesiology and Intensive Care Medicine
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Salgado OJ, Chacón RE, Mora E, Mora-LaCruz E. Angiotomographically-proven Left Innominate Vein Occlusion in Dialysis Patients With Prior Left Internal Jugular Vein Catheterization Presenting With Arm Swelling After Ipsilateral Access Creation: Report of Four Cases. Ther Apher Dial 2007; 11:396-401. [PMID: 17845401 DOI: 10.1111/j.1744-9987.2007.00502.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Central vein occlusion (CVO) is not uncommonly observed after hemodialysis (HD) catheter placement and it may prevent subsequent ipsilateral arteriovenous (AV) access creation. Right internal jugular vein catheterization (RJVC) appears to be the insertion site with the lowest incidence of CVO, but little is known about the incidence of CVO following left internal jugular vein catheterization (LJVC). We report on four patients with left innominate vein occlusion after LJVC who developed severe arm swelling after ipsilateral AV access creation. In three of the four cases swelling appeared 12-26 months after access creation, and in the fourth, swelling developed immediately after surgery while the catheter was still in place. Two patients underwent access ligation and in the remainder the arm swelling improved either spontaneously or after LJVC removal. LJVC is not as safe as RJVC as an insertion route for HD catheter placement in terms of CVO frequency.
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Affiliation(s)
- Octavio J Salgado
- Center of Experimental Surgery and Medicine, University of Zulia, Maracaibo, Venezuela.
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Abstract
OBJECTIVE To provide current information related to central venous catheterization. DESIGN Review of literature relevant to central venous catheterization and its indications, insertion techniques, and prevention of complications. RESULTS Central venous catheterization can be lifesaving but is associated with complication rates of approximately 15%. Operator experience, familiarity with the advantages and disadvantages of the various catheterization sites, and strict attention to detail during insertion help in reducing mechanical complications associated with catheterization. Strict aseptic technique and proper catheter maintenance decrease the frequency of catheter-related infections. CONCLUSIONS Appropriate catheter and site selection, sufficient operator experience, careful technique, and proper catheter maintenance with removal as soon as possible are associated with optimal outcome.
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Affiliation(s)
- Robert W Taylor
- Critical Care Training Program, Saint Louis University, St. John's Mercy Medical Center, MO, USA.
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