Knotting of central venous catheters: nonsurgical correction

Advanced Practice Organ Procurement Techniques: Insertion of Central Venous Catheters

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.

Knot in the Cava—An Unusual Complication of Swan–Ganz Catheters

Complications associated with the use of the Swan-Ganz catheters including coiling and knotting of the catheter in the central venous system or in the chambers of the heart, often with disastrous consequences. We report a case of knotting of a Swan-Ganz catheter in the superior vena cava which necessitated surgical removal via the right internal jugular vein.

Removal of knotted intravascular devices. Case report and review of the literature

OBJECTIVE

to review published reports on knotted intravascular devices/catheters.

METHOD

report of two cases and systematic review of the literature.

RESULTS

a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113).

CONCLUSIONS

interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.

Triple knotting of a central venous catheter

A case of unusual triple knotting of a central venous catheter inserted through the left basilic vein is reported. The catheter with intact triple knots could be withdrawn without an invasive maneuver. A possible cause of triple knotting was discussed in regard to the anatomic configuration of the central veins. This case emphasizes that a central venous catheter should not be advanced if resistance is encountered.

Knotting of a bypass graft catheter: report of a case

A case of knotting of a bypass graft catheter during coronary arteriography is presented. An arteriotomy had to be done to remove the catheter. A possible mechanism causing this complication and precautions to avoid it are described.

Transthoracic intracardiac monitoring lines in pediatric surgical patients: a ten-year experience

A study of 6,690 transthoracic intracardiac monitoring (TIM) catheters in 5,666 pediatric patients undergoing cardiac surgical procedures during a 10-year period demonstrates the safety of this monitoring method. The utility of TIM catheters in patients undergoing a modified Fontan procedure, those undergoing repair of tetralogy of Fallot, and those with elevated or labile pulmonary resistance is stressed. Right atrial (RA) and left atrial (LA) catheters are particularly safe; they have a low incidence of bleeding complications (RA = 0%, LA = 0.13%) and retention complications (RA = 0.15%, LA = 0.63%). Pulmonary artery (PA) catheters that are introduced through the right ventricular infundibulum have higher complication rates (1.07%); unpredictable hemodynamic compromise occurs in approximately 0.5% of such patients. PA catheters placed through the wall of the atrium have a lower complication rate-approximately equal to that for RA and LA catheters. The benefits of TIM catheters far outweight the associated risks if care is exercised in placing and removing them, and if complications are rapidly recognized and aggressively managed. The continued use of TIM catheters in pediatric cardiac surgical patients is therefore strongly recommended.

Use of wire-guided (Seldinger-type) catheters in the emergency department

The use of wire-guided catheters is a major technical advance for emergency physicians. The technique is simple, safe, and efficient, and allows tremendous flexibility in usage.

Knotting of intracardiac flow-directed balloon catheter. Simple surgical method of removal

A complete knot occurred in a 7F flow-directed balloon catheter inserted through the right internal jugular vein. The patient was intubated and placed under positive pressure ventilation. After gaining surgical exposure of the venipuncture site, a purse-string of Prolene 4--0 suture was placed around it. The patient was placed in the Trendelenburg position and the knotted catheter withdrawn, while the purse-string suture was immediately tightened avoiding uncontrollable hemorrhage or massive air embolism.

Guide wire-sheath technique for pulmonary artery catheterization and central vein cannulation

The combination of a spring guide wire with a sheath introducer system has been successfully used for the routine placement of pulmonary artery and central venous catheters. The method, which is described is simple, quick, and safe. It is applicable to the initial placement of the catheter, to any necessary alterations in its position, and to its eventual replacement with a central venous cannula.