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Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: A retrospective cohort study. J Vasc Access 2024:11297298241263886. [PMID: 39129328 DOI: 10.1177/11297298241263886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND A multitude of challenges arises from the growing utilisation of peripherally inserted central catheters (PICCs), including the ability to provide timely, effective and safe insertion, which must be ensured and prioritised in patient care. A nurse-led model of care has become more prevalent as PICCs become extensively needed due to their applications. However, despite their widespread use, such intervention is yet in its inception in Saudi Arabia, and thereby, evaluating the outcomes of this service is of utmost importance to support patient safety initiatives and quality of care. PURPOSE This research aims to assess the effectiveness of a nurse-led PICC placement service. METHODS A quantitative retrospective cohort design was used. The sample of this study was 333 random subsets of records on PICC insertion for adult patients between 1st April 2019 and 31st March 2023 in a tertiary medical facility in Riyadh, Saudi Arabia. RESULTS A nurse-led PICC service demonstrated an overall successful placement of 330 cases (99.1%), out of which 323 PICCs (97%) were successfully inserted under intra-cavitary electrocardiogram (IC-ECG) guidance, while 7 PICCs (2.1%) were successfully inserted with fluoroscopy. The overall complication rate was 2.35 occurrences per 1000 CL days, whereas the complication rate within the first 10 days after PICC insertion was 0.42 per 1000 CL days. CONCLUSION A nurse-led model for PICC insertion has remarkably high success rates and low rates of complication, highlighting the pivotal role of a specialised PICC team. This service boasted a commendable track record of achieving a high rate of success in its implementation, implying that a nurse-led PICC service operates effectively to improve the patient experience by delivering timely and high-quality healthcare service.
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Affiliation(s)
- Kawthar Alsaleh
- Medical Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Dalyal Alosaimi
- Medical Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Adnan Almousawi
- Intensive Care Unit, King Fahad Hufuf Hospital, AlAhsa Health Cluster, Ministry of Health, AlAhsa, Saudi Arabia
| | - Mohammed Alshaikh
- Interventional Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hisham Omar
- Interventional Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
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2
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Gaulee P, Sharma P, Cacho NT, Ruoss JL, Rajderkar D. Preterm Neonates with Umbilical Venous Catheter and Radiographic Abnormalities Overlying the Liver. Neoreviews 2024; 25:e173-e179. [PMID: 38425204 DOI: 10.1542/neo.25-3-e173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Pratima Gaulee
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL
| | - Priya Sharma
- Department of Radiology, Division of Pediatric Radiology, University of Florida, Gainesville, FL
| | - Nicole Theresa Cacho
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL
| | - J Lauren Ruoss
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL
| | - Dhanashree Rajderkar
- Department of Radiology, Division of Pediatric Radiology, University of Florida, Gainesville, FL
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Yang M, Lopez A. Total parenteral nutrition pleural effusion after peripherally inserted central venous catheter insertion despite fluoroscopic confirmation. SAGE Open Med Case Rep 2023; 11:2050313X221147421. [PMID: 36643710 PMCID: PMC9834923 DOI: 10.1177/2050313x221147421] [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: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Peripherally inserted central catheters are frequently used for durable central venous access for nutrition. Depending on the medical and surgical history, there are times when a person's vasculature has become scarred or stenotic due to multiple previous vascular devices, catheters, or pacemaker/defibrillator leads, that causes placement of a peripherally inserted central catheter challenging. Choosing the correct catheter and approach must be weighed against invasiveness of the procedure as unforeseen complications can arise. When pleural effusions quickly accumulate after placement of a peripherally inserted central catheter despite using confirmatory image guidance, delayed complications must be thought of, and offending medications and catheter should be removed in a timely fashion to avoid further morbidity and mortality.
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Affiliation(s)
- Michael Yang
- Procedure Center, Internal Medicine,
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Michael Yang, Procedure Center, Internal
Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
90048, USA.
| | - Angelena Lopez
- Procedure Center, Pulmonary Critical
Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA,
USA
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John S, Bürkle M, Well H, Lackermeier P. Quiz intensiv – stellen Sie die Diagnose! Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:642-645. [DOI: 10.1055/a-1875-7397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. J Intensive Care Med 2022; 37:1215-1222. [PMID: 35723623 DOI: 10.1177/08850666221076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention. This study aims to evaluate local practices of mechanical complication frequency, type, and subsequent intervention(s) related to mechanical AE with an emphasis on catheter malpositioning. Methods: This is a retrospective review of CVC placements in a tertiary hospital setting from 1/2013 to 12/2013. Pneumothorax and CVC positioning were evaluated on post-insertion chest x-ray (CXR). Malposition was defined as unintended placement of the catheter in a vessel other than the intended superior vena cava on CXR. Catheter reposition was defined as radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included pneumothorax and thoracostomy rate, CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Result: Among 2045 eligible CVC insertions, pneumothoraces occurred in 14 (0.7%; 95%CI 0.38, 1.17) and malpositions were identified in 275 (13.4%; 95% CI 12.3, 15.3). The proportion of pneumothoraces that required tube thoracostomy was 57%. The proportion of CVCs with malposition that were removed or replaced within 24h was 32.7%. "Malpositioned" catheters that were left in place by the clinical team (n = 185) had an average catheter duration of 8.2 days (95% CI 7.2, 9.3) versus 7.2 days (95% CI 6.17, 8.23) for catheters that were replaced after initial malposition (p = 0.14, t test). The incidence of venous thrombosis in repositioned "malpositioned" catheters was 7.8% versus 4.9% for "malpositioned" catheters that were left in place. Conclusions: Clinically significant catheter malposition and pneumothorax after CVC insertion are low. In this study, replaced and non-replaced "malpositioned" catheters had similar catheter duration and rates of complications, challenging the current dogma of CVC malposition practice.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Huang
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian Holley
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Willman
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Griffey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel L Theodoro
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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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.
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7
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Alhatem A, Estrella Y, Jones A, Algarrahi K, Fofah O, Heller DS. Percutaneous Route of Life: Chylothorax or Total Parenteral Nutrition-Related Bilateral Pleural Effusion in a Neonate? Fetal Pediatr Pathol 2021; 40:505-510. [PMID: 32000556 DOI: 10.1080/15513815.2020.1716897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peripherally Inserted Central Catheter (PICC) lines are an essential tool in the management of premature neonates. Pleural effusion (PLE) secondary to the leakage of alimentation into the pleural cavity is an encountered complication of central-line total parenteral nutrition (TPN) administration. Methods: We review a case of a premature neonate who suffered large, bilateral PLE after insertion of an upper extremity PICC line for TPN. Results: Pleural fluid biochemical analysis confirmed PICC line infiltration, predominantly with monocytes, low protein, high triglycerides and high glucose. These results favored TPN leakage over chylothorax. Conclusions: To our knowledge, this is the first case of bilateral PLE due to PICC complication in a neonate, which highlights the importance of chylothorax differential diagnosis, the role of autopsy, and the need for clinical precautions when providing premature neonates with high osmolarity TPN.
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Affiliation(s)
- Albert Alhatem
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ydamis Estrella
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anja Jones
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Khalid Algarrahi
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Onajovwe Fofah
- Pediatrics and Neonatology, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Debra S Heller
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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8
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Vertemati M, Rizzetto F, Cassin S, Zerbi P, Giordano A, Cariati M, Gallieni M. Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients. Clin Anat 2020; 33:1120-1129. [PMID: 31891199 DOI: 10.1002/ca.23549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Most hemodialysis patients start renal replacement therapy with a central venous catheter (CVC). The left internal jugular vein (LIJV) is the second-choice vein for CVC positioning, after the right IJV. However, to reach the right atrium, the CVC must pass through the left brachiocephalic vein (LBV), which also drains blood from the left arm through the subclavian vein. The purpose of this study is to describe how the anatomy of the central venous system and in particular that of the LBV affects vascular access in hemodialysis patients. MATERIALS AND METHODS Three-dimensional (3D) virtual model reconstructions of the central thoracic veins of three hemodialysis patients were obtained from contrast-enhanced computed tomography scans acquired in the venous phase. The images were exported as DICOM files and loaded on open-source software for visualizing and analyzing the medical imaging (3D Slicer, Windows version 4.8.1). RESULTS As expected, the 3D reconstructions showed that the LBV has a tortuous path with three main angulations that could be associated with external compression and stenosis. These could determine the difficulties and increased risks of venous injury during CVC placement, and an increased risk of medium to long-term catheter-associated vein thrombosis and stenosis. CONCLUSIONS The anatomical features of the LBV indicate that the path of a CVC from the LIJV to the right atrium is tortuous and can easily be complicated by vein injury, negatively affecting the creation of future arterio-venous vascular accesses in the left arm.
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Affiliation(s)
- Maurizio Vertemati
- Institute of Human Anatomy, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy.,CIMaINa (Interdisciplinary Centre for Nano structured Materials and Interfaces), Università degli Studi di Milano, Milan, Italy
| | - Francesco Rizzetto
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Simone Cassin
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Antonino Giordano
- Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maurizio Cariati
- Department of Radiology, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maurizio Gallieni
- School of Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy.,Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
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9
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Jarineshin H, Sharifi M, Kashani S. Comparing the conventional 15 cm and the C-length approaches for central venous catheter placement. J Cardiovasc Thorac Res 2018; 10:221-226. [PMID: 30680081 PMCID: PMC6335980 DOI: 10.15171/jcvtr.2018.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/16/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: The present guidelines recommend placing the catheter tip in the superior vena cava (SVC) above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the Central venous catheter (CVC) at the suggested vascular zone. Methods: This was an interventional study on two hundred patients undergoing Coronary artery bypass surgery (CABG) operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a C-length method was applied for measuring the depth of catheter tip placement from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used. Results: In the first group (15 cm) 100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was +4.22±2.10 cm. In the second (C-Length) group 52% of the catheters were below C-line with an average distance of +0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone of placement (P<0.001). Conclusion: The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.
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Affiliation(s)
- Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Maryam Sharifi
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Saeid Kashani
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
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Ahn JH, Kim IS, Yang JH, Lee IG, Seo DH, Kim SP. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres' formula or a radiological landmark-based approach: a prospective randomized single-centre study. Br J Anaesth 2018; 118:215-222. [PMID: 28100525 DOI: 10.1093/bja/aew430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography. METHODS Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (n=93) or the R group (n=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA-SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view. RESULTS The distance from the skin insertion point to the RA-SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; r=0.821, P<0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; r=0.517, P<0.001], with z=3.96 (P<0.001). More tips were correctly positioned in the R group than in the P group (74 vs 93%, P=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable. CONCLUSIONS Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp KCT0001937.
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Affiliation(s)
- J H Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Woncheon-Dong, Yeongtong-Gu, Suwon, Gyeonggi-Do 443-721, Republic of Korea
| | - I S Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - J H Yang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - I G Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - D H Seo
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - S P Kim
- Department of Cardiovascular Surgery, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Republic of Korea
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11
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Kang SS, Shin YS, Lee SY, Kim H. Simplified equation for determining proper depth of peripherally inserted central catheter in relation to anatomical landmarks. Korean J Anesthesiol 2018; 71:300-304. [PMID: 29684986 PMCID: PMC6078871 DOI: 10.4097/kja.d.18.27185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to develop a formula guiding the peripherally inserted central catheter (PICC) tip placement based on anatomical landmarks such as the upper arm, clavicle, and sternum as well as the patient’s height, weight, and body mass index. Methods Fifty-five patients who were scheduled to have PICCs were included in the study. We measured four distances along the passage of the PICC, which were as follows; the tip of the third finger to the middle of the elbow crease (Distance A), the middle of the elbow crease to the acromion process (Distance B), the acromion process to the sternal head of the clavicle (Distance C), and the sternal head of the clavicle to the end of the xiphoid process (Distance D). The lengths from the elbow creases to their carina bifurcations as determined by fluoroscopy during PICC insertions were recorded and used as reference. Results The formula for determining PICC depth based on the four distances was determined by regression analysis. The optimal formula was determined to be 25.3 + 0.5 × (Distance C) + 0.6 × (Distance D) which yielded an R2 value of 0.3. Conclusions The formula proposed for proper depth of the adult, 25.0 + 0.5 × (clavicle length) + 0.6 × (sternum length) for PICC insertion can be used to place the tip at the carina bifurcation level. The distance from elbow crease to catheter insertion point should be added to the length generated by this formula.
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Affiliation(s)
- Sang-Soo Kang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yang-Sik Shin
- Department of Anesthesiology and Pain Medicine, Cha Bundang Hospital, Cha University College of Medicine, Seongnam, Korea
| | - Seon-Yi Lee
- Department of Anesthesiology and Pain Medicine, Cha Bundang Hospital, Cha University College of Medicine, Seongnam, Korea
| | - Hyunzu Kim
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
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12
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De Carvalho BR, Eagar GM. Immediate post-insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration. J Med Imaging Radiat Oncol 2017; 62:324-329. [DOI: 10.1111/1754-9485.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Gerard M Eagar
- Department of Radiology; Tauranga Hospital; Tauranga New Zealand
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Abstract
Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates. The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself. In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case. This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients.
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14
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Ki S, Kim MH, Lee W, Cho H. Tension hydrothorax induced by malposition of central venous catheter -A case report-. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Seunghee Ki
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myoung-hun Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wonjin Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hakmoo Cho
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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15
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Kurabe M, Watanabe T, Kohno T. Perforation of the superior vena cava 5 days after insertion of a central venous catheter through the left internal jugular vein. J Clin Anesth 2016; 31:193-6. [PMID: 27185708 DOI: 10.1016/j.jclinane.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/30/2015] [Accepted: 02/04/2016] [Indexed: 11/16/2022]
Abstract
We describe a very rare case of an indwelling central venous catheter (CVC) through the left internal jugular vein that perforated the superior vena cava (SVC) wall postoperatively, although the CVC was placed in the appropriate position preoperatively. Three days after CVC insertion, a chest radiograph showed that the CVC tip had moved from the lower SVC to the upper SVC. Five days after the insertion, computed tomography showed SVC perforation and the resulting hydrothorax. In cases of CVC insertion through the left side, the CVC tip should not be placed in the upper SVC (zone B). Considering individual clinical factors and the indwelling period for the CVC, the left innominate vein (zone C) may be a suitable site for the left-sided CVC tip to reduce the risk of SVC perforation.
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Affiliation(s)
- Miyuki Kurabe
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Tatsunori Watanabe
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuro Kohno
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Pereira S, Preto C, Pinho C, Vasconcelos P. When one port does not return blood: two case reports of rare causes for misplaced central venous catheters. Braz J Anesthesiol 2016; 66:78-81. [PMID: 26768935 DOI: 10.1016/j.bjane.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022] Open
Abstract
We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.
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Affiliation(s)
- Sandra Pereira
- Department of Anesthesiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.
| | - César Preto
- Department of Anesthesiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Carla Pinho
- Department of Anesthesiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Vasconcelos
- Department of Anesthesiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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17
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Quando uma porta não apresenta retorno sanguíneo: relato de dois casos de causas raras de mau posicionamento de cateter venoso central. Braz J Anesthesiol 2016. [DOI: 10.1016/j.bjan.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Bilateral pleural effusion as a complication of central venous catheterization. J Vasc Access 2015; 16:e80-1. [PMID: 25656254 DOI: 10.5301/jva.5000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2015] [Indexed: 11/20/2022] Open
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19
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Álvarez-Baena L, Duque P, Ramos R, Zarain Obrador L, Fernández-Quero L. [Unilateral pleural effusion caused by vessel perforation due to peripherally inserted central catheter: Indocyanine green as a diagnostic tool]. ACTA ACUST UNITED AC 2015; 63:54-7. [PMID: 26025285 DOI: 10.1016/j.redar.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
A peripherally inserted central catheter (PICC) was inserted into a 44-year-old man to provide parenteral nutrition in a protein-calorie malnutrition secondary to a benign pyloric stenosis. On the fifth day while monitoring the catheter, the patient presented with a massive whitish pleural effusion after undergoing gastric endoscopy in order to treat pyloric stenosis. Chylothorax was initially suspected, and the patient was admitted to a recovery unit. Indocyanine green was administered through the PICC, obtaining a greenish discoloration in the pleural effusion 30 min later. This led to the diagnosis of a pleural effusion caused by a vessel perforation due to the PICC, leading to parenteral nutrition extravasation. Thoraco-abdominal computed tomography was performed, which confirmed an innominate vein perforation due to the PICC. PICC insertion may be associated with severe complications, such as central vessel perforation, and therefore the correct position of a central catheter should be always checked. Intravenous computed tomography contrast is the gold standard for central vascular perforation diagnosis. However if a pleural effusion occurs in this context, it is possible to use a dye, which administered intravenously can lead us to the correct diagnosis in situ. Indocyanine green was used for this purpose in this case.
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Affiliation(s)
- L Álvarez-Baena
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - P Duque
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Ramos
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Zarain Obrador
- Departamento de Cirugía General y Aparato Digestivo II, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Fernández-Quero
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
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20
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Jain M, Rastogi B, Singh VP, Gupta K. Central venous catheter placement: An alternative of Certodyn(®) (Universal Adapter). Anesth Essays Res 2015; 5:242-3. [PMID: 25885401 PMCID: PMC4173389 DOI: 10.4103/0259-1162.94798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Manish Jain
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, NH-58, Meerut, India
| | - Bhavana Rastogi
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, NH-58, Meerut, India
| | - V P Singh
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, NH-58, Meerut, India
| | - Kumkum Gupta
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, NH-58, Meerut, India
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21
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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.
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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
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22
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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.
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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
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23
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Şahutoğlu C, Pestilci Z, Kocabaş S, Aşkar FZ, Sunal SÖ, Çevik AG. A Venous Catheter Complication: Venous Perforation and Lung Injury. Turk J Anaesthesiol Reanim 2014; 42:270-2. [PMID: 27366434 DOI: 10.5152/tjar.2014.64325] [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: 09/09/2013] [Accepted: 10/30/2013] [Indexed: 11/22/2022] Open
Abstract
Central venous catheters are frequently used for different causes, like fluid infusions, haemodialysis, and measurement of central venous pressure. Complications that occur at the time or after the placement of these catheters can give harm to the patient or can cause need for a new attempt. Complications, like malfunction of the catheter, arterial puncture, haemothorax, or pneumothorax, can be seen in 5%-26% of the patients, and early detection is very important. We want to present a venous perforation and lung injury case according to the catheter based upon the literature.
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Affiliation(s)
- Cengiz Şahutoğlu
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Zeynep Pestilci
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Seden Kocabaş
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Fatma Zekiye Aşkar
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Seda Özen Sunal
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Gül Çevik
- Department of Chest Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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24
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Kronlage M, Sprengel SD, Weber MA, Rehnitz C. [Decisive radiological findings in multiple trauma and shock unresponsive to volume therapy]. Radiologe 2014; 54:1103-5. [PMID: 25204960 DOI: 10.1007/s00117-014-2746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Kronlage
- Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland,
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25
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A Rare Case of Port-a-Cath Migration into the Mediastinum. W INDIAN MED J 2014; 63:676-7. [PMID: 25803390 DOI: 10.7727/wimj.2013.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 07/24/2013] [Indexed: 11/18/2022]
Abstract
Port-a-cath is commonly used in patients who require frequent administration of intravenous medications. We describe a rare case of port-a-cath migration into the mediastinum 16 months after its insertion.
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26
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FRYKHOLM P, PIKWER A, HAMMARSKJÖLD F, LARSSON AT, LINDGREN S, LINDWALL R, TAXBRO K, ÖBERG F, ACOSTA S, ÅKESON J. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2014; 58:508-24. [PMID: 24593804 DOI: 10.1111/aas.12295] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
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Affiliation(s)
- P. FRYKHOLM
- Department of Surgical Sciences; Anaesthesiology and Intensive Care Medicine; University Hospital; Uppsala University; Uppsala Sweden
| | - A. PIKWER
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - F. HAMMARSKJÖLD
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
- Division of Infectious Diseases; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - A. T. LARSSON
- Department of Anaesthesiology and Intensive Care Medicine; Gävle-Sandviken County Hospital; Gävle Sweden
| | - S. LINDGREN
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. LINDWALL
- Department of Clinical Sciences; Division of Anaesthesiology and Intensive Care Medicine; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - K. TAXBRO
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
| | - F. ÖBERG
- Department of Anaesthesiology and Intensive Care Medicine; Karolinska University Hospital Solna; Stockholm Sweden
| | - S. ACOSTA
- Department of Clinical Sciences Malmö; Vascular Centre; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. ÅKESON
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
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27
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Dialysis Central Venous Catheter Types and Performance. J Vasc Access 2014; 15 Suppl 7:S140-6. [DOI: 10.5301/jva.5000262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
Abstract
The choice of both short-term (nontunneled) and long-term (tunneled) central venous catheters (CVCs) for hemodialysis is a difficult one, due to the large number of available catheters, with very different characteristics and cost. CVC-related complications (in particular infections, thrombosis and inefficient dialysis) can determine ominous consequences and death, with extremely elevated costs due to prolonged hospitalization and expensive procedures. Thus, the correct balance between cost and quality of CVC is required when deciding which kind of CVC should be adopted. In this regard, the design of CVCs has become a very active area of industrial and clinical research, with the ultimate goal of improving the long-term function of the catheter and of reducing complication rates, because even small improvements in the complication or reintervention rates have a positive impact on individual patient care and cost to society. In this article we review the general features of CVCs, including differences between tunneled and nontunneled CVCs, materials and their compatibility with lock solutions, the implications of straight versus precurved design in nontunneled CVCs, lumen and tip features with their clinical implications, catheter coatings and their effect on infection and thrombosis.
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28
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Balasubramanian S, Gupta S, Nicholls M, Laboi P. Rare complication of a dialysis catheter insertion. Clin Kidney J 2014; 7:194-6. [PMID: 25852871 PMCID: PMC4377782 DOI: 10.1093/ckj/sfu006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 11/12/2022] Open
Abstract
Insertion of a dialysis catheter is a very common procedure in renal medicine, which is associated with one or more complications in ∼15% of patients. Central venous catheter vascular erosion is a rare but serious complication, the incidence appears to be between 0.4 and 1% which can be difficult to diagnose, leading to increased morbidity and mortality. We report a case of a persistent left-sided superior vena cava (PLSVC) and a possible central venous catheter vascular erosion following insertion of a left-sided internal jugular dialysis catheter. We discuss the mechanisms, diagnosis and measures to limit vascular erosion and also briefly discuss PLSVC.
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Affiliation(s)
| | - Sanjay Gupta
- Department of Cardiology , York Teaching Hospital NHS Foundation Trust , York , UK
| | - Marcus Nicholls
- Department of Radiology , York Teaching Hospital NHS Foundation Trust , York , UK
| | - Paul Laboi
- Department of Renal Medicine , York Teaching Hospital NHS Foundation Trust , York , UK
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29
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Emergent Median Sternotomy for Mediastinal Hematoma: A Rare Complication following Internal Jugular Vein Catheterization for Chemoport Insertion-A Case Report and Review of Relevant Literature. Case Rep Anesthesiol 2014; 2014:190172. [PMID: 24592335 PMCID: PMC3926366 DOI: 10.1155/2014/190172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
Mediastinal hematoma is a rare complication following insertion of a central venous catheter with only few cases reported in the English literature. We report a case of a 71-year-old female who was admitted for elective chemoport placement. USG guided right internal jugular access was attempted using the Seldinger technique. Resistance was met while threading the guidewire. USG showed a chronic clot burden in the RIJ. A microvascular access was established under fluoroscopic guidance. Rest of the procedure was completed without any further issues. Following extubation, the patient complained of right-sided chest pain radiating to the back. Chest X-ray revealed a contained white out in the right upper lung field. She became hemodynamically unstable. Repeated X-ray showed progression of the hematoma. Median Sternotomy showed posterior mediastinal hematoma tracking into right pleural cavity. Active bleeding from the puncture site at RIJ-SCL junction was repaired. Patient had an uneventful recovery. Injury to the central venous system is the result of either penetrating trauma or iatrogenic causes as in our case. A possible explanation of our complication may be attributed to the forced manipulation of the dilator or guidewire against resistance. Clavicle and sternum offer bony protection to the underlying vital venous structures and injuries often need sternotomy with or without neck extension. Division of the clavicle and disarticulation of the sternoclavicular joint may be required for optimum exposure. Meticulous surgical technique, knowledge of the possible complications, and close monitoring in the postprocedural period are of utmost importance. Chest X-ray showed to be routinely done to detect any complication early.
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30
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Burrah R, Patel R, Sonig A, Devi U. An unusual complication of internal jugular vein catheterization. Indian J Crit Care Med 2013; 17:265-6. [PMID: 24133341 PMCID: PMC3796912 DOI: 10.4103/0972-5229.118419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Kim H, Jeong CH, Byon HJ, Shin HK, Yun TJ, Lee JH, Park YH, Kim JT. Predicting the optimal depth of left-sided central venous catheters in children. Anaesthesia 2013; 68:1033-7. [DOI: 10.1111/anae.12371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- H. Kim
- Department of Anesthesiology and Pain Medicine; Severance Hospital; Yonsei University College of Medicine; Seoul; Korea
| | - C-H. Jeong
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - H-J. Byon
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - H. K. Shin
- Department of Anesthesiology and Pain Medicine; Inha University Hospital; Incheon; Korea
| | - T. J. Yun
- Department of Radiology; Seoul National University Hospital; Seoul; Korea
| | - J-H. Lee
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - Y-H. Park
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - J-T. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
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32
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Maroun R, Chalhoub M, Harris K. Right internal jugular venous cannulation complicated by tension hydrothorax. Heart Lung 2013; 42:372-4. [PMID: 23871236 DOI: 10.1016/j.hrtlng.2013.06.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/14/2013] [Accepted: 06/15/2013] [Indexed: 11/30/2022]
Abstract
Central Venous Catheter (CVC) is a common procedure performed in patients' management, especially the critically ill ones. CVC has been used as main access in patients requiring large amount of fluid resuscitation, total parenteral nutrition or measuring the central venous pressure. Although most complications associated with central venous cannulation are minimal, local and easy to control, others may be critical and rapidly fatal if not recognized and treated immediately. One of the most serious incidents that can occur post CVC placement is delayed hydrothorax. It usually results from migration and perforation of the catheter through the SVC wall. In this report, we describe a case of tension hydrothorax that occurred a few hours after placement of CVC in the right internal jugular vein. In acutely ill patients that are already unstable, making the diagnosis of tension hydrothorax secondary to CVC placement requires high level of suspicion. Prompt pleural effusion drainage like in our case is crucial for favorable outcome.
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Affiliation(s)
- Rabih Maroun
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
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33
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Impact of phase of respiration on central venous catheter tip position. J Vasc Access 2013; 14:383-7. [PMID: 23599138 DOI: 10.5301/jva.5000135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the impact of the phase of respiration on CVC tip position using cross-sectional imaging. METHODS We retrospectively analyzed the CT scans of 24 consecutive patients (eight men and 16 women, mean age 56.3 years, range 18-79) who underwent a CT scan protocol that includes both imaging of the thorax in inspiration and expiration. Only patients with a central venous catheter and absence of any substantial pulmonary pathology that might affect lung volumes were included. Measurements of the catheter tip location and central venous structures were obtained from inspiratory and expiratory phase images in each patient and compared using the paired <i>t</i> test. RESULTS The length of the SVC and superior mediastinum were significantly longer during inspiration compared to expiration (9 mm and 7 mm respectively, P<0.001 for both). The distance between the superior and inferior cavo-atrial junction did not change significantly with respiration. The catheter tip location moved on average 9 mm (range 0-25 mm) cephalad during inspiration compared to expiration (P=0.001) in relation to the superior cavoatrial junction. The amount of catheter tip movement correlated significantly with the degree of diaphragmatic excursion with respiration (R=0.58). During inspiration, the cavo-atrial junction was on average 11 mm inferior to the right cardiomediastinal angle observed on radiography, but was nearly identical during expiration (R=0.78, P<0.001). CONCLUSIONS The central catheter tip position varied significantly with respiratory motion, with a mean excursion of 9 mm. The right cardiomediastinal border demonstrated a strong correlation with the actual location of the superior cavo-atrial junction in expiration, but not in inspiration.
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34
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Anomalous venous anatomy leading to malposition and unusual complication of a left subclavian Hickman line. J Vasc Access 2013; 14:301-2. [PMID: 23543489 DOI: 10.5301/jva.5000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/20/2022] Open
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35
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Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The Art of Pleural Fluid Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/cpm.0b013e318285ba37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lee HK, Hong SW, Kim GJ, Ryu T, Han JK, Kim JC. Massive hemothorax immediately after removal of central venous catheter -A case report-. Korean J Anesthesiol 2013; 65:77-9. [PMID: 23904944 PMCID: PMC3726852 DOI: 10.4097/kjae.2013.65.1.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
Hemothorax is a possible immediate complication of central venous catheterization. We experienced a patient who suffered from massive hemothorax 72 hours after right subclavian venous catheterization. A 29-year-old female patient with Marfan's syndrome underwent the Bentall's operation and aortic arch replacement with an artificial graft, which was performed uneventfully. She recovered favorably in the intensive care unit and was transferred to the general ward on postoperative day 3. Immediately after the removal of the catheter in the general ward, massive hemothorax developed and emergent thoracotomy should have been performed to control bleeding. We report this case to re-emphasize the careful monitoring even after removal of central venous catheter and the need for ultrasound guidance during insertion of central venous catheters.
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Affiliation(s)
- Hae-Kyoung Lee
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seong-Wook Hong
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Gun-Jik Kim
- Division of Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Taeha Ryu
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Jae-Kyung Han
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu, Korea
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Zaghal A, Khalife M, Mukherji D, El Majzoub N, Shamseddine A, Hoballah J, Marangoni G, Faraj W. Update on totally implantable venous access devices. Surg Oncol 2012; 21:207-15. [DOI: 10.1016/j.suronc.2012.02.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/17/2012] [Accepted: 02/10/2012] [Indexed: 11/26/2022]
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Flannigan C, Bourke T, Keown K, Terris M. Bilateral total parenteral nutrition pleural effusions in a 5-week-old male infant. BMJ Case Rep 2012; 2012:bcr.01.2012.5608. [PMID: 22761198 DOI: 10.1136/bcr.01.2012.5608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 5-week-old male infant was admitted to the paediatric intensive care unit with small bowel obstruction secondary to an inguinal hernia. His postoperative course was complicated by suspected migration of his left internal jugular central venous catheter into branches of the inferior thyroid artery and mediastinum. This resulted in bilateral pleural effusions which were biochemically and visually similar to the total parenteral nutrition he was receiving. After drainage of the pleural effusions he made an uneventful recovery.
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Affiliation(s)
- Christopher Flannigan
- Paediatric Intensive Care Unit, Royal Belfast Hospital for Sick Children, Belfast, UK.
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Silvah JH, Lima CMM, Chagas-Neto FAD, Araújo GT, Chueire FB, Cunha SFDC, Marchini JS. Hidrotórax secundário à nutrição parenteral: relato de caso. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000300009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hidrotórax secundário à infusão de nutrição parenteral é uma condição rara, embora se apresente cada vez mais comum. Neste relato de caso, uma paciente com síndrome do intestino curto desenvolveu instabilidade hemodinâmica e insuficiência respiratória algumas horas após o início da infusão de nutrição parenteral. Ressaltamos também as manobras para evitar e tratar tal complicação.
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Joshi S, Kulkarni A, Bhargava AK. Evaluation of length of central venous catheter inserted via cubital route in Indian patients. Indian J Crit Care Med 2011; 14:180-4. [PMID: 21572748 PMCID: PMC3085218 DOI: 10.4103/0972-5229.76081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Peripherally inserted central venous catheters (PICCs) are popular due to the ease of insertion, low cost and low risk of complications. Anteroposterior (AP) chest radiograph (CXR) is then obtained to assess the location of the catheter tip. But poor-quality X-rays remain a significant problem. We planned a study using radiopaque marker at sternal angle, as a radiological landmark, to relate height of the patient and optimal length of PICC fixation, at the antecubital fossa, and to know the incidence of malpositioning. Materials and Methods: A total of 200 patients aged above 20 years, scheduled for elective major cancer surgeries were studied. Vygoflex PUR, 16-G catheter, length 70 cm was used. The right or the left arm was chosen depending on the availability of veins. Catheter tip was observed in the post procedure CXR. Results: 200 patients [100 patients in group 1 (length of catheter fixation at antecubital fossa 45 cm) and 100 patients in group 2 (length of catheter fixation 50 cm)] were enrolled. The groups were further subdivided into 1a, 1b, 2a, 2b and results tabulated. Conclusions: Appropriate length of catheter fixation for group 1a was <45 cm, group 1b = 45 cm, group 2a = 50 cm, and for group 2b it was ≥50 cm. Gender and arm (right or left) did not have any bearing on the length of fixation. Incidence of malpositioning (15.5%) was more in right-sided catheters, more so, in short heighted people. PICC insertion via cubital route stands better compared with other routes, viz., Internal jugular vein IJV, subclavian and femoral.
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Affiliation(s)
- Saurabh Joshi
- Department of Anesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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41
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Rodrigo Rivas T. Complicaciones mecánicas de los accesos venosos centrales. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70435-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Perforation of the superior vena cava by a central venous catheter in a female undergoing adjuvant chemotherapy. J Vasc Access 2010; 12:264. [PMID: 21104673 DOI: 10.5301/jva.2010.6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2010] [Indexed: 11/20/2022] Open
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Schulmeister L. Management of non-infectious central venous access device complications. Semin Oncol Nurs 2010; 26:132-41. [PMID: 20434646 DOI: 10.1016/j.soncn.2010.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the central venous access device (VAD) complications of inadvertent device damage, device malfunction, and various causes of mechanical occlusion and to describe the limitations of VAD complication data. DATA SOURCES Journal articles, legal cases, case reports, manufacturers' product information, personal experience. CONCLUSION The available data on VAD complications are difficult to interpret and apply in practice because of the many limitations of the studies that have been conducted (eg, single-institution, mixed patient populations, inconsistent measurement of complications). However, considerable information is known about the signs and symptoms of non-thrombotic, non-infectious VAD complications and their management. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses routinely use central VADs and are on the frontline for detecting VAD complications. Well-informed nurses can serve as patient advocates and help ensure that patients' VADs are functional and safe to use.
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Choi JG, Choi JS, Park CH, Lee CS, Kim LK, Chung YR. Hydrothorax due to extravasation of intravenous contrast through left subclavian catheter -A case report-. Korean J Anesthesiol 2010; 58:550-4. [PMID: 20589180 PMCID: PMC2892589 DOI: 10.4097/kjae.2010.58.6.550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/30/2009] [Accepted: 11/02/2009] [Indexed: 11/22/2022] Open
Abstract
Central venous catheterization is associated with a large number of complications, such as pneumothorax, hydrothorax, hemothorax, phlebothrombosis, pericardial tamponade, air embolism, aberrant placement and line sepsis. There are many case reports of the extravasation of various central venous catheter fluids, including the intravenous fluids, total parenteral nutrition and chemotherapeutic agents into the pleural cavity and mediastinum. These have led to hydrothorax, hydromediastinum and pericardial effusions. We report a case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter.
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Affiliation(s)
- Jung-Gi Choi
- Department of Anesthesiology and Pain Medicine, Gwangju Christian Hospital, Gwangju, Korea
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Johnson TJ, Jamous FG, Kooistra A, Zawada ET. Iatrogenic chylothorax due to pleural cavity extravasation of total parenteral nutrition in two adults receiving nutrition through a peripherally inserted central catheter. Hosp Pract (1995) 2010; 38:50-2. [PMID: 20469624 DOI: 10.3810/hp.2010.02.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extravasation of total parenteral nutrition (TPN) delivered via central lines is a known potential complication, but significant extravasations of infusate into the pleural space when using peripherally inserted central catheters (PICCs) have not been reported in adults. We report 2 cases ofpleural cavity extravasation ofTPN delivered via a PICC. Measurement of the glucose level of the effusate is a quick way to determine the presence of TPN and should be considered in any patient receiving TPN via any type of central line with a rapidly developing effusion.
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Affiliation(s)
- Thomas J Johnson
- Avera McKennan Hospital and University Health Center, Sioux Falls, SD 57117, USA.
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Westermann SA, Pahlplatz PVM, Brouwers MAM. Timeline of Cellulitis and Late Development of Hydrothorax Induced by a Right-Sided Central Venous Catheter. JPEN J Parenter Enteral Nutr 2010; 34:341-3. [DOI: 10.1177/0148607109348611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zochios V, Gilhooly M, Fenner S. Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit. J Vasc Access 2010; 11:128-31. [DOI: 10.1177/112972981001100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.
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Affiliation(s)
- Vasileios Zochios
- Acute Care (ACCS Anesthetics/ICM), Northampton General Hospital NHS Trust, Northampton - UK
| | - Michael Gilhooly
- Anesthesia, Worcestershire Acute Hospitals NHS Trust, Alexandra Hospital, Redditch - UK
| | - Simon Fenner
- Consultant in Anesthesia, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton - UK
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Sequeira A, Sachdeva B, Abreo K. Uncommon Complications of Long-Term Hemodialysis Catheters: Adhesion, Migration, and Perforation by the Catheter Tip. Semin Dial 2010; 23:100-4. [DOI: 10.1111/j.1525-139x.2009.00681.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Wildenauer R, Kobbe P, Waydhas C. [Bilateral hydrothorax and hydromediastinum after puncture of the right subclavian vein]. Unfallchirurg 2009; 112:81-3. [PMID: 18712332 DOI: 10.1007/s00113-008-1486-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Complications after the percutaneous insertion of central venous catheters are pneumothoraces, catheter-associated infections and thrombosis. In rare cases, late problems occur as a disruption of the main thoracic duct or vascular erosion. The developing pleural effusion must be analysed for other causes such as congestive heart disease, inflammatory or tumorous disease, pancreatitis, low blood protein, or subdiaphragmatic abscess. The following case report describes a rare catheter complication in a 16-year-old polytraumatised patient. The differentiation to a chylothorax and suitable therapy are described.
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Affiliation(s)
- R Wildenauer
- Abteilung für Unfallchirurgie, Universitätsklinikum Essen, Essen.
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50
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Sposato LA, Yap CH, Powar N, Alizzi AM, Tatoulis J, Newcomb AE. Acute mediastinitis secondary to venous perforation by a peripherally inserted central venous catheter. J Cardiothorac Vasc Anesth 2009; 23:672-4. [PMID: 19201204 DOI: 10.1053/j.jvca.2008.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Luigi A Sposato
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Victoria, Australia.
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