1
|
Chen Q, Zhang X, Zhang H, Li J, Zhang Y, Zhang K, Chen X. Prediction of internal jugular vein catheter length inserted through the posterior approach of the sternocleidomastoid muscle. Medicine (Baltimore) 2024; 103:e38876. [PMID: 39058850 PMCID: PMC11272274 DOI: 10.1097/md.0000000000038876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
This study aimed to determine an equation to estimate the optimal insertion length for catheter placement via the posterior approach of the sternocleidomastoid muscle in cancer patients. This retrospective study included patients with cancer who underwent infusion port implantation surgery in the Oncology Department of the 900th Hospital of Joint Logistic Support Force of the Chinese People Liberation Army from April 2017 to September 2023. Patient height (H), weight (W), chest length (C), and length of the internal jugular vein catheter (L) were collected from medical records. The patients were randomized 7:3 to the training and validation sets. Linear regression analyses were used in the training set to determine formulas to predict catheter length. The formula predictive value was analyzed using the Bland-Altman method in the validation set. This study included 336 patients, with a mean age of 58.27 ± 11.70 years, randomized in the training (n = 235) and validation (n = 101) sets. Linear regression analysis revealed that the equations for catheter length relative to H, body mass index (BMI), and C are L = 0.144 × H - 8.258 (R² = 0.608, P < .001), L = -0.103 × B + 17.384 (R² = 0.055, P < .001), and L = 0.477 × C + 1.769 (R² = 0.342, P < .001), respectively. The multivariable linear regression analysis showed that the equation between the length of the catheter and H and C was L = 0.131 × H + 0.086 × C-8.515 (R² = 0.614, P < .001). The Bland-Altman analysis in the validation set showed that the predicted values of internal jugular vein catheter length and the actual values showed good agreement. The optimal L might be determined by simple formulas based on patients H and C.
Collapse
Affiliation(s)
- Qunxiang Chen
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiaoyu Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huanlin Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie Li
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kaixiang Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| |
Collapse
|
2
|
Žarskus A, Zykutė D, Lukoševičius S, Jankauskas A, Trepenaitis D, Macas A. Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:28. [PMID: 38256289 PMCID: PMC10820046 DOI: 10.3390/medicina60010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.
Collapse
Affiliation(s)
- Ainius Žarskus
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Dalia Zykutė
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Saulius Lukoševičius
- Department of Radiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Darius Trepenaitis
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| |
Collapse
|
3
|
Naik S, Pappu A, Sarathkumar M, Ramachandran R, Arora M, Trikha A, Singh PM, Anand RK, Das CJ, Rewari V. Determination of the optimal length of insertion for central venous catheterization via axillary vein cannulation using preoperative chest X-ray- A prospective feasibility study. J Anaesthesiol Clin Pharmacol 2023; 39:215-219. [PMID: 37564859 PMCID: PMC10410044 DOI: 10.4103/joacp.joacp_223_21] [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: 05/07/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims Ensuring safe central venous catheter tip placement is important. Multiple techniques are available to estimate the length of catheter insertion for subclavian and internal jugular approaches. However, the methods to determine the length of insertion for the axillary route have not been validated. The purpose of this feasibility study was to evaluate a simple method for the calculation of catheter length to be inserted and assess whether it accurately predicts the correct tip placement. Material and Methods A total of 102 patients requiring preoperative central venous cannulation were evaluated, out of which 60 had successful axillary vein (AxV) cannulation. The length of insertion was calculated using the formula: (2/3* A + B) +Y (A: Clavicular length on chest radiograph [CXR], B: Vertical distance between the sternal head and carina on CXR, Y: Perpendicular distance from the skin to the AxV on ultrasound). A postoperative CXR was used to assess the accurate tip placement (2 cm above the carina to 0.5 cm below it). The primary outcome of the study was the rate of successful placement of the central venous catheter (CVC) in terms of the correct position of the tip of the catheter when the length of the catheter inserted was predicted by the formula described previously. Results Optimal placement was observed in 83.33% of the cases. A higher rate of accuracy was seen in the females (P value = 0.03) and shorter patients (P value = 0.01). A Bland-Altman plot depicted a high degree of agreement. Conclusion Use of the formula using a CXR and ultrasound allowed P successful placement of the CVC tip at the desired location in 83.33% of the cases.
Collapse
Affiliation(s)
- Srikanth Naik
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Ameya Pappu
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - M.S Sarathkumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - M.K. Arora
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Preet M. Singh
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, USA
| | - Rahul Kumar Anand
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| | - Chandan J. Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Muacevic A, Adler JR, Tekgul ZT. Assessment of the Tip Position of Central Venous Catheters Inserted Using Peres' Height Formula. Cureus 2022; 14:e31988. [PMID: 36589175 PMCID: PMC9797751 DOI: 10.7759/cureus.31988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The tip of a central venous catheter (CVC) should be positioned in the proximity of the cavo-atrial junction (CAJ) where the lower third of the superior vena cava (SVC) and the upper right atrium (RA) are located to prevent life-threatening complications. This study aimed to determine the accuracy of Peres' height formula in predicting the correct insertion depth of CVC. Methods: A total of 332 patients were enrolled in this prospective observational study. All CVCs were inserted using Peres' formula. The 'correct' tip position of CVC was the placement of the CVC tip 1 cm above and 1 cm below the carina in CXR. Rates of correct placements for each side and site of catheter insertions, gender, and body mass index (BMI) differences were evaluated. RESULTS The correct placement rate of all catheters was 74.4%. There were statistically significant correlations between the correct placement of right-sided jugular and subclavian catheters (p<0.001) and left-sided jugular and subclavian catheters (p=0.014). There was a statistically significant difference in male patients (p=0.047). Higher BMI resulted in a lower rate of correct placement with no statistically significant difference (p=0.457). CONCLUSIONS Peres' formula can be easily used to determine the correct position of CVC tips with a success rate in the Turkish population. However, practitioners should be aware of the low accuracy rate of Peres' formula in female patients (68.5%) and patients with BMI over 35 kg/m2 (62.5%).
Collapse
|
6
|
Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients. Resuscitation 2022; 179:277-284. [PMID: 35870557 DOI: 10.1016/j.resuscitation.2022.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022]
Abstract
AIM of the study Resuscitative endovascular balloon occlusion of the aorta (REBOA), originally designed to block blood flow to the distal part of the aorta by placing a balloon in trauma patients, has recently been shown to increase coronary perfusion in cardiac arrest patients. This study evaluated the effect of REBOA on aortic pressure and coronary perfusion pressure (CPP) in non-traumatic out of-hospital cardiac arrest (OHCA) patients. METHODS Adult OHCA patients with cerebral performance category 1 or 2 prior to cardiac arrest, and without evidence of aortic disease, were enrolled from January to December 2021. Aortic pressure and right atrial pressure were measured before and after balloon occlusion. The CPP was calculated using the measured aortic and right atrial pressures, and the values before and after the balloon occlusion were compared. RESULTS Fifteen non-traumatic OHCA patients were enrolled in the study. The median call to balloon time was 46.0 (IQR, 38.0-54.5) min. The median CPP before and after balloon occlusion was 13.5 (IQR, 5.8-25.0) and 25.2 (IQR, 12.0-44.6) mmHg, respectively (P = 0.001). The median increase in the estimated CPP after balloon occlusion was 86.7%. CONCLUSIONS The results of this study suggest that REBOA may increase the CPP during cardiopulmonary resuscitation in patients with non-traumatic OHCA. Additional studies are needed to investigate the effect on clinical outcomes.
Collapse
|
7
|
Shah Z, Khan I, Dixe de Oliveira Santo I. Intraperitoneal Hematoma After Femoral Catheterization: A Case Report and Literature Review. Cureus 2022; 14:e25140. [PMID: 35733506 PMCID: PMC9205448 DOI: 10.7759/cureus.25140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Central venous catheters (CVCs) are often crucial in managing severely ill patients, especially those in the intensive care unit. It is estimated that over 5 million CVCs are inserted per year in the United States. The internal jugular, subclavian, or femoral veins are the most used access sites. The catheter is advanced until its tip lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Unfortunately, the use of CVCs is not without its drawbacks, and multiple immediate and delayed complications have been described. Herein, we report a case of a 70-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronavirus disease 2019, pneumonia, type 2 diabetes mellitus, and hypertension, who presented to the emergency department from a skilled nursing facility with a two-day history of dyspnea. She was later diagnosed with an intraperitoneal hematoma, an uncommon complication caused by a CVC placement.
Collapse
|
8
|
Singh T, Chopra S, Luthra N, Kathuria S, Saggar K, Gupta S. Optimal positioning of right internal jugular venous catheter: A randomised study comparing modified Peres' height formula and distance between insertion point and right third intercostal space. Indian J Anaesth 2022; 66:585-590. [PMID: 36274797 PMCID: PMC9580582 DOI: 10.4103/ija.ija_879_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/01/2022] [Accepted: 05/04/2022] [Indexed: 11/04/2022] Open
|
9
|
Central Venous Catheters for Hemodialysis-the Myth and the Evidence. Kidney Int Rep 2021; 6:2958-2968. [PMID: 34901568 PMCID: PMC8640568 DOI: 10.1016/j.ekir.2021.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hemodialysis-central venous catheter (HD-CVC) insertion is a most often performed procedure, with approximately 80% of patients with end-stage kidney disease in the United States initiating kidney replacement therapy through a HD-CVC. Certain adverse events arising from HD-CVC placement, including catheter-related bloodstream infections (CR-BSIs), thrombosis, and central vein stenosis, can complicate the clinical course of patients and lead to considerable financial impact on the health care system. Medical professionals with different training backgrounds are responsible for performing this procedure, and therefore, comprehensive operator guidelines are crucial to improve the success rate of HD-CVC insertion and prevent complications. In this review article, we not only discuss the basic principles behind the use of HD-CVCs but also address frequently asked questions and myths regarding catheter asepsis, length selection, tip positioning, and flow rate assessment.
Collapse
|
10
|
Liu S, Jiang L, Wang X. Intelligent Internet of Things Medical Technology in Implantable Intravenous Infusion Port in Children with Malignant Tumors. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8936820. [PMID: 34876968 PMCID: PMC8645386 DOI: 10.1155/2021/8936820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Due to the recent technological revolution that is centered around information technology, the Internet of Medical Things (IoMT) has become an important research domain. IoMT is a combination of Internet of Things (IoT), big data, cloud computing, ubiquitous network, and three-dimensional holographic technology, which is used to build a smart medical diagnosis and treatment system. Additionally, this system should automate various activities, such as the patient's health record and health monitoring, which is an important issue in the development of modern and smart healthcare system. In this paper, we have thoroughly examined the role of a smart healthcare system architecture and other key supporting technologies in improving the health status of both indoor and outdoor patients. The proposed system has the capacity to investigate and predict (if feasible) the clinical application and nursing effects of totally implantable intravenous port (TIVAP) in pediatric hematological tumors. For this purpose, seventy children with hematologic tumors were treated with TIVAP, and IoMT-enabled care was provided to them, where the occurrence of adverse events, specifically after the treatment, was observed. The experimental results collected after the 70 children were treated and cared for by TIVAP show that there were five cases of adverse events, whereas the incidence rate of the adverse events was 7.14%. Moreover, TIVAP has significant efficacy in the treatment of hematologic tumors in children, and it equally reduces the vascular injury caused by chemotherapy in younger patients. Likewise, targeted care reduces the incidence of adverse events in children with expected ratio.
Collapse
Affiliation(s)
- Shaohong Liu
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Luxing Jiang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| | - Xin Wang
- Department of Pediatric Surgery, Hunan Children's Hospital, Changsha 410007, China
| |
Collapse
|
11
|
Juncos LA, Chandrashekar K, Karakala N, Baldwin I. Vascular access, membranes and circuit for CRRT. Semin Dial 2021; 34:406-415. [PMID: 33939859 DOI: 10.1111/sdi.12977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 01/09/2023]
Abstract
The advances in the technology for providing continuous renal replacement therapy (CRRT) have led to an increase in its utilization throughout the world. However, circuit life continues to be a major problem. It leads not only to decreased delivery of dialysis but also causes blood loss, waste of disposables, alters dose delivery of medications and nutrition, and increases nurse workload, all of which increases healthcare cost. Premature circuit failure can be caused by numerous factors that can be difficult to dissect out. The first component is the vascular access; without a well-placed, functioning access, delivery of CRRT becomes very difficult. This is usually accomplished by placing a short-term dialysis catheter into either the right internal jugular or femoral vein. The tips should be located at the caval atrial junction or inferior vena cava. In addition to establishing suitable vascular access, a comprehensive understanding of the circuit facilitates the development of a methodical approach in providing efficient CRRT characterized by optimal circuit life. Moreover, it aids in determining the cause of circuit failure in patients experiencing recurrent episodes. This review therefore summarizes the essential points that guide providers in establishing optimal vascular access. We then provide an overview of the main components of the CRRT circuit including the blood and fluid pumps, the hemofilter, and pressure sensors, which will assist in identifying the key mechanisms contributing to premature failure of the CRRT circuit.
Collapse
Affiliation(s)
- Luis A Juncos
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kiran Chandrashekar
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nithin Karakala
- Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ian Baldwin
- Department of Intensive Care, Austin Hospital, Melbourne, Vic., Australia
| |
Collapse
|
12
|
Yang S, Kong X, Liu L, Xu Y, Zhang J. Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children. Clin Cardiol 2020; 44:129-135. [PMID: 33241579 PMCID: PMC7803355 DOI: 10.1002/clc.23518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022] Open
Abstract
A totally implantable venous access port (TIVAP) is important in children who need intravenous infusion for a long time. A number of studies have shown methods for locating the tip of the TIVAP catheter. To explore whether transesophageal echocardiography (TEE) can be used to accurately locate the TIVAP catheter tip through a subclavian approach and to improve the rate of correct TIVAP catheter placement and reduce complications of TIVAP placement. In 36 children who needed TIVAP implantation surgery, we used real‐time TEE guidance to place the catheter tip around the crista terminalis. In all children, chest X‐rays were used to figure out whether the catheter tip as localized by TEE was within the T5‐T7 segment. Then, we compared the length of the catheter calculated by the height formula and the actual catheter length applied under TEE guidance. The medical records, surgical details, nursing records, and recorded complications were collected during the follow‐up. The success rate of TIVAP implantation was 100% in all enrolled patients and no hemopneumothorax or pinch‐off syndrome occurred. Compared with TEE, chest X‐ray showed a coincidence rate of 80.56% in correctly detecting the TIVAP catheter tip locate. The height‐derived catheter length (11.0 [9.6, 11.8]) cm and the TEE‐derived catheter length (10.0 [9.3, 10.8]) cm were significantly different (p < .001). TEE can be used to guide TIVAP catheter positioning through a left subclavian approach in children accurately and successfully and more accurate than chest X‐ray and height calculation formula.
Collapse
Affiliation(s)
- Shujun Yang
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiangru Kong
- Department of Surgical Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lifei Liu
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ying Xu
- Department of Anesthesiology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jun Zhang
- Department of Surgical Oncology, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child development and Critical Disorders, Chongqing, China.,Childrens Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
15
|
Salimi F, Sajjadieh Khajouei A, Keighobadi S, Keshavarzian A. Practical anatomical landmark for optimal positioning of left-sided long-term central venous catheter (a pilot study). JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:27. [PMID: 32419784 PMCID: PMC7213000 DOI: 10.4103/jrms.jrms_981_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/21/2018] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Background: Long-term central venous catheter (CVC) insertion in dialysis patients is an accepted method of hemodialysis. The appropriate CVC tip placement may reduce both early and late complications related to catheter and increase patency rate. This study aimed to evaluate a new, simple, and feasible method based on surface anatomy for the proper placement of tunneled CVC in the left internal jugular vein for hemodialysis or chemotherapy. Materials and Methods: The study was carried out as a quasi-experimental model at Saint Al-Zahra Education Hospital in 2016. A total of forty patients with an indication of left-sided (upper) long-term CVC insertion were enrolled. The length of catheter to be inserted in the left internal jugular vein was considered as the sum of distance from the insertion point of the needle up to sternal notch plus the total distance between the left and right sternoclavicular joint and half-length of the sternum. The right atrium (RA) or superior vena cava-RA junction was the correct region for inserting the catheter tip. The collected data were analyzed using Fisher's exact test and t-test using SPSS (version 22). Results: The patients were 63.75 ± 17.96 years of age, weighed 67.33 ± 13.20 kg, and height of 166.92 ± 8.99 cm. Catheters were inserted successfully in 95% of patients (n = 38). No significant relationship was found between the success of new method and age, gender, height, weight, body mass index, and sternum half-length plus the distance between the right and left sternoclavicular joint. Conclusion: “The mid – sternal length plus sternoclavicular joints spacing” as a new formula (based on anatomical landmarks) was found practical and safe and could easily be used among adult patients who undergo tunneled CVC in the left internal jugular vein.
Collapse
Affiliation(s)
- Fereshteh Salimi
- Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Saeed Keighobadi
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Keshavarzian
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Medical Ethics, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
16
|
Optimal Prediction of the Central Venous Catheter Insertion Depth Targeting the Cavoatrial Junction. World J Surg 2020; 44:2170-2174. [PMID: 32144470 DOI: 10.1007/s00268-020-05449-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Central venous catheters should be positioned at the cavoatrial junction or the right atrium. If catheters are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the length between the clavicular notch and the carina, the catheter tip can be placed near the carina. Based on this, we aim to make a formula to place a catheter tip near the cavoatrial junction. METHODS This prospective nonrandomized interventional study included patients who needed a central venous catheter from June 2017 to July 2018. The location of the cavoatrial junction was identified using a fluoroscopic technique. The following variables were measured: L1, the length between the needle insertion point and the clavicular notch; L2, the length between the clavicular notch and the carina; and α, the length between the carina and the cavoatrial junction. RESULTS A total of 70 patients were enrolled. The mean age was 65.5 ± 11.6 years, and 62.9% were male. The mean L1 and L2 were 7.6 ± 1.4 and 7.0 ± 1.4 cm, respectively. The mean α was 4.4 ± 1.5 cm (95% CI 4.1-4.8), and it was not affected by demographic factors, such as sex, age, height or weight. CONCLUSIONS Central venous catheters in adult patients can be placed near the cavoatrial junction using a simple formula: the distance between the insertion point and the clavicular notch + the distance between the clavicular notch to the carina + 4.4 cm.
Collapse
|
17
|
Parmar MS. (F)utility of "routine" postprocedural chest radiograph after hemodialysis catheter (central venous catheter) insertion. J Vasc Access 2020; 22:4-8. [PMID: 32114897 DOI: 10.1177/1129729820907259] [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] Open
Abstract
A routine postprocedural chest radiograph had been a safe, checklist-based final step of the procedure, since the start of central venous catheter insertion for hemodialysis to check the position of the catheter tip and to rule out complications. However, the chest radiograph is a suboptimal method to rule out complications like pneumothorax and is not a reliable test to confirm its position. Although it is relatively inexpensive, it is labor-intensive and exposes patient to unnecessary radiation exposure, cost, and often results in delayed use of the catheter. Various studies question the value of a routine chest radiograph as a screening test to rule out the mechanical complications of catheter insertion. We, in this brief viewpoint, present evidence to support the futility of a routine postprocedural chest radiograph in majority of asymptomatic patients and support Choosing Wisely Initiative to avoid low-value studies. However, it should be considered under specific indications, as discussed.
Collapse
Affiliation(s)
- Malvinder S Parmar
- Northern Ontario School of Medicine, Timmins and District Hospital, Timmins, ON, Canada
| |
Collapse
|
18
|
Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
Collapse
Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
| |
Collapse
|
19
|
Wright D, Williams D. Central venous catheter tip position on chest radiographs. Anaesthesia 2019; 75:124-125. [PMID: 31794645 DOI: 10.1111/anae.14894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Wright
- Dumfries and Galloway Royal Infirmary, Dumfries, Scotland
| | - D Williams
- Dumfries and Galloway Royal Infirmary, Dumfries, Scotland
| |
Collapse
|
20
|
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
| |
Collapse
|
21
|
Hade AD, Beckmann LA, Basappa BK. A checklist to improve the quality of central venous catheter tip positioning. Anaesthesia 2019; 74:896-903. [PMID: 31062348 DOI: 10.1111/anae.14679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
Central venous catheter insertion is a routine procedure performed by anaesthetists in the peri-operative setting. Upper body central venous catheters are usually placed such that their tip lies within the superior vena cava or at the cavo-atrial junction. Positioning the tip 'too low' in the right atrium has long been argued against on the basis that it increases the risk of perforation, leading to cardiac tamponade. Positioning the tip 'too high' in the brachiocephalic vein or above can also be problematic in that proximal migration can result in extravascular placement of the proximal lumen. Such an incident occurred at our hospital in 2016, resulting in extravasation of a vesicant medication causing tissue necrosis. We undertook a quality improvement project involving a standardised bundle of care and a peri-operative central venous catheter insertion checklist with the aim of reducing the risk of such an incident re-occurring. We conducted a three-month pre-intervention audit (n = 84) in 2016 and a post-intervention audit (n = 84) in 2017. Compared with the pre-intervention audit, the post-intervention audit coincided with a lower rate of central venous catheter tip malpositioning (5.6% vs. 9.2%); and a higher rate of 'optimal' central venous catheter tip position in the distal superior vena cava or cavo-atrial junction (45.1% vs. 29.2%). The central venous catheter insertion checklist also substantially improved documentation of sterility measures, insertion depth and post-insertional documentation of tip position on chest radiograph.
Collapse
Affiliation(s)
- A D Hade
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - L A Beckmann
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - B K Basappa
- Toowoomba Base Hospital, Toowoomba, QLD, Australia
| |
Collapse
|
22
|
Wu CY, Fu JY, Wu CF, Hsieh MJ, Wen CT, Cheng CH, Liu YH, Ko PJ. Superior Vena Cava Port Catheter Tip Confirmation: Quantified Formula for Intravascular Catheter Length versus Anatomic Landmark Reference. Ann Vasc Surg 2019; 60:193-202. [PMID: 31075484 DOI: 10.1016/j.avsg.2019.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate tip location is crucial for intravenous port implantation because it can minimize catheter-related complications. Adequate tip location cannot be observed directly and needs to be confirmed by imaging tools. A quantified intravascular catheter length formula has been proposed and we attempt to compare its clinical effectiveness with anatomic landmark references. METHODS During the period from March 2012 to February 2013, 503 patients who received port implantation where implanted catheter length depended on carina level as confirmed by intraoperative fluoroscopy were assigned to Group A. From March 2013 to February 2014, 521 patients who received port implantation based on quantified intravascular catheter length formula were assigned to Group B. Clinical outcomes were compared. RESULTS Catheter tip location of Group A, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.18 ± 0.51 and 1.1 ± 1.3 cm below carina, respectively. Catheter tip location of Group B, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.25 ± 1.05 and 1.05 ± 1.32 cm below carina, respectively. Similar catheter tip location was identified in both groups. The functional period of implanted ports, complication rate (3.58% and 2.53%), and incidence (0.049 and 0.0506 episodes/1,000 catheter days) were similar in both groups. CONCLUSIONS The quantified intravascular catheter length formula can predict an adequate catheter length just as well as carina do and results in good catheter tip location. The formula could replace the clinical use of anatomic landmarks and serve as an easy tool for practitioners.
Collapse
Affiliation(s)
- Ching-Yang Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Jui-Ying Fu
- Chest Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Feng Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tsung Wen
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hui Cheng
- Cardiovascular Physiology Laboratory, Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Ramin Jamshidi
- 1919 E Thomas Avenue, Pediatric Surgery, Clinic D, Phoenix Children's Hospital, Phoenix, AZ 85016, United States.
| |
Collapse
|
24
|
Jayaraman J, Shah V. Bedside prediction of the central venous catheter insertion depth - Comparison of different techniques. J Anaesthesiol Clin Pharmacol 2019; 35:197-201. [PMID: 31303709 PMCID: PMC6598586 DOI: 10.4103/joacp.joacp_125_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Central venous catheterization is a frequently performed procedure in anesthesia and critical care, and is indispensable in the practice of emergency medicine. Correct positioning of the central venous catheter (CVC) tip is often regarded as a secondary goal and there are various complications that can occur due to abnormal position of the catheter tip. Different methods have been advocated to guide accurate prediction of optimal CVC depth insertion before or during the procedure at the bedside. Material and Methods A prospective randomized double blinded study was conducted in 180 patients aged between 18 to 65 years requiring central venous catheterization. The optimal depth of insertion of right internal jugular vein (IJV) catheter using three different techniques, Peres' formula method, Landmark technique and Intra atrial Electrocardiography (ECG) guided technique was performed and the three techniques were compared with respect to optimal positioning using carina as a landmark in post procedural chest radiograph. Correct position of the catheter tip was considered upto 1 cm above or below the carina in post procedure X ray. Results The average final depth of insertion was 15.30 ± 0.62 cms in the Formula group, 12.74 ± 0.77 cms in landmark group and 12.64 ± 0.70 cms in ECG group. The vertical distance from carina was 0.91 ± 0.94 cms in formula group, 0.54 ± 0.67 cms in landmark group and 0.53 ± 0.43 cms in ECG group. The CVC tip was properly positioned within 1 cm above and below the carina in 58.33% patients in the formula group, 93.33% patients in landmark group and 96.67% patients in ECG group. Conclusion We conclude that both landmark guidance and ECG guidance are comparable with regard to accurate central venous catheter tip positioning when CVCs are placed through right internal jugular vein whereas formula based technique is least accurate and results in over insertion of CVCs.
Collapse
Affiliation(s)
- Jayaprakash Jayaraman
- Department of Anaesthesia and Critical Care, Smt. K. M. Mehta and Smt. G. R. Doshi Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Veena Shah
- Department of Anaesthesia and Critical Care, Smt. K. M. Mehta and Smt. G. R. Doshi Institute of Kidney Diseases and Research Center, Civil Hospital Campus, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| |
Collapse
|
25
|
Jarineshin H, Sharifi M, Kashani S. Comparing the conventional 15 cm and the C-length approaches for central venous catheter placement. J Cardiovasc Thorac Res 2018; 10:221-226. [PMID: 30680081 PMCID: PMC6335980 DOI: 10.15171/jcvtr.2018.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/16/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: The present guidelines recommend placing the catheter tip in the superior vena cava (SVC) above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the Central venous catheter (CVC) at the suggested vascular zone. Methods: This was an interventional study on two hundred patients undergoing Coronary artery bypass surgery (CABG) operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a C-length method was applied for measuring the depth of catheter tip placement from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used. Results: In the first group (15 cm) 100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was +4.22±2.10 cm. In the second (C-Length) group 52% of the catheters were below C-line with an average distance of +0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone of placement (P<0.001). Conclusion: The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.
Collapse
Affiliation(s)
- Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Maryam Sharifi
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Saeid Kashani
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| |
Collapse
|
26
|
Ahn JH, Kim IS, Yang JH, Lee IG, Seo DH, Kim SP. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres' formula or a radiological landmark-based approach: a prospective randomized single-centre study. Br J Anaesth 2018; 118:215-222. [PMID: 28100525 DOI: 10.1093/bja/aew430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography. METHODS Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (n=93) or the R group (n=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA-SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view. RESULTS The distance from the skin insertion point to the RA-SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; r=0.821, P<0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; r=0.517, P<0.001], with z=3.96 (P<0.001). More tips were correctly positioned in the R group than in the P group (74 vs 93%, P=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable. CONCLUSIONS Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp KCT0001937.
Collapse
Affiliation(s)
- J H Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Woncheon-Dong, Yeongtong-Gu, Suwon, Gyeonggi-Do 443-721, Republic of Korea
| | - I S Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - J H Yang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - I G Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - D H Seo
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - S P Kim
- Department of Cardiovascular Surgery, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Republic of Korea
| |
Collapse
|
27
|
Wu CY, Cheng CH, Fu JY, Chu Y, Wu CF, Chiu CH, Ko PJ, Liu YH. Recommended irrigation volume for an intravenous port: Ex vivo simulation study. PLoS One 2018; 13:e0201785. [PMID: 30106976 PMCID: PMC6091923 DOI: 10.1371/journal.pone.0201785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An intravenous port, which differs from a central venous catheter, has an injection chamber at the end of the catheter. This structural difference causes the irrigation flow pattern to be quite different from that of the central venous catheter. Furthermore, the intraluminal volume differs due to the size of the injection chamber and implanted catheter length. Hence, the ideal recommended irrigation volume varies because of differences in intraluminal volume, however, the recommended irrigation volume is 10 ml and may be a cause for reported port malfunctions. This study investigates the best irrigation volume for an intravenous port by simulating the clinical scenario ex-vivo to access its usefulness. MATERIALS AND METHODS This study was composed of two tests. The irrigation volume test attempted to quantify the irrigation volume of an implanted port while the irrigation rate test attempted to simulate daily nursing practice in order to clarify the effect of irrigation flow. The human blood needed for the simulation was donated by volunteers and the total volume was 10 ml per test. The irrigation volume test was done by syringe pump with varying pre-set irrigation volume after the port and connected catheter were filled with volunteer blood. After irrigation with pre-set volume, the retained intraluminal solution was collected and quantified by Bradford assay in order to titrate the best irrigation volume. The irrigation rate test tried to simulate daily maintenance practice in different settings with the quantified irrigation volume as identified by the irrigation volume test. The retained intraluminal solution was collected and quantified by Bradford assay in order to confirm the efficacy of the quantified irrigation volume. RESULTS In both SVC and IVC ports, we identified the twenty times the intravascular volume as sufficient for a complete wash out of the blood component in the irrigation volume test. The minimal irrigation volume for SVC and IVC port were 10 ml and 15.6 ml respectively. In irrigation rate test, the irrigation for SVC and IVC port was 10 and 20 ml, respectively, for the sake of preparation convenience. We not only identified the importance of preparation, i.e. irrigation of the extension line but also confirmed the efficacy of the recommended irrigation volume. CONCLUSION The irrigation volume should be varied according to the intraluminal volume. Maintenance should be performed after the extension line has been irrigated. The recommended port irrigation volume for SVC and IVC route were 10 and 20 ml, respectively.
Collapse
Affiliation(s)
- Ching-Yang Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Hui Cheng
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jui-Ying Fu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chest Division, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yen Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Laboratory of Cardiovascular Physiology, Department of Medical Research and Development, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Feng Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Hung Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Jen Ko
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yun-Hen Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| |
Collapse
|
28
|
Reeson M, Forster A, van Walraven C. Incidence and trends of central line associated pneumothorax using radiograph report text search versus administrative database codes. BMJ Qual Saf 2018; 27:982-988. [PMID: 29802131 DOI: 10.1136/bmjqs-2017-007715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Central line associated pneumothorax (CLAP) could be a good quality of care indicator because they are objectively measured, clearly undesirable and possibly avoidable. We measured the incidence and trends of CLAP using radiograph report text search with manual review and compared them with measures using routinely collected health administrative data. METHODS For each hospitalisation to a tertiary care teaching hospital between 2002 and 2015, we searched all chest radiography reports for a central line with a sensitive computer algorithm. Screen positive reports were manually reviewed to confirm central lines. The index and subsequent chest radiography reports were screened for pneumothorax followed by manual confirmation. Diagnostic and procedural codes were used to identify CLAP in administrative data. RESULTS In 685 044 hospitalisations, 10 819 underwent central line insertion (1.6%) with CLAP occurring 181 times (1.7%). CLAP risk did not change over time. Codes for CLAP were inaccurate (sensitivity 13.8%, positive predictive value 6.6%). However, overall code-based CLAP risk (1.8%) was almost identical to actual values possibly because patient strata with inflated CLAP risk were balanced by more common strata having underestimated CLAP risk. Code-based methods inflated central line incidence 2.2 times and erroneously concluded that CLAP risk decreased significantly over time. CONCLUSIONS Using valid methods, CLAP incidence was similar to those in the literature but has not changed over time. Although administrative database codes for CLAP were very inaccurate, they generated CLAP risks very similar to actual values because of offsetting errors. In contrast to those from radiograph report text search with manual review, CLAP trends decreased significantly using administrative data. Hospital CLAP risk should not be measured using administrative data.
Collapse
Affiliation(s)
- Marc Reeson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
29
|
Kosaka M, Oyama Y, Uchino T, Ogihara Y, Koga H, Shingu C, Matsumoto S, Kitano T. Ultrasound-guided central venous tip confirmation via right external jugular vein using a right supraclavicular fossa view. J Vasc Access 2018; 20:19-23. [DOI: 10.1177/1129729818771886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Ultrasound-guided central venous catheter tip confirmation has a potential to precisely locate the central venous catheter, preventing its misplacement, using real-time guidance. This observational study sought to determine the accuracy of central venous catheter tip positioning via the external jugular vein via a supraclavicular fossa view under ultrasound guidance. Methods: In total, 77 patients scheduled for central venous catheter insertion via the right external jugular vein were enrolled. The depth of central venous catheter insertion was determined by advancing the tip of the guidewire to the junction of the superior vena cava and right pulmonary artery, using a right supraclavicular fossa view ultrasound method. We determined the reference insertion depth to the carina using a postoperative chest x-ray photograph method. We then compared insertion depths obtained by the ultrasound and x-ray photograph methods and body-height formula. Results: In total, 62 patients were able to advance the guidewire and underwent ultrasound-guided central venous catheter insertion. In four patients, we corrected for misplaced guidewires. According to Bland–Altman plots, the insertion depth was 0.88 cm shorter for the ultrasound method (95% limits of agreement, −1.66 to 3.41 cm) and 0.90 cm shorter for the formulaic method (95% limits of agreement, −2.77 to 4.56 cm), compared with the x-ray photograph method. The x-ray photograph method had significantly positive correlations with the ultrasound (r = 0.73) and formulaic methods (r = 0.27). Conclusion: A right supraclavicular fossa view improves the accuracy of central venous catheter tip positioning and prevents central venous catheter misplacement via the right external jugular vein.
Collapse
Affiliation(s)
- Mariko Kosaka
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Yoshimasa Oyama
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Tetsuya Uchino
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Yojiro Ogihara
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hironori Koga
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Chihiro Shingu
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Shigekiyo Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Oita University, Yufu City, Japan
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Cavatorta F, Zollo A, Galli S, Dolla D. Real-Time Ultrasound and Endocavitary Electrocardiography for Venous Catheter Placement. J Vasc Access 2018; 2:40-4. [PMID: 17638258 DOI: 10.1177/112972980100200203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report on their experience with internal jugular vein catheterization with temporary and tunnelled cuffed hemodialysis catheters in 527 patients from 1991 to 2001, using ultrasound guidance and monitoring of catheter placement by endocavitary electrocardiography. The incidence of successful puncture and cannulation using ultrasound was 99.62%. The majority of patients had catheters inserted on the first pass (93%) and fewer attempts were required (range, 2 to 5). In the first year of the procedure in 1991, we observed two cases of accidental puncture of the carotid artery because of an error in ultrasound localization of the neck vessel. Arrhythmias were not observed during this procedure. Right atrial electrocardiography was successful on 504 occasions (96.83%), and correct catheter placement was confirmed by plain chest-X-ray in the first 100 patients. The results confirm that real-time ultrasound guidance for catheter insertion is superior to traditional techniques relying on anatomic landmarks and should be adopted as the standard of care. Ultrasound guidance and EC-ECG improves both the success and the safety of internal jugular catheter insertion. The authors propose that EC-ECG be validated as a technique in compliance with recent Food and Drug Administration guidelines regarding the location of central venous catheter tips.
Collapse
Affiliation(s)
- F Cavatorta
- Department of Nephrology and Dialysis, General Hospital, Imperia - Italy
| | | | | | | |
Collapse
|
32
|
Kwon HJ, Jeong YI, Jun IG, Moon YJ, Lee YM. Evaluation of a central venous catheter tip placement for superior vena cava-subclavian central venous catheterization using a premeasured length: A retrospective study. Medicine (Baltimore) 2018; 97:e9600. [PMID: 29480861 PMCID: PMC5943868 DOI: 10.1097/md.0000000000009600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system. To evaluate the placement of the tip of the CVC in subclavian central venous catheterizations using the C-length, we reviewed the medical records and chest radiographs of 122 adult patients in whom CVC catheterization was performed (from January 2012 to December 2014) via the right subclavian vein using the C-length. The tips of all subclavian CVCs were placed in the SVC using the C-length. No subclavian CVC entered the right atrium. Tip placement was not affected by demographic characteristics such as age, sex, height, weight, and body mass index. The evidence indicates that the C-length on chest radiographs can be used to determine the available insertion length and place the right subclavian CVC tip into the SVC.
Collapse
|
33
|
|
34
|
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
|
35
|
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
|
36
|
Utility of blind percutaneous jugular venous cannulation in resource-limited settings. J Vasc Access 2017; 18:26-29. [PMID: 27886366 DOI: 10.5301/jva.5000627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND For the nephrologist practicing in resource-limited settings, vascular ultrasound is often unavailable; consequently, blind percutaneous puncture of large veins is often employed to establish vascular access for hemodialysis. METHODS To examine the efficacy and safety of this approach we evaluated 53 consecutive patients in whom central vascular access was required. The vascular access route utilized was primarily the right internal jugular vein. In the majority of cases, the indication for central vascular access was hemodialysis. RESULTS The average number of needle passes required to obtain vascular access was 1.6 for the patient population studied. A total of 90.6% of the patients required ≤2 needle passes during cannulation. Complication rate for the blind approach was low (7.6%) and no serious or life-threatening complications occurred. CONCLUSIONS Our findings suggest that blind percutaneous puncture of the internal jugular vein by trained hands is a relatively safe and effective approach for establishing vascular access for hemodialysis in resource-limited settings. Nevertheless, wherever vascular ultrasound is available, it should be primarily utilized because of the documented advantages of image-guided insertion. Keeping in view the risk of serious peri-procedural complications which include death, the emphasis on image-guided insertion, is appropriate, particularly, in non-emergent situations.
Collapse
|
37
|
Miccini M, Cassini D, Gregori M, Gazzanelli S, Cassibba S, Biacchi D. Ultrasound-Guided Placement of Central Venous Port Systems via the Right Internal Jugular Vein: Are Chest X-Ray and/or Fluoroscopy Needed to Confirm the Correct Placement of the Device? World J Surg 2016; 40:2353-8. [PMID: 27216807 DOI: 10.1007/s00268-016-3574-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Percutaneous central venous port (CVP) placement using ultrasound-guidance (USG) via right internal jugular vein is described as a safe and effective procedure. The aim of this study is to determine whether intraoperative fluoroscopy (IF) and/or postoperative chest X-ray (CXR) are required to confirm the correct position of the catheter. METHODS Between January 2012 and December 2014, 302 adult patients underwent elective CVP system placement under USG. The standard venous access site was the right internal jugular vein. The length of catheter was calculated based on the height of the patient. IF was always performed to confirm US findings. RESULTS 176 patients were men and 126 were women and average height was 176.2 cm (range 154-193 cm). The average length of the catheter was 16.4 cm (range 14-18). Catheter malposition and pneumothorax were observed in 4 (1.3 %) and 3 (1 %) patients, respectively. IF confirmed the correct position of the catheter in all cases. Catheter misplacement (4 cases) was previously identified and corrected on USG. Our rates of pneumothorax are in accordance with those of the literature (0.5-3 %). CONCLUSION Ultrasonography has resulted in improved safety and effectiveness of port system implantation. The routine use of CXR and IF should be considered unnecessary.
Collapse
Affiliation(s)
| | - Diletta Cassini
- Department of Surgery, "Abano Terme" Hospital, Abano Terme, Padua, Italy
| | - Matteo Gregori
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
| | - Sergio Gazzanelli
- Department of Anaesthesiology, Sapienza University Medical School, Rome, Italy
| | - Simone Cassibba
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
| | - Daniele Biacchi
- First Department of Surgery, Sapienza University Medical School, Rome, Italy
| |
Collapse
|
38
|
Anandaswamy TC, Marulasiddappa V. A comparative study of landmark-based topographic method versus the formula method for estimating depth of insertion of right subclavian central venous catheters. Indian J Anaesth 2016; 60:496-8. [PMID: 27512166 PMCID: PMC4966354 DOI: 10.4103/0019-5049.186021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Subclavian central venous catheterisation (CVC) is employed in critically ill patients requiring long-term central venous access. There is no gold standard for estimating their depth of insertion. In this study, we compared the landmark topographic method with the formula technique for estimating depth of insertion of right subclavian CVCs. Methods: Two hundred and sixty patients admitted to Intensive Care Unit requiring subclavian CVC were randomly assigned to either topographic method or formula method (130 in each group). Catheter tip position in relation to the carina was measured on a post-procedure chest X-ray. The primary endpoint was the need for catheter repositioning. Mann–Whitney test and Chi-square test was performed for statistical analysis using SPSS for windows version 18.0 (Armonk, NY: IBM Corp). Results: Nearly, half the catheters positioned by both the methods were situated >1 cm below the carina and required repositioning. Conclusion: Both the techniques were not effective in estimating the approximate depth of insertion of right subclavian CVCs.
Collapse
Affiliation(s)
- Tejesh C Anandaswamy
- Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Vinay Marulasiddappa
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| |
Collapse
|
39
|
Vinay M, Tejesh CA. Depth of insertion of right internal jugular central venous catheter: Comparison of topographic and formula methods. Saudi J Anaesth 2016; 10:255-8. [PMID: 27375377 PMCID: PMC4916806 DOI: 10.4103/1658-354x.174904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Central venous catheters (CVCs) are inserted in many critically ill patients, but there is no gold standard in estimating their approximate depth of insertion. Many techniques have been described in literature. In this study, we compare the topographic method with the standard formula technique. MATERIALS AND METHODS 260 patients, in whom central venous catheterization was warranted, were randomly assigned to either topographic method or formula method (130 in each group). The position of the CVC tip in relation to carina was measured on a postprocedure chest X-ray. The primary endpoint was the need for catheter repositioning. RESULTS The majority of the CVCs tips positioned by the formula method were situated below the carina, and 68% of these catheters required repositioning after obtaining postprocedure chest X-ray (P < 0.001). CONCLUSION The topographic method is superior to formula approach in estimating the depth of insertion of right internal jugular CVCs.
Collapse
Affiliation(s)
- M Vinay
- Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - C A Tejesh
- Department of Anesthesiology, MS Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| |
Collapse
|
40
|
|
41
|
Correct positioning of central venous catheters with ECG guidance in paediatric patients. Eur J Anaesthesiol 2016; 33:550-2. [PMID: 26760405 DOI: 10.1097/eja.0000000000000404] [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]
|
42
|
Formulas for prediction of insertion depths of internal jugular vein catheters adjusted to body height categories. J Vasc Access 2015; 17:191-4. [PMID: 26660038 DOI: 10.5301/jva.5000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Whether formulas for prediction of central venous catheter (CVC) insertion depths have different applicability in patients with different body heights is not known. Goal of study was to test formulas for catheterizations of internal jugular veins (IJVs) in a population of different body height classes with correct CVC tip positions. METHODS Consecutive adult patients requiring CVC for cardiac surgery were enrolled and those with tip positions at the junction of the superior vena cava and the right atrium ±1 cm underwent formula analysis. Precision of formula prediction was calculated for three classes of body height. RESULTS Of the 635 included patients, 254 underwent right IJV catheterization and 381 underwent left IJV catheterization, respectively. Formula-guided approach for both right [formulas (height/10) (in cm) and (height/10) -1 (in cm)] and left [formula (height/10) + 4 (in cm)] IJV CVC was more precise in patients with a body height of 170-180 cm compared with patients with a body height <170 cm (who required deeper insertion than predicted by formula) and patients with a body height >180 cm (who required a more proximal insertion than predicted by formula). CONCLUSIONS Independent from body height classes, all formulas calculated a relatively low likelihood of atrial positions but high risks of proximal mal-positioning. Thus, considering inter-individual differences of vascular anatomy and for safety reasons, formulas cannot be recommended.
Collapse
|
43
|
Wu CY, Fu JY, Wu CF, Ko PJ, Liu YH, Kao TC, Yu SY. Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route? Medicine (Baltimore) 2015; 94:e2199. [PMID: 26656351 PMCID: PMC5008496 DOI: 10.1097/md.0000000000002199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.
Collapse
Affiliation(s)
- Ching-Yang Wu
- From the Chang Gung University; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (C-YW, C-FW, P-JK, Y-HL, T-CK, S-YY); and Chang Gung University; Division of Pulmonary and Critical care, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan (J-YF)
| | | | | | | | | | | | | |
Collapse
|
44
|
Struck MF, Schmidt T, Winkler BE, Reinhart K, Schummer W. Central venous catheters and insertion depths: are formulas still up to date? Intensive Care Med 2015; 41:2002-3. [PMID: 26156109 DOI: 10.1007/s00134-015-3959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Manuel F Struck
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Thomas Schmidt
- Department of Medical Psychology, Bergmannstrost Hospital Halle, Halle, Germany
| | - Bernd E Winkler
- Department of Anaesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany
| | - Konrad Reinhart
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Wolfram Schummer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| |
Collapse
|
45
|
[Technical criteria of central venous catheters: Anaesthesiologist/intensivist and pharmacist opinions]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 73:471-81. [PMID: 25980636 DOI: 10.1016/j.pharma.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The lack of technical information from suppliers and from the literature, a wide variety of features and the absence of medical device reference document explain the difficulty for medical and pharmaceutical staffs to choose a central venous catheter (CVC). The aim of this study was to establish the specifications to choose a CVC according to the clinician needs. METHODS An analysis of suppliers' technical documentation and a literature review was performed to identify criteria and to collect them in a questionnaire to conduct semi-structured interviews between 1 pharmacist and 5 anaesthesiologists/intensivists. With these interviews, the technical criteria were classified according to their importance in 3 levels. RESULTS Thirteen technical criteria were identified after reading the technical documents and the literature. Among them, 8 were classified as "essential criteria" (level I) by the physicians: J-shaped guide, one clamp on each way, identified lumen, radiopacity, graduation every centimeter by 5 to 20 cm from the distal extremity, a length of 15 to 25 cm, a single-lumen catheter with a 14 to 16G way and a three-lumen catheter with 14 to 18G way. Finally, three criteria were classified as "intermediate criteria" (level II) and two as "optional criteria" (level III). CONCLUSIONS This collaborative approach allowed to reference new medical devices according to the clinicians needs. These CVC are a mean to respect guidelines for physicians and nurses and to secure the patient's care.
Collapse
|
46
|
Sharma D, Singh VP, Malhotra MK, Gupta K. Optimum depth of central venous catheter - Comparision by pere's, landmark and endocavitory (atrial) ECG technique: A prospective study. Anesth Essays Res 2015; 7:216-20. [PMID: 25885836 PMCID: PMC4173511 DOI: 10.4103/0259-1162.118966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Blind insertion of central venous catheter has many implications. Better options should be sought to perform this procedure. Aim: To evaluate various options for positioning central venous catheter tip. Settings and Design: This is institutional based randomized prospective controlled study. Materials and Methods: In this prospective study depth and position of central venous catheter were evaluated in 150 patients in intensive care unit. Three different methods: Pere's, landmark, and endocavitory (atrial) ECG control were used. Statistical Analysis: Twoway ANOVA test was applied on SPSS version 16 to test the significant difference between the three groups. Results: Patient characteristic and demographic data were similar in the three groups. The average depth of central venous catheter by Pere's, landmark, and endocavitory (ECG) technique were 14.20 ± 0.69 cm, 12.08 ± 0.98 cm, and 8.18 ± 0.74 cm, respectively. Conclusion: The correct position of central venous catheter by endocavitory (atrial) ECG appears not only to reduce the procedure related complications but also post procedure manipulation of catheter tip detected by post procedure chest X-ray.
Collapse
Affiliation(s)
- Deepak Sharma
- Department of Anesthesiology and critical care, Subharti University, Meerut, Uttar Pradesh, India
| | - V P Singh
- Department of Anesthesiology and critical care, Subharti University, Meerut, Uttar Pradesh, India
| | - M K Malhotra
- Department of Anesthesiology and critical care, Subharti University, Meerut, Uttar Pradesh, India
| | - Kumkum Gupta
- Department of Anesthesiology and critical care, Subharti University, Meerut, Uttar Pradesh, India
| |
Collapse
|
47
|
Shin HJ, Kim BG, Na HS, Oh AY, Park HP, Jeon YT. Estimation of catheter insertion depth during ultrasound-guided subclavian venous catheterization. J Anesth 2015; 29:724-7. [PMID: 25877309 DOI: 10.1007/s00540-015-2012-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several methods have been used to predict the optimal depth of central venous catheter (CVC) tip position when using the anatomical landmark technique. In the present study, we devised a simple formula to predict CVC depth using ultrasound images and chest X-ray (CXR) in patients undergoing ultrasound-guided subclavian venous catheterization. METHODS Central venous catheterization via the subclavian vein was performed under ultrasound guidance. We measured five parameters to determine the distance between the needle insertion point and the CVC tip: insertion point to vein puncture point (A), insertion point to a skin point indicating a vertical position above the vein puncture point (B), insertion point to the clavicular notch (C), clavicular notch to the carina (D), and catheter tip to carina (E). Catheter insertion depth was then determined as follows: calculated catheter insertion depth = A - B + C + D; actual catheter insertion depth = (A - B + C + D) + E. RESULTS The calculated CVC insertion depth (mean ± SD) was 15.4 ± 1.5 cm from the needle insertion point to the carina [95 % confidence interval (CI) 15.0-15.9 cm]. Actual depth was 15.4 ± 1.5 cm (95 % CI 15.0-15.9 cm). No significant difference was observed between the calculated CVC insertion depth and the actual distance from the needle insertion point to the carina (p = 0.940). CONCLUSIONS The appropriate length of a CVC inserted through the subclavian vein can be estimated by a formula using ultrasound images and CXR.
Collapse
Affiliation(s)
- Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea
| | - Byung Gun Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea.
| |
Collapse
|
48
|
Byeon GJ, Kim EJ, Yoon JY, Yoon SH, Woo MN, Kim CH. Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition. J Dent Anesth Pain Med 2015; 15:31-34. [PMID: 28879256 PMCID: PMC5564067 DOI: 10.17245/jdapm.2015.15.1.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/20/2022] Open
Abstract
Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.
Collapse
Affiliation(s)
- Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Korea
| | - Ji-Young Yoon
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Korea
| | - Seok-Hyun Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Korea
| | - Mi-Na Woo
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Korea
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Korea
| |
Collapse
|
49
|
Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe. Eur J Anaesthesiol 2015; 32:29-36. [DOI: 10.1097/eja.0000000000000042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Choi YJ, Hahm KD, Kwon K, Lee EH, Ro YJ, Yang HS. [Bedside prediction of right subclavian venous catheter insertion length]. Rev Bras Anestesiol 2014; 64:419-24. [PMID: 25437699 DOI: 10.1016/j.bjan.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). METHOD In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. RESULTS L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45±0.68cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient=0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm)=-0.037+0.036×Height (cm)+0.903×I-T-IC (cm) (adjusted r(2)=0.64). CONCLUSION The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.
Collapse
Affiliation(s)
- Yoon Ji Choi
- Departamento de Anestesiologia e Medicina da Dor, Seoul Paik Hospital, College of Medicine, Inje University, Seul, República da Coreia
| | - Kyung-Don Hahm
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia.
| | - Koo Kwon
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Eun-Ho Lee
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Young Jin Ro
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Hong Seuk Yang
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| |
Collapse
|