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Chen Q, Zhang X, Zhang H, Li J, Zhang Y, Zhang K, Chen X. Prediction of internal jugular vein catheter length inserted through the posterior approach of the sternocleidomastoid muscle. Medicine (Baltimore) 2024; 103:e38876. [PMID: 39058850 PMCID: PMC11272274 DOI: 10.1097/md.0000000000038876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
This study aimed to determine an equation to estimate the optimal insertion length for catheter placement via the posterior approach of the sternocleidomastoid muscle in cancer patients. This retrospective study included patients with cancer who underwent infusion port implantation surgery in the Oncology Department of the 900th Hospital of Joint Logistic Support Force of the Chinese People Liberation Army from April 2017 to September 2023. Patient height (H), weight (W), chest length (C), and length of the internal jugular vein catheter (L) were collected from medical records. The patients were randomized 7:3 to the training and validation sets. Linear regression analyses were used in the training set to determine formulas to predict catheter length. The formula predictive value was analyzed using the Bland-Altman method in the validation set. This study included 336 patients, with a mean age of 58.27 ± 11.70 years, randomized in the training (n = 235) and validation (n = 101) sets. Linear regression analysis revealed that the equations for catheter length relative to H, body mass index (BMI), and C are L = 0.144 × H - 8.258 (R² = 0.608, P < .001), L = -0.103 × B + 17.384 (R² = 0.055, P < .001), and L = 0.477 × C + 1.769 (R² = 0.342, P < .001), respectively. The multivariable linear regression analysis showed that the equation between the length of the catheter and H and C was L = 0.131 × H + 0.086 × C-8.515 (R² = 0.614, P < .001). The Bland-Altman analysis in the validation set showed that the predicted values of internal jugular vein catheter length and the actual values showed good agreement. The optimal L might be determined by simple formulas based on patients H and C.
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Affiliation(s)
- Qunxiang Chen
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiaoyu Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huanlin Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie Li
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kaixiang Zhang
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
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Hajeh H, Garcia A, Mishra S, Radicic K. Malposition of the central venous catheter secondary to accessory hemiazygos vein variant. J Vasc Access 2024; 25:995-997. [PMID: 36782408 DOI: 10.1177/11297298231154291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
A 36-year-old female with sickle cell disease presented with sickle cell pain crisis. After failure to establish peripheral venous access, an internal jugular central venous catheter (CVC) was placed. Confirmation of internal jugular cannulation was performed with bedside ultrasound. A confirmatory chest X-ray revealed an unusual position of the catheter, taking a course inferiorly, making a loop and remaining on the left side of the mediastinum. A lateral view was done and revealed that the catheter passed inferiorly through the internal jugular vein then posteriorly and inferiorly giving the looped appearance. This is better delineated on a sagittal view CT scan showing the tip of the catheter terminating in the accessory hemiazygos vein. This unusual course is due to a variant of the accessory hemiazygos vein which is connected to the left superior intercostal vein. This creates a lower resistance pathway for the CVC which passes from the internal jugular vein, down the left superior intercostal vein (instead of the left brachiocephalic vein) and into the accessory hemiazygos vein. Discussion: The correct tip placement of an internal jugular CVC terminates in the superior vena cava just above the cardiac silhouette. In 1%-2% of individuals, a connection between the accessory hemiazygos and the left superior intercostal vein is present. Rare cases are discovered incidentally during CVC placement. The diameter of the accessory hemiazygos vein is less than half of that of the superior vena cava. The catheter should not be used as central venous access and removal is recommended. Malpositioning of central catheters is unpredictable but can be easily avoided by using intraprocedural methods to confirm tip position. Such modalities include intracavitary ECG or ultrasound with agitated saline injection as described in the SIC (Safe Insertion of Centrally Inserted Central Catheters) protocol.
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Affiliation(s)
- Haidar Hajeh
- UCLA - David Geffen School of Medicine - Kern Medical Center, Bakersfield, CA, USA
| | - Austin Garcia
- Ross University School of Medicine, Miramar, FL, USA
| | - Shikha Mishra
- UCLA - David Geffen School of Medicine - Kern Medical Center, Bakersfield, CA, USA
| | - Kasey Radicic
- UCLA - David Geffen School of Medicine - Kern Medical Center, Bakersfield, CA, USA
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Žarskus A, Zykutė D, Lukoševičius S, Jankauskas A, Trepenaitis D, Macas A. Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:28. [PMID: 38256289 PMCID: PMC10820046 DOI: 10.3390/medicina60010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.
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Affiliation(s)
- Ainius Žarskus
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Dalia Zykutė
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Saulius Lukoševičius
- Department of Radiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Darius Trepenaitis
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Merin R, Gal-Oz A, Adi N, Vine J, Schvartz R, Aconina R, Stavi D. Central catheter tip migration in critically ill patients. PLoS One 2022; 17:e0277618. [PMID: 36534662 PMCID: PMC9762564 DOI: 10.1371/journal.pone.0277618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Chest X-ray (CXR) is routinely required for assessing Central Venous Catheter (CVC) tip position after insertion, but there is limited data as to the movement of the tip location during hospitalization. We aimed to assess the migration of Central Venous Catheter (CVC) position, as a significant movement of catheter tip location may challenge some of the daily practice after insertion. DESIGN AND SETTINGS Retrospective, single-center study, conducted in the Intensive Care and Cardiovascular Intensive Care Units in Tel Aviv Sourasky Medical Center 'Ichilov', Israel, between January and June 2019. PATIENTS We identified 101 patients with a CVC in the Right Internal Jugular (RIJ) with at least two CXRs during hospitalization. MEASUREMENTS AND RESULTS For each patient, we measured the CVC tip position below the carina level in the first and all consecutive CXRs. The average initial tip position was 1.52 (±1.9) cm (mean±SD) below the carina. The maximal migration distance from the initial insertion position was 1.9 (±1) cm (mean±SD). During follow-up of 2 to 5 days, 92% of all subject's CVCs remained within the range of the Superior Vena Cava to the top of the right atrium, regardless of the initial positioning. CONCLUSIONS CVC tip position can migrate significantly during a patient's early hospitalization period regardless of primary location, although for most patients it will remain within a wide range of the top of the right atrium and the middle of the Superior Vena Cava (SVC), if accepted as well-positioned.
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Affiliation(s)
- Roei Merin
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- * E-mail:
| | - Amir Gal-Oz
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nimrod Adi
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacob Vine
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Reut Schvartz
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Reut Aconina
- Dept of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dekel Stavi
- Department of Anesthesiology and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Panda S, Baby SR, Thosani R. Evaluation of the Efficacy of Ultrasound in Detecting Correct Placement of Central Venous Catheter and Determining the Elimination of the Need for Chest Radiography. JOURNAL OF CARDIAC CRITICAL CARE TSS 2021. [DOI: 10.1055/s-0041-1723747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background and Aims Ultrasound guidance of central venous catheter (CVC) insertion improves the safety and efficacy of its placement, but still it may not ensure correct placement of catheter tip. In our study, we aimed to identify the correct placement of CVC tip and to detect mechanical complications, by visualizing it in real time with the help of sonography and comparing this to the chest X-ray findings.
Patients and Methods This was a cross-sectional observational study conducted on 80 patients with American Society of Anesthesiologists grades 1 and 2, in the age group of 18 to 65 years, who required central venous catheterization in intensive care unit. The CVC tip placement was identified with ultrasound and then the finding was compared with postinsertion chest X-ray.
Results In only 9 out of the 80 patients (11.3%) malposition was detected on ultrasound and was corrected immediately, whereas in remaining 71 patients (88.8%) no intervention was required. It was observed that all the patients had correct position of CVC tip on postprocedural chest X-ray. Accidental arterial cannulation occurred in two (2.5%) patients in whom right internal jugular vein was cannulated and in two (2.5%) patients who had arrhythmia.
Conclusion Ultrasonography (USG) examination can be used as a diagnostic tool method for confirmation of CVC tip and identification of cannulation-related complications. Thus, we can say that USG might obviate the need for post-CVC insertion chest X-ray.
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Affiliation(s)
- Suvendu Panda
- Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology & Research Centre (UNMICRC), Ahmedabad, Gujarat, India
| | - S.K. Rojalin Baby
- Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology & Research Centre (UNMICRC), Ahmedabad, Gujarat, India
| | - Rajesh Thosani
- Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology & Research Centre (UNMICRC), Ahmedabad, Gujarat, India
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Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24:527-530. [PMID: 32963434 PMCID: PMC7482340 DOI: 10.5005/jp-journals-10071-23478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Central venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmia's, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications. Objective To compare Peres’ formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach. Materials and methods A total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups—Peres’ group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups. Results About 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups. Conclusion Radiological landmark formula is superior to Peres’ formula for measuring optimal depth of insertion of right internal jugular venous catheter. How to cite this article Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24(7):527–530.
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Affiliation(s)
- A R Manudeep
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - B P Manjula
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - U S Dinesh Kumar
- Deparatment of Cardiothoracic and Vascular Anaesthesia, JSS Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Tran QK, Foster M, Bowler J, Lancaster M, Tchai J, Andersen K, Matta A, Haase DJ. Emergency and critical care providers' perception about the use of bedside ultrasound for confirmation of above-diaphragm central venous catheter placement. Heliyon 2020; 6:e03113. [PMID: 32042935 PMCID: PMC7002808 DOI: 10.1016/j.heliyon.2019.e03113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/21/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Chest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications. Recent studies have shown that point-of-care ultrasound (POCUS) has better sensitivity and is faster than CXR for these purposes. We were interested in documenting how often emergency medicine and critical care practitioners perform POCUS to confirm proper CVC positioning as well as their confidence in performing it. Methods We surveyed members of our state's chapters of the College of Emergency Physicians and the Society of Critical Care Medicine between April and December 2018. Our primary outcome was the percentage of providers who would agree to perform only POCUS, forgoing CXR, for confirmation of CVC position. We performed multivariable logistic regressions to measure associations between demographic, clinical information, and outcomes. Results One hundred thirty-six providers participated (a 25% participation rate). Their specialties were as follows: emergency medicine, 75%; critical care, 13%; and emergency medicine/critical care, 11%. Thirty-one percent would use POCUS only for CVC confirmation, while 42% were confident in performing POCUS for this purpose. Multivariable logistic regressions showed that performing more non-procedural ultrasound examinations was associated with a higher likelihood of agreeing to perform POCUS only (OR, 2.9; 95% CI: 1.3-6.3). Forty-six percent of relevant comments suggested more training to increase the use of POCUS. Conclusion Participants in this study did not frequently use POCUS for CVC confirmation. Designers of training curricula should consider including more instruction in the use of POCUS to confirm proper CVC placement and to detect complications.
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Affiliation(s)
- Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mark Foster
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Bowler
- University of Maryland at College Park, College Park, MD, USA
| | - Mia Lancaster
- University of Maryland at College Park, College Park, MD, USA
| | - Jennifer Tchai
- University of Maryland at College Park, College Park, MD, USA
| | - Katie Andersen
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Ann Matta
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel J Haase
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Kesarkar N, Kulkarni K, Dave N. Cascade sign: A guide to sonographic confirmation of central venous catheter position. Paediatr Anaesth 2019; 29:772-773. [PMID: 31155784 DOI: 10.1111/pan.13674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/25/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nikhil Kesarkar
- Department of Paediatric Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Ketan Kulkarni
- Department of Paediatric Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Nandini Dave
- Department of Paediatric Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, India
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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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Steinhagen F, Kanthak M, Kukuk G, Bode C, Hoeft A, Weber S, Kim SC. Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation. J Vasc Access 2018; 19:528-534. [PMID: 29512399 DOI: 10.1177/1129729818757976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. METHODS: An observational prospective case-control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery. Each intervention was crosschecked with ultrasound-guided positioning via right supraclavicular fossa view and chest radiography. Ultrasound-guided supraclavicular venipuncture of the right subclavian vein and guidewire advancement were performed. A B-mode view of the superior vena cava and the right pulmonary artery was obtained to visualize the J-tip of the guidewire. The central venous catheter was advanced over the guidewire and the electrocardiography was derived from the J-tip of the guidewire protruding from the central venous catheter tip. Electrocardiography was read for increased p- and atrial fibrillation waves, respectively, and insertion depth was compared with the ultrasound method. RESULTS: Electrocardiography indicated significantly increasing fibrillation and p-waves, respectively, in all patients and ultrasound-guided central venous catheter positioning confirmed a tip position within the lower third of the superior vena cava. CONCLUSION: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.
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Affiliation(s)
- Folkert Steinhagen
- 1 Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Maximilian Kanthak
- 1 Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Guido Kukuk
- 2 Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- 1 Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- 1 Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Se-Chan Kim
- 1 Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany.,4 Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD, USA
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Krishnan AK, Menon P, Gireesh Kumar KP, Sreekrishnan TP, Garg M, Kumar SV. Electrocardiogram-guided Technique: An Alternative Method for Confirming Central Venous Catheter Tip Placement. J Emerg Trauma Shock 2018; 11:276-281. [PMID: 30568370 PMCID: PMC6262658 DOI: 10.4103/jets.jets_122_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The current standard followed for assessing central venous catheter (CVC) tip placement location is through radiological confirmation using chest X-ray (CXR). Placement of CVCs under electrocardiogram (ECG) guidance may save cost and time compared to CXR. Objective The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique. Another objective is to compare CVC placement time and postprocedural complications between the two techniques. Methods and Materials A total of 144 adult individuals, who were critically ill and required CVC placement in the Emergency Department, were included for the study. Study duration was 6 months. Anatomical landmark and ECG-guided groups were assigned 72 participants each. Analyses were performed using t and Chi square-tests. Results It was observed that 13 (18%) in the landmark technique were malpositioned as compared to none in the ECG-guided technique (P = 0.000). The landmark group had 22 (30.6%) participants with arrhythmias during the procedure, compared to none in the ECG-guided group (P = 0.000). The landmark group revealed that 30 (41.7%) of the CVC were overinserted and required immediate repositioning, compared to none in the ECG-guided group (P = 0.000). Conclusion ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement.
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Affiliation(s)
- Arun Kumar Krishnan
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India
| | - Priya Menon
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India
| | - K P Gireesh Kumar
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India
| | - T P Sreekrishnan
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India
| | - Manish Garg
- Department of Emergency Medicine, Temple University Hospital, Philadelphia PA, U.S.A
| | - S Vijay Kumar
- Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India
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Single-Operator Ultrasound-Guided Central Venous Catheter Insertion Verifies Proper Tip Placement*. Crit Care Med 2017; 45:e994-e1000. [DOI: 10.1097/ccm.0000000000002500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Formulas for prediction of insertion depths of internal jugular vein catheters adjusted to body height categories. J Vasc Access 2015; 17:191-4. [PMID: 26660038 DOI: 10.5301/jva.5000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Whether formulas for prediction of central venous catheter (CVC) insertion depths have different applicability in patients with different body heights is not known. Goal of study was to test formulas for catheterizations of internal jugular veins (IJVs) in a population of different body height classes with correct CVC tip positions. METHODS Consecutive adult patients requiring CVC for cardiac surgery were enrolled and those with tip positions at the junction of the superior vena cava and the right atrium ±1 cm underwent formula analysis. Precision of formula prediction was calculated for three classes of body height. RESULTS Of the 635 included patients, 254 underwent right IJV catheterization and 381 underwent left IJV catheterization, respectively. Formula-guided approach for both right [formulas (height/10) (in cm) and (height/10) -1 (in cm)] and left [formula (height/10) + 4 (in cm)] IJV CVC was more precise in patients with a body height of 170-180 cm compared with patients with a body height <170 cm (who required deeper insertion than predicted by formula) and patients with a body height >180 cm (who required a more proximal insertion than predicted by formula). CONCLUSIONS Independent from body height classes, all formulas calculated a relatively low likelihood of atrial positions but high risks of proximal mal-positioning. Thus, considering inter-individual differences of vascular anatomy and for safety reasons, formulas cannot be recommended.
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Ultrasound confirmation of central venous catheter position via a right supraclavicular fossa view using a microconvex probe. Eur J Anaesthesiol 2015; 32:29-36. [DOI: 10.1097/eja.0000000000000042] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Transesophageal Echocardiography as a Guide to Central Venous Catheter Placement in a Patient With Functional Ventriculo-atrial CSF Shunt. J Neurosurg Anesthesiol 2014; 27:272-3. [PMID: 25493929 DOI: 10.1097/ana.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kumar A, Gupta K, Bhandari S, Singh R. Folding back of central venous catheter in the internal jugular vein: Methods to diagnose it at the time of insertion? Indian J Anaesth 2013; 57:104-5. [PMID: 23716794 PMCID: PMC3658326 DOI: 10.4103/0019-5049.108600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amitabh Kumar
- Department of Anesthesia, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Eriksson M, Dörenberg R. Intracardiac ECG for confirmation of correct positioning of central venous catheters is safe and cost-effective. Crit Care 2013. [PMCID: PMC3642435 DOI: 10.1186/cc12113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Abstract
The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.
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Affiliation(s)
- Omar Rahman
- Adult Intensive Care/Shock Trauma Unit, Geisinger Medical Center, Danville, PA 17822, USA.
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Kujur R, Rao MS, Mrinal M. How correct is the correct length for central venous catheter insertion. Indian J Crit Care Med 2010; 13:159-62. [PMID: 20040815 PMCID: PMC2823099 DOI: 10.4103/0972-5229.58543] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Aim: Central venous catheters (CVC) are important in the management of critically ill patients. Incorrect positioning may lead to many serious complications. Chest radiograph is a convenient means of determining the correct position of the catheter tip. The present study was designed to evaluate the depth of CVC placed through the right and left internal jugular vein (IJV) in order to achieve optimum placement of the catheter tip. Materials and Methods: A total of 107 patients in whom CVCs were put through either the right or left IJV through a central approach were included in this prospective study. Catheter tip position was observed in the post procedure chest radiograph. It was considered correct if the tip was just below the carina in the left-sided catheters and just above carina in the right-sided catheters. The catheters were repositioned based on the chest radiographs. The catheter depth leading to optimum tip placement was noted. Results: In males, catheter repositioning was required in 13 of 58 patients (22.41%) in the right IJV catheters, whereas in 2 of 13 patients (15.38%) in the left IJV catheters. In females, repositioning was required in 12 of 25 patients (48%) in the right IJV catheters and 2 of 11 patients (18.18%) in the left IJV catheters. Repositioning rate was higher in females (14/36) compared with males (15/71), which was statistically significant (P = 0.05, 95% CI). Repositioning rates were significantly higher in females (12/25) as compared with males (13/58) in the right IJV catheters (P = 0.019, 95% CI). Conclusion: By cannulating the IJV through a central approach, the catheters can be fixed at a length of 12-13 cm in males and 11-12 cm in females in the right IJV and at a length of 13-14 cm in males and 12-13 cm in females in the left IJV in order to achieve correct positioning.
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Affiliation(s)
- Rash Kujur
- Department of Critical Care, Yashoda Hospital, Somajiguda, Hyderabad, India
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