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Kumar K, Mathew JL, Sodhi KS. Confirmation of pleural displacement of central venous catheter tip in an infant, by bedside contrast injection. J Vasc Access 2024; 25:340-343. [PMID: 35915562 DOI: 10.1177/11297298221115561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 14-week infant, with respiratory distress since birth, was referred to our institution. Chest radiography and ultrasonographic examination confirmed right-sided diaphragmatic eventration. Owing to difficulty in securing a peripheral venous access, a double-lumen 4-Fr central venous catheter (CVC) was inserted into the right internal jugular vein, under ultrasonographic guidance. Aspiration of blood from both ports confirmed intravascular placement. A frontal radiograph done after the procedure showed the catheter tip in the right atrium, hence it was withdrawn to a level just below the carina. Surgical plication of the right dome of the diaphragm was performed, following which an intercostal tube was placed. After 3 days, there was increased drainage of clear fluid. Biochemical analysis ruled out exudative effusion, hence displacement of the CVC into the pleural cavity was suspected. A frontal chest radiograph was done to confirm this, but it did not suggest CVC tip displacement. Bedside ultrasonography was done but the CVC tip could not be visualized. The patient was too unstable to perform a chest CT scan or echocardiography. Therefore, a bedside chest radiograph was taken while injecting 1 ml of iohexol (diluted with 4 ml of normal saline) into the CVC. This showed the contrast leaking out of the CVC, flowing into the mediastinal pleural space, and ultimately into the ICD tube, confirming displacement of the CVC tip. The catheter was immediately removed, and an alternate venous access was established.
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Affiliation(s)
- Ketan Kumar
- Pediatric Pulmonology Unit, Department of Pediatrics, PGIMER Chandigarh, Chandigarh, India
| | - Joseph L Mathew
- Pediatric Pulmonology Unit, Department of Pediatrics, PGIMER Chandigarh, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, PGIMER Chandigarh, Chandigarh, India
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D'Andrea V, Pezza L, Prontera G, Ancora G, Pittiruti M, Vento G, Barone G. The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates. J Vasc Access 2023; 24:1134-1139. [PMID: 35081816 DOI: 10.1177/11297298211068302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. METHODS This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. RESULTS A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. CONCLUSIONS When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate.
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
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Struck MF, Rost F, Schwarz T, Zimmermann P, Siekmeyer M, Gräfe D, Ebel S, Kirsten H, Kleber C, Lacher M, Donaubauer B. Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements. CHILDREN 2023; 10:children10030515. [PMID: 36980073 PMCID: PMC10047298 DOI: 10.3390/children10030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments.
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Affiliation(s)
- Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-17700
| | - Franziska Rost
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Thomas Schwarz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
- Department of Anesthesiology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Peter Zimmermann
- Department of Pediatric Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Manuela Siekmeyer
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Daniel Gräfe
- Institute of Pediatric Radiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Statistics, Informatics, and Epidemiology, Medical Faculty, University of Leipzig, 04107 Leipzig, Germany
| | - Christian Kleber
- Department of Orthopedics, Traumatology, and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Bernd Donaubauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
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Gambato M, Scotti N, Borsari G, Zambon Bertoja J, Gabrieli JD, De Cassai A, Cester G, Navalesi P, Quaia E, Causin F. Chest X-ray Interpretation: Detecting Devices and Device-Related Complications. Diagnostics (Basel) 2023; 13:599. [PMID: 36832087 PMCID: PMC9954842 DOI: 10.3390/diagnostics13040599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
This short review has the aim of helping the radiologist to identify medical devices when interpreting a chest X-ray, as well as looking for their most commonly detectable complications. Nowadays, many different medical devices are used, often together, especially in critical patients. It is important for the radiologist to know what to look for and to remember the technical factors that need to be considered when checking each device's positioning.
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Affiliation(s)
- Marco Gambato
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Nicola Scotti
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Giacomo Borsari
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Jacopo Zambon Bertoja
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | | | - Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35121 Padua, Italy
| | - Giacomo Cester
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
- Institute of Radiology, University Hospital of Padova, 35121 Padua, Italy
| | - Francesco Causin
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
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