Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

Comparison of different venous access ways for right heart catheterization-a meta-analysis

OBJECTIVES

Right heart catheterization (RHC) is a common diagnostic tool and of special importance in the diagnosis of pulmonary hypertension (PH). Until today, there have been no clear instructions or guidelines on which venous access to prefer. This meta-analysis assessed whether the choice of the venous access site for elective RHC has an impact on procedural or clinical outcomes.

METHODS

A structured literature search was performed. Single-arm reports and controlled trials reporting event data were eligible. The primary endpoint was a composite of access-related and overall complications.

RESULTS

Nineteen studies, including 6509 RHC procedures, were eligible. The results were analyzed in two groups. The first group compared central venous access (CVA; n = 2072) with peripheral venous access (PVA; n = 2680) and included only multi-arm studies (n = 12, C/P comparison). In the second group, all studies (n = 19, threeway comparison) were assessed to compare the three individual access ways. The overall complication rate was low at 1.0% (n = 68). The primary endpoint in the C/P comparison occurred significantly less for PVA than for CVA (0.1% vs. 1.2%; p = 0.004). In the threeway comparison, PVA had a significantly lower complication rate than femoral access (0.3% vs. 1.1%; p = 0.04). Jugular access had the numerically highest complication rate (2.0%), but the difference was not significant compared to peripheral (0.3%; p = 0.29) or femoral access (1.1%; p = 0.32).

CONCLUSION

This meta-analysis showed that PVA for RHC has a significantly lower complication rate than CVA. There was a low level of certainty and high heterogeneity. This pooled data analysis indicated PVA as the primary venous access for RHC.

Bedside Clinician's Guide to Pulmonary Artery Catheters

BACKGROUND

Pulmonary artery catheters provide important information about cardiac function, mixed venous oxygenation, and right-sided pressures and potentially provide temporary pacing ability.

OBJECTIVE

To provide bedside clinicians with guidance for techniques to insert right heart monitors and devices, describe risk factors for difficult insertion and contraindications to placement, and provide updates on new technologies that may be encountered in the intensive care unit.

METHODS

An extensive literature review was performed. Experienced clinicians were asked to identify topics not addressed in the literature.

RESULTS

Advanced imaging techniques such as transesophageal echocardiography or fluoroscopy can supplement traditional pressure waveform-guided insertion when needed, and several other techniques can be used to facilitate passage into the pulmonary artery. Caution is warranted when attempting insertion in patients with right-sided masses or preexisting conduction abnormalities. New technologies include a pacing catheter that anchors to the right ventricle and a remote monitoring device that is implanted in the pulmonary artery.

DISCUSSION

Bedside clinicians should be aware of risk factors such as atrial fibrillation with dilated atria, decreased ventricular function, pulmonary hypertension, and right-sided structural abnormalities that can make pulmonary artery catheter insertion challenging. Clinicians should be familiar with advanced techniques and imaging options to facilitate placement.

CONCLUSION

The overall risk of serious complications with right heart catheter placement and manipulation is low and often outweighed by its benefits, specifically pressure monitoring and pacing.

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

Objective

As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation.

Methods

Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected.

Results

Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series.

Conclusions

Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications.

The best vein to be accessed based on descriptive study of dorsal metacarpal vein

It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.

Right heart catheterization procedures in patients with suspicion of pulmonary hypertension - experiences of a tertiary center

INTRODUCTION

Right heart catheterization (RHC) is an invasive procedure providing direct and accurate measurements of hemodynamics of the cardiovascular system. Acute pulmonary vasoreactivity testing (APVT) following basal RHC in some patients is an established tool evaluating the reversibility of hypertension in the pulmonary vasculature.

AIM

We sought to assess the most common indications, vascular approaches and complications during RHC in a single high-volume center.

MATERIAL AND METHODS

A total of 534 RHC procedures in 348 patients (64% male) were performed. The prospective registry was carried out for 28 months. Collected data included indications for RHC, vascular approaches, hemodynamic and clinical data, complications and response of pulmonary vessels in APVT.

RESULTS

In 401 (75%) procedures pulmonary hypertension (mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg) was confirmed. Left heart failure was the most common indication (55.8%), mainly ischemic (26%) or dilated cardiomyopathy (19.9%). Other indications included a suspicion of arterial (21.7%), or chronic thromboembolic pulmonary hypertension (14.6%). The right internal jugular vein approach was used in 89.1% of procedures. Acute pulmonary vasoreactivity testing was performed in 143 patients, and it was positive in 67 (46.9%) cases. Complications occurred in 21 (3.9%) procedures and included pulmonary edema (0.2%), pneumothorax (0.2%) and puncture of the artery followed by the insertion of a vascular sheath (0.4%), atrial arrhythmia (0.2%), superior vena cava dissection (0.2%), incidental artery puncture (1.1%) and local hematoma (2.2%).

CONCLUSIONS

The most frequent indication for RHC was left heart failure, and the most common approach was the right internal jugular vein. RHC is safe procedure with a low rate of major complications.