1
|
Li Y, Du T, Du J. Suggestions for Enhancing the Evaluation of Central Venous Catheter-Associated Complications. JAMA Intern Med 2024; 184:1129-1130. [PMID: 38976256 DOI: 10.1001/jamainternmed.2024.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Yue Li
- Department of Nursing, Yantai Yuhuangding Hospital, Shandong, China
| | - Tiantian Du
- Department of Respiratory and Critical Medicine, Yantai Yuhuangding Hospital, Shandong, China
| | - Junying Du
- Department of Pediatrics, Yantai Yuhuangding Hospital, Shandong, China
| |
Collapse
|
2
|
Irigoyen PM, Jimenez MG, Arellano EML, Pérez MS, Cabredo RV. Patency, assessment, and management of central catheter occlusion in adult patients in the intensive care unit: a best practice implementation project. JBI Evid Implement 2024; 22:261-270. [PMID: 38666477 DOI: 10.1097/xeb.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs. OBJECTIVE The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency. METHODS This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning. RESULTS After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%. CONCLUSION The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents. SPANISH ABSTRACT http://links.lww.com/IJEBH/A200.
Collapse
Affiliation(s)
| | - Marina Gallego Jimenez
- Spanish Centre for Evidence-Based Nursing and Healthcare: A JBI Centre of Excellence, Madrid, Spain
| | | | | | | |
Collapse
|
3
|
Shin KW, Park S, Jo WY, Choi S, Kim YJ, Park HP, Oh H. Comparison of Catheter Malposition Between Left and Right Ultrasound-Guided Infraclavicular Subclavian Venous Catheterizations: A Randomized Controlled Trial. Crit Care Med 2024:00003246-990000000-00350. [PMID: 38912886 DOI: 10.1097/ccm.0000000000006368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Catheter malposition after subclavian venous catheterization (SVC) is not uncommon and can lead to serious complications. This study hypothesized that the left access is superior to the right access in terms of catheter malposition after ultrasound-guided infraclavicular SVC due to the asymmetry of the bilateral brachiocephalic veins. DESIGN Parallel-armed randomized controlled trial. SETTING A tertiary referral hospital in Korea. PATIENTS Patients 20-79 years old who were scheduled to undergo SVC under general anesthesia. INTERVENTIONS Patients were randomly assigned to either the left (n = 224) or right (n = 225) SVC group. The primary outcome measure was the overall catheter malposition rate. The secondary outcome measures included catheter malposition rates into the ipsilateral internal jugular and contralateral brachiocephalic veins, other catheterization-related complications, and catheterization performance. MEASUREMENTS AND MAIN RESULTS The catheter malposition rate was lower (10 [4.5%] vs. 31 [13.8%], p = 0.001), especially in the ipsilateral internal jugular vein (9 [4.0%] vs. 24 [10.7%], p = 0.007), in the left SVC group than in the right SVC group. In the left SVC group, catheterization success rates on the first pass (88 [39.3%] vs. 65 [28.9%], p = 0.020) and first-catheterization attempt (198 [88.4%] vs. 181 [80.4%], p = 0.020) were higher whereas times for vein visualization (30 s [18-50] vs. 20 s [13-38], p < 0.001) and total catheterization (134 s [113-182] vs. 132 s [103-170], p = 0.034) were longer. There were no significant differences in other catheterization performance and catheterization-related complications between the two groups. CONCLUSIONS These findings strengthen the rationale for choosing the left access over the right access for ultrasound-guided infraclavicular SVC.
Collapse
Affiliation(s)
- Kyung Won Shin
- All authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
4
|
Yee J, Holliday S, Spitzer CR, Essandoh M, Way DP, Panchal AR. Preparing interns for clinical practice through an institution-wide simulation-based mastery learning program for teaching central venous catheter placement. Medicine (Baltimore) 2024; 103:e38346. [PMID: 38847719 PMCID: PMC11155558 DOI: 10.1097/md.0000000000038346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/03/2024] [Indexed: 06/10/2024] Open
Abstract
Central venous catheter (CVC) placement is a challenging procedure with known iatrogenic risks. However, there are no residency program requirements to demonstrate baseline CVC procedural competency. Competency-based procedural education has been shown to decrease CVC-associated morbidity, but there has been limited literature about institution-wide efforts to ensure initial trainee competency for CVC placement. This study describes the implementation of a competency-based CVC curriculum for first-year interns across an institution before supervised clinical care. An institution-wide, simulation-based mastery training curriculum was designed to assess initial competency in CVC placement in first-year residents during 2021 and 2022. A checklist was internally developed with a multidisciplinary team. Using the Mastery-Angoff technique, minimum passing standards were derived to define competency levels considered appropriate for intern participation in supervised clinical care. Interns were trained through the competency-based program with faculty assessing intern performance using the CVC checklist to verify procedural competency. Over 2 academic cycles, 229 interns from 20 specialties/subspecialties participated. Overall, 83% of interns met performance standards on their first posttest attempt, 14% on the second attempt, and 3% on the third attempt. Interns from both cycles demonstrated significant improvement from baseline to posttest scores (P < .001). Overall, 10.5% of interns performed dangerous actions during assessment (malpositioning, retained guidewire, or carotid dilation). All interns ultimately achieved the passing standard to demonstrate initial competency in the simulation assessment. All participating interns demonstrated simulation-based competency allowing them to place CVCs under supervised clinical care. Dangerous actions, however, were not uncommon. Simulation-based teaching and learning frameworks were a feasible method to promote patient safety through an institutional-wide verification of preliminary procedural competency.
Collapse
Affiliation(s)
- Jennifer Yee
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Scott Holliday
- Department of Pediatric Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carleen R. Spitzer
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David P. Way
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
5
|
Gayatri A, Panidapu N, Sen B, Palamattam DJ, Kerala VP, Kumar NP. Lancisi Sign due to Malpositioned Central Venous Catheter. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00360-4. [PMID: 38955615 DOI: 10.1053/j.jvca.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Annusha Gayatri
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Nagarjuna Panidapu
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Barsha Sen
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Don Jose Palamattam
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Varma Praveen Kerala
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Neema Praveen Kumar
- Department of Cardiac Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, India
| |
Collapse
|
6
|
Syska B, Veer AS, Matusik PS, Jarczewski JD, Krzanowska K, Popiela TJ. Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization. Diagnostics (Basel) 2024; 14:1038. [PMID: 38786336 PMCID: PMC11119990 DOI: 10.3390/diagnostics14101038] [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: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.
Collapse
Affiliation(s)
- Barbara Syska
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Anna S. Veer
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Patrycja S. Matusik
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Jarosław D. Jarczewski
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, 31-008 Cracow, Poland;
| | - Tadeusz J. Popiela
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
| |
Collapse
|
7
|
Rodriguez L, Pydi R, Choi PJK, Pradhan J, Thite S, Satoskar S, Parikh HR, Shah A, Girishkumar H. Two Cases of Malpositioning of Internal Jugular Central Venous Catheters: A Review of Literature and Current Treatment Recommendations. Cureus 2024; 16:e59814. [PMID: 38846204 PMCID: PMC11156211 DOI: 10.7759/cureus.59814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Percutaneous central venous catheterization, despite ultrasound guidance, is known to carry significant risks. While central venous catheters are widely used in clinical practice, they are also associated with various complications, including incorrect positioning during insertion. Arterial puncture is a well-recognized complication, and although unintended subclavian or carotid artery cannulation is rare, it can lead to serious consequences. We present two cases, in which a dual-lumen, non-tunneled temporary hemodialysis catheter was inadvertently inserted into the left common carotid artery and in the left innominate vein.
Collapse
Affiliation(s)
| | - Reshma Pydi
- Surgery, BronxCare Health System, New York, USA
| | | | | | - Sania Thite
- Surgery, BronxCare Health System, New York, USA
| | | | | | - Ajay Shah
- Surgery, BronxCare Health System, New York, USA
| | | |
Collapse
|
8
|
Amllay A, Owolo E, Nowicki KW, Sujijantarat N, Koo A, Antonios JP, Renedo D, Matouk CC, Hebert RM. Angiographic evidence of an inadvertent cannulation of the marginal sinus following central line migration: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23607. [PMID: 38684119 PMCID: PMC11058405 DOI: 10.3171/case23607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Central venous catheters (CVCs) play an indispensable role in clinical practice. Catheter malposition and tip migration can lead to severe complications. The authors present a case illustrating the endovascular management of inadvertent marginal sinus cannulation after an internal jugular vein (IJV) catheter tip migration. OBSERVATIONS A triple-lumen CVC was inserted without complications into the right IJV of a patient undergoing a repeat sternotomy for aortic valve replacement. Two weeks postinsertion, it was discovered that the tip had migrated superiorly, terminating below the torcula in the posterior fossa. In the interventional suite, a three-dimensional venogram confirmed the inadvertent marginal sinus cannulation. The catheter was carefully retracted to the sigmoid sinus to preserve the option of catheter exchange if embolization became necessary. After a subsequent venogram, which displayed an absence of contrast extravasation, the entire catheter was safely removed. The patient tolerated the procedure well. LESSONS Clinicians must be vigilant of catheter tip migration and malposition risks. Relying solely on postinsertion radiographs is insufficient. Once identified, prompt management of the malpositioned catheter is paramount in reducing morbidity and mortality and improving patient outcomes. Removing a malpositioned catheter constitutes a critical step, best performed by a specialized team under angiographic visualization.
Collapse
Affiliation(s)
- Abdelaziz Amllay
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Edwin Owolo
- 2Duke University School of Medicine, Durham, North Carolina
| | - Kamil W Nowicki
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Nanthiya Sujijantarat
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Andrew Koo
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Joseph P Antonios
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Daniela Renedo
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Charles C Matouk
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Ryan M Hebert
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| |
Collapse
|
9
|
Feng Y, Liu Y, Xu S, Zhong H, Jiang S. On the way to the azygos vein: a road of return rather than ruined. J Cardiothorac Surg 2024; 19:259. [PMID: 38643163 PMCID: PMC11031928 DOI: 10.1186/s13019-024-02708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/29/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter. CASE PRESENTATION A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications. CONCLUSIONS CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.
Collapse
Affiliation(s)
- Yiping Feng
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Yeqing Liu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Heath, Hangzhou, China
| | - Shanxiang Xu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Huiming Zhong
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Shouyin Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province; Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China.
| |
Collapse
|
10
|
Choudhary N, Banerjee N, Singh J, Kumari M, Kaur M. Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Ann Card Anaesth 2023; 26:418-422. [PMID: 37861576 PMCID: PMC10691558 DOI: 10.4103/aca.aca_32_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation. Aim Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Design Randomized comparative study. Materials and Methods After approval from Institutional Review Board and Ethical Committee, 100 patients of 18-70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique. Results First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group. Conclusion For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position.
Collapse
Affiliation(s)
- Nirmala Choudhary
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Neerja Banerjee
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Jyoti Singh
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Meena Kumari
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Mohandeep Kaur
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| |
Collapse
|
11
|
Gambato M, Scotti N, Borsari G, Zambon Bertoja J, Gabrieli JD, De Cassai A, Cester G, Navalesi P, Quaia E, Causin F. Chest X-ray Interpretation: Detecting Devices and Device-Related Complications. Diagnostics (Basel) 2023; 13:599. [PMID: 36832087 PMCID: PMC9954842 DOI: 10.3390/diagnostics13040599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
This short review has the aim of helping the radiologist to identify medical devices when interpreting a chest X-ray, as well as looking for their most commonly detectable complications. Nowadays, many different medical devices are used, often together, especially in critical patients. It is important for the radiologist to know what to look for and to remember the technical factors that need to be considered when checking each device's positioning.
Collapse
Affiliation(s)
- Marco Gambato
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Nicola Scotti
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Giacomo Borsari
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Jacopo Zambon Bertoja
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | | | - Alessandro De Cassai
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35121 Padua, Italy
| | - Giacomo Cester
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine (DIMED), University of Padova, 35121 Padua, Italy
- Institute of Radiology, University Hospital of Padova, 35121 Padua, Italy
| | - Francesco Causin
- Department of Neuroradiology, University Hospital of Padova, 35121 Padua, Italy
| |
Collapse
|
12
|
Ibarra-Sifuentes HR, Sánchez-Serna JF, Castillo-Torres SA, Vera-Pineda R, Cuellar-Monterrubio JE, Pezina-Cantú CO, Alvizures-Solares SR, Ramírez-Ramírez MG, Avila-Velázquez JL, Guerrero-González EM, Sánchez-Martínez C. Non-tunneled catheter tip depth position in urgent hemodialysis: a randomized controlled trial. Minerva Urol Nephrol 2023; 75:116-123. [PMID: 34114785 DOI: 10.23736/s2724-6051.21.04222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The average accepted depth for non-tunneled catheters (NTC) insertion does not guarantee its correct position, so controversy exists. The aim of this study was to assess the effect of two NTC placement depths on the number of NTC complication episodes. METHODS We designed a triple blind, parallel group, randomized controlled trial in a single Hemodialysis Center in Mexico (Registry: ACTRN12619000774123). We included patients in urgent need of hemodialysis via internal right jugular vein NTC. The length of the NTC tip placement depth was randomized to second intercostal space (2ICS) or fourth intercostal space (4ICS), using physical landmarks. The primary outcome was to compare the composite number of NTC dysfunction, repositioning, and relocation episodes for 48 hours post-procedure. RESULTS One hundred and sixty-five patients were included, 86 and 79 patients to NTC placement in the 2ICS and 4ICS, respectively. All patients underwent intention-to-treat analysis. The incidence of the composite outcome was lower in the 2ICS group compared to the 4ICS group, 4 (4.6%) and 50 (63%) combined episodes, respectively (P<0.001). Compared to the 4ICS group, the 2ICS group presented a relative risk of 0.06 (CI: 0.02-0.21, P<0.001) and number needed to treat (NNT) of 2.1. No adverse events occurred, derived from the NTC placement. CONCLUSIONS NTC tip placement in the 2ICS compared to 4ICS decreases the incidence of the combined number of dysfunctions, repositioning and relocation episodes, with a NNT of 2 for its prevention.
Collapse
Affiliation(s)
- Héctor R Ibarra-Sifuentes
- Department of Internal Medicine, Instituto Mexicano del Seguro Social, Hospital General de Zona11, Piedras Negras, Mexico - .,Unit of Nephrology, Instituto Mexicano del Seguro Social, Hospital General de Zona11, Piedras Negras, Mexico - .,Department of Internal Medicine, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico - .,Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico - .,Unidad Norte School of Medicine, Autonomous University of Coahuila, Piedras Negras, Mexico -
| | - José F Sánchez-Serna
- Secretaría de Salud, Unit of Nephrology, General Hospital Chetumal, Chetumal, Mexico
| | - Sergio A Castillo-Torres
- Department of Internal Medicine, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico.,Unit of Neurology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Raymundo Vera-Pineda
- Unit of Cardiology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Jesús E Cuellar-Monterrubio
- Unit of Gastroenterology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Cesar O Pezina-Cantú
- Unit of Hematology, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Constitución Hospital, Monterrey, Mexico
| | - Sergio R Alvizures-Solares
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - María G Ramírez-Ramírez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - José L Avila-Velázquez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elisa M Guerrero-González
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Concepción Sánchez-Martínez
- Unit of Nephrology, University Hospital of Monterrey, Autonomous University of Nuevo León, Monterrey, Mexico
| |
Collapse
|
13
|
Žarskus A, Zykutė D, Trepenaitis D, Macas A. Implementation of Ultrasound-Guided Infraclavicular Subclavian Venous Catheterization During Anesthesia and Elective Surgery: A Prospective Observational Study at a Single Center in Lithuania. Med Sci Monit 2023; 29:e938851. [PMID: 36627833 PMCID: PMC9844010 DOI: 10.12659/msm.938851] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ultrasound-guided procedures have become more reliable and efficient in daily anesthesiology practice, with increased patient comfort, better antimicrobial pattern, and easer care, and can be used in routine central vein catheterization practice. The infraclavicular subclavian vein approach provides all these advandages and in some clinical scenarios ensures the only appropriate route to central vein access. Therefore, this study of 105 patients aimed to implement and evaluate the use of ultrasound-guided infraclavicular subclavian venous catheterization. MATERIAL AND METHODS We enrolled 108 patients who were scheduled for elective major abdominal surgery and had an indication for central venous access. Catheterization was done according to the developed protocol. Anesthesiologists with at least 1 year of experience in regional ultrasound-guided anesthesia participated in this study. Data were collected and compared with the existing literature. RESULTS Out of 108 patients enrolled, 3 were excluded due to unfulfilled protocol. The successful catheterization rate was 98.1%. A significant relationship with deeper and narrower vein and failure was noted. On average, the distance between the vein entry point and acoustic shadow of the clavicle was 10.45 mm, at this point the depth was 22.01 mm and the diameter of the vein was 10.74 mm. The length of catheter intratissue passage was 42.06 mm. The angle between the skin and catheter passage was 31.58°. The malposition rate was 8.7%, and no predictive factors were identified. Equations to predict vein diameter and depth were generated. Patient weight more than 119.5 kg predicted procedure failure. There were no complications. CONCLUSIONS Ultrasound-guided infraclavicular subclavian vein catheterization can be easily and safely integrated into daily clinical practice, with high success rates and low complication rates.
Collapse
Affiliation(s)
- Ainius Žarskus
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Zykutė
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Darius Trepenaitis
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
14
|
Rabia R, Liaqat A, Mariam M, Kanwal A, Khan ZA, Mumtaz H. A case of accidental displacement of a central venous catheter in lung parenchyma leading to hydrothorax: A case report. Int J Surg Case Rep 2022; 102:107813. [PMID: 36470052 PMCID: PMC9720431 DOI: 10.1016/j.ijscr.2022.107813] [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: 10/04/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Effective critical care requires the placement of a central venous catheter (CVC), which is frequently indicated for volume resuscitation, hemodynamic assessment, and the administration of vasopressors, blood products, and parenteral nourishment. However, central venous catheterization is not without its complications. The majority of these problems are avoidable and treatable with proper patient selection, cautious insertion technique, and attention after catheter insertion. CASE We present a case of a 34-year-old male patient who developed unilateral hydrothorax as a result of a central venous catheter malposition in the lung parenchyma. The condition was resolved since the complication was identified and treated quickly. CONCLUSION Previous studies have revealed a few unusual incidences of catheter misplacement. This case report can be serviceable to the medical community as they should be aware of this unique presentation, it's management and outcome.
Collapse
Affiliation(s)
| | | | | | | | | | - Hassan Mumtaz
- Public Health Scholar, Health Services Academy, Pakistan,Corresponding author.
| |
Collapse
|
15
|
Maneuvers to Facilitate Central Venous Catheter Advancement in the Clavicular Region. JOURNAL OF INFUSION NURSING 2022; 45:326-336. [DOI: 10.1097/nan.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
16
|
de Smalen PP, Stoutjesdijk MJ. Vascular anomaly diagnosis by central venous catheter misplacement: a case report. J Med Case Rep 2022; 16:259. [PMID: 35729662 PMCID: PMC9215029 DOI: 10.1186/s13256-022-03467-8] [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: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Congenital heart diseases rarely have a primary manifestation in adulthood. They are a rare cause of pulmonary hypertension in adults. Case presentation A 70-year-old woman of Eurasian descent underwent emergency surgery for bowel ischemia. Her history of mild pulmonary hypertension likely correlates with a peculiar diagnosis of an anatomic anomaly on the postoperative x-ray and computed tomography scan. The central venous catheter was misplaced. Initial management consisted of removal of the catheter. The diagnosis, partial anomalous pulmonary venous return, may pose a clinical therapeutic dilemma. Conclusions Partial anomalous pulmonary venous return is a potentially treatable cause of pulmonary hypertension. With the current trend toward more medical imaging, we expect this diagnosis to be made more often in the future.
Collapse
Affiliation(s)
- Peter Paul de Smalen
- Department of Anesthesiology, Erasmus University Medical Centre, Na-17, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | | |
Collapse
|
17
|
Ulas AB, Aydin Y, Ogul H, Eroglu A. Incorrect placement of the central venous catheter directly into the superior vena cava. Intern Emerg Med 2022; 17:1223-1224. [PMID: 35349006 DOI: 10.1007/s11739-022-02972-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ali Bilal Ulas
- Department of Thoracic Surgery, Ataturk University, Medical Faculty, 25240, Erzurum, Turkey.
| | - Yener Aydin
- Department of Thoracic Surgery, Ataturk University, Medical Faculty, 25240, Erzurum, Turkey
- Anesthesiology Clinical Research Office, Ataturk University, Medical Faculty, Erzurum, Turkey
| | - Hayri Ogul
- Anesthesiology Clinical Research Office, Ataturk University, Medical Faculty, Erzurum, Turkey
- Department of Radiology, Duzce University, Medical Faculty, Duzce, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Ataturk University, Medical Faculty, 25240, Erzurum, Turkey
| |
Collapse
|
18
|
Santos ÁVD, Barbosa ED, Nunes GV, Cavalcante RDS, Diniz AKF, Freitas GRC, Araújo JFSBD. Inadequate positioning of central venous catheters inserted at intensive care units. EINSTEIN-SAO PAULO 2022; 20:eAO6497. [DOI: 10.31744/einstein_journal/2022ao6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/10/2021] [Indexed: 11/05/2022] Open
|
19
|
YEŞİLTAŞ MA, KAVALA AA, TURKYILMAZ S, KUSERLI Y, TOZ H. Comparison of the results of tunneled catheters from the subclavian vein and internal jugular vein for hemodialysis in older patients: a retrospective study. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Maddali DMM, Salim Al Aliyani DKR, Arora DNR, Sathiya MPM. Central Venous Catheter Tip Malposition Following Internal Jugular Vein Cannulation In Pediatric Patients With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2022; 36:2483-2487. [DOI: 10.1053/j.jvca.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
|
21
|
Babu S, Chennakeshavallu GN, Sruthi S. Artifact in central venous pressure waveform due to central venous catheter tip abutting the wall of superior vena cava. Ann Card Anaesth 2022; 25:243-244. [PMID: 35417983 PMCID: PMC9244253 DOI: 10.4103/aca.aca_241_20] [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: 11/04/2022] Open
|
22
|
Central venous catheter penetrating the spinal canal via the spinal foramen: A case report and literature review. Ann Vasc Surg 2021; 80:393.e1-393.e4. [PMID: 34780938 DOI: 10.1016/j.avsg.2021.09.027] [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: 06/12/2021] [Revised: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
The insertion of a neck central venous catheter (CVC) is a common procedure in medical practice; however, malposition and complications frequently occur. A 66-year-old woman had CVC inserted through the right internal jugular vein. CVC malposition was observed on chest radiography and computed tomography. The catheter was accidentally inserted via the vertebral vein and had entered the C6-C7 intervertebral foramen, penetrating the spinal canal with the tip at the T2 epidural space. We present this rare CVC complication to demonstrate the possibility of incorrect insertion of the catheter and penetration of the spinal canal, possibly causing neuronal damage.
Collapse
|
23
|
Al-Shareef AS, Darweish A, Shirah B. Inadvertent Arterial Cannulation and Norepinephrine Infusion Due to a Misplaced Central Venous Catheter. Cureus 2021; 13:e17757. [PMID: 34659970 PMCID: PMC8494162 DOI: 10.7759/cureus.17757] [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] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Central venous catheter (CVC) insertion is one of the most common procedures done for critically ill patients. The subclavian vein is the particular preferred site. Misplacement of a CVC via the subclavian vein is frequent and can result in life-threatening complications. We aim to report a rare complication of misplaced CVC in the left subclavian vein and norepinephrine infusion that was associated with right upper limb ischemia. Immediate recognition and intervention are key to prevent further complications. The use of ultrasound has proven to reduce such complication, and the hospital implemented the use of ultrasound prior to any CVC placement.
Collapse
Affiliation(s)
- Ali S Al-Shareef
- Department of Emergency Medicine, King Abdulaziz Medical City, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Aida Darweish
- Department of Emergency Medicine, King Abdulaziz Medical City, Jeddah, SAU.,Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bader Shirah
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| |
Collapse
|
24
|
Central venous catheterization site choice based on anatomical landmark technique: a systematic review and meta-analysis. J Anesth 2021; 35:801-810. [PMID: 34341863 DOI: 10.1007/s00540-021-02976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically. Individual preference and institutional routine dominate the traditional CVC choice; however, it is lack of high-level evidence. We sought to provide better clinical strategy for CVC site choice based on anatomical landmark technique between IJVC and SCVC. METHODS We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.Gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. Ethical problems are not applicable. RESULTS A total of 3378 patients from 7 studies were included in the analyses. Neither difference was found on the catheterization time (SMD 95% CI: -0.095-0.124, p = 0.792), nor any difference on the overall success rate (RR = 1.017, 95% CI: 0.927-1.117, p = 0.721, I2 = 89.6%) between the 2 procedures. However, subgroup analyses showed overall success rate of IJVC was significantly lower than that of SCVC (RR = 0.906, 95% CI: 0.850-0.965, p = 0.002) in adults. The first-attempt success rate of IJVC group was higher in the adults (RR = 1.472, 95% CI: 1.004-2.156, p = 0.047). No significance was detected in arterial injury (RR = 1.137, 95% CI: 0.541-2.387, p = 0.735) and pneumothorax (RR = 0.600, 95% CI: 0.32-1.126, p = 0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR = 2.824, 95% CI: 1.181-6.751, p = 0.02). CONCLUSIONS Compared with IJVC, SCVC shows a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma. PROSPERO REGISTRATION CRD42020165444.
Collapse
|
25
|
Kim YJ, Ma S, Yoon HK, Lee HC, Park HP, Oh H. Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: a randomised controlled non-inferiority trial. Anaesthesia 2021; 77:59-65. [PMID: 34231204 DOI: 10.1111/anae.15525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non-inferior to the infraclavicular approach in terms of safety during ultrasound-guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound-guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. We assessed catheterisation-related complications (primary outcome measure) including catheter misplacement and mechanical complications (arterial puncture, haematoma formation, pneumothorax and haemothorax). We also recorded catheterisation success rates and time required for venous puncture and catheterisation. The number (proportion) of patients with catheterisation-related complications was six (3.0%) in the supraclavicular group and 27 (13.4%) in the infraclavicular group, mean difference (95%CI) -10.4% (-15.7 to -5.1%), p < 0.001, with a significant difference also seen for catheter misplacement. Except for a shorter time (median (IQR [range]) required for venous puncture in the supraclavicular group, being 9 (6-20 [2-138]) vs. 13 (8-20 [3-99]) s, the incidence of mechanical complications and other catheterisation characteristics were similar between the two groups. We recommend the supraclavicular approach for ultrasound-guided right subclavian venous catheterisation.
Collapse
Affiliation(s)
- Y J Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - S Ma
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - H K Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - H C Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - H P Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - H Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
26
|
Choi H, Jeon JP, Huh J, Kim Y, Hwang W. Cephalad misplacement of a pulmonary artery catheter in a patient with a preexisting Hickman catheter. BMC Anesthesiol 2021; 21:73. [PMID: 34059000 PMCID: PMC8168018 DOI: 10.1186/s12871-021-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date. Case presentation An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications. Conclusions To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.
Collapse
Affiliation(s)
- Hoon Choi
- Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Joon Pyo Jeon
- Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jaewon Huh
- Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Youme Kim
- Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Wonjung Hwang
- Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| |
Collapse
|
27
|
De La Hoz Polo M, Sandhu A, Kashef E, Aylwin C, Bew D, Manikon M, Dick E. Medical and surgical devices in the emergency and trauma patient: what the radiologist should know, and how they can add value. Br J Radiol 2021; 94:20200530. [PMID: 33095656 DOI: 10.1259/bjr.20200530] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A variety of different external and internal medical devices are used in the acute setting to maintain life support and manage severely injured and unstable trauma or emergency patients. These devices are inserted into the acutely ill patient with the specific purpose of improving outcome, but misplacement can cause additional morbidity and mortality. Consequently, meaningful interpretation of the position of devices can affect acute management. Some devices such as nasopharyngeal, nasogastric and endotracheal tubes and chest and surgical drains are well known to most clinicians, however, little formal training exists for radiologists in composing their report on the imaging of these devices. The novice radiologist often relies on tips and phrases handed down in an aural tradition or resorts to phrases such as: "position as shown". Furthermore, radiologists with limited experience in trauma might not be familiar with the radiological appearance of other more specific devices. This review will focus on the most common medical devices used in acute trauma patients, indications, radiological appearance and their correct and suboptimal positioning.
Collapse
Affiliation(s)
| | - Amandeep Sandhu
- Radiology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Interventional and Trauma Radiology Department, Clinical Lead for Interventional and Trauma Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Christopher Aylwin
- Vascular & Trauma Surgery Department,Head of Specialty Major Trauma, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Duncan Bew
- Major Trauma and Surgery Department, Clinical Director of Major Trauma and Surgery, King´s College Hospital NHS Foundation Trust, London, UK
| | - Maribel Manikon
- Intensive Care Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Dick
- Radiology Department, Lead for Emergency Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
28
|
Poth JM, Ehrentraut SF, Kim SC. The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter. J Vasc Access 2021; 23:474-476. [PMID: 33645330 DOI: 10.1177/1129729821998531] [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: 11/16/2022] Open
Abstract
Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications.Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved.While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture.In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.
Collapse
Affiliation(s)
- Jens M Poth
- Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stefan F Ehrentraut
- Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Se-Chan Kim
- Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
29
|
ESPEN guideline on home parenteral nutrition: Comment. Clin Nutr 2021; 40:657. [DOI: 10.1016/j.clnu.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
|
30
|
Taman H, El Said Saber H, Farid A, Wafa T. Central venous access in neonates: Comparison of ultrasound-guided percutaneous access and minimal surgical open methods. Anesth Essays Res 2021; 15:395-400. [PMID: 35422540 PMCID: PMC9004281 DOI: 10.4103/aer.aer_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/04/2022] Open
|
31
|
Liu B, Xie J, Sun X, Wang Y, Yuan Z, Liu X, Huang Z, Wang J, Mo H, Yi Z, Guan X, Li L, Wang W, Li H, Ma F, Zeng Y. Development and Validation of a New Clinical Prediction Model of Catheter-Related Thrombosis Based on Vascular Ultrasound Diagnosis in Cancer Patients. Front Cardiovasc Med 2020; 7:571227. [PMID: 33195460 PMCID: PMC7649194 DOI: 10.3389/fcvm.2020.571227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/18/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Central venous catheters are convenient for drug delivery and improved comfort for cancer patients, but they also cause serious complications. The most common complication is catheter-related thrombosis (CRT). Objectives: This study aimed to evaluate the incidence and risk factors for CRT in cancer patients and develop an effective prediction model for CRT in cancer patients. Methods: The development of our prediction model was based on a retrospective cohort (n = 3,131) from the National Cancer Center. Our prediction model was confirmed in a prospective cohort from the National Cancer Center (n = 685) and a retrospective cohort from the Hunan Cancer Hospital (n = 61). The predictive accuracy and discriminative ability were determined by receiver operating characteristic (ROC) curves and calibration plots. Results: Multivariate analysis demonstrated that sex, cancer type, catheter type, position of the catheter tip, chemotherapy status, and antiplatelet/anticoagulation status at baseline were independent risk factors for CRT. The area under the ROC curve of our prediction model was 0.741 (CI: 0.715-0.766) in the primary cohort and 0.754 (CI: 0.704-0.803) and 0.658 (CI: 0.470-0.845) in validation cohorts 1 and 2, respectively. The model also showed good calibration and clinical impact in the primary and validation cohorts. Conclusions: Our model is a novel prediction tool for CRT risk that accurately assigns cancer patients into high- and low-risk groups. Our model will be valuable for clinicians when making decisions regarding thromboprophylaxis.
Collapse
Affiliation(s)
- Binliang Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junying Xie
- Department of Management, Cancer Hospital of Huanxing, Beijing, China
| | - Xiaoying Sun
- Department of Medical Oncology, Cancer Hospital of Huanxing, Beijing, China
| | - Yanfeng Wang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhong Yuan
- Vascular Access Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiyu Liu
- Department of Lymphoma and Hematology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhou Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiani Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongnan Mo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongbi Yi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuwen Guan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lixi Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenna Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixin Zeng
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| |
Collapse
|
32
|
Puspitasari M, Sinorita H, Bagaswoto HP, Kuswadi I, Prasanto H, Wardhani Y, Kurniawan WT. Persistent Left Superior Vena Cava Identified After Hemodialysis Catheter Insertion: A Case Report. Int Med Case Rep J 2020; 13:465-469. [PMID: 33061669 PMCID: PMC7534844 DOI: 10.2147/imcrj.s266858] [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] [Received: 06/10/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Central venous catheter (CVC) insertion is the most commonly performed clinical procedure when a patient initiates hemodialysis. Despite its clinical benefits, CVC insertion has several risks of complications. Thrombosis, venous stenosis, infection, arrhythmia, pneumothorax, and bleeding are among these complications. Malposition of the tip of the CVC can also occur with an incidence of up to 7%. One of several factors that could contribute to malposition is venous anatomy variation. Persistent left superior vena cava (PLSVC) is an extremely rare venous anatomical disorder but might have a significant clinical impact. Case Presentation Here we report a PLSVC case that was identified in chest radiography after the insertion of a CVC catheter in a patient with end-stage renal disease (ESRD). A 40-year-old woman with a history of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was presented in the emergency room with dyspnea for 1 week. Acute hemodialysis was required because of the ESRD and pulmonary edema. The PLSVC condition accompanied by various complications that occurred in this patient became a dilemma for the nephrologist in determining the diagnosis and proper CVC management. Discussion PLSVC is the most common congenital abnormality of the vena cava, even though it has a very small incidence. PLSVC occurs in about 0.1–0.5% of the total population and reaches 10% in individuals with congenital heart abnormalities. Most PLSVC presents along with normal superior vena cava and drains into the right atrium, which makes it very difficult to see the clinical signs and symptoms. Almost all PLSVC conditions are found incidentally during or after invasive procedures such as CVC insertion. CVC insertion in the PLSVC condition needs proper management to minimize the risk of complications. Conclusion This case shows the importance of understanding the PLSVC condition, which, although very rare, is expected to increase the awareness of the nephrologist in making the diagnosis, determining appropriate management, and preventing complications, thereby improving patient safety.
Collapse
Affiliation(s)
- Metalia Puspitasari
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hemi Sinorita
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hendry Purnasidha Bagaswoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Iri Kuswadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Heru Prasanto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Yulia Wardhani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wahyu Tri Kurniawan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| |
Collapse
|
33
|
[Finger pain and personality changes after chemotherapy initiation via a central venous port system in a 67-year-old female patient]. Internist (Berl) 2020; 61:1055-1058. [PMID: 32757047 DOI: 10.1007/s00108-020-00848-3] [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: 10/23/2022]
Abstract
Central venous port systems are an integral part of chemotherapy. Early recognition and management of arterial malposition are crucial to prevent further complications. A 67-year-old female with breast cancer underwent central venous port implantation for adjuvant chemotherapy. After administration of the first chemotherapy the patient developed acute bihemispheric cerebral infarction and myocardial ischemia due to arterio-arterial emboli with a toxic encephalopathic component. After systemic lysis and surgical removal of the central venous port system, the patient showed a complete recovery.
Collapse
|
34
|
Calcium priming of the central venous catheter prevents a drop in ionized calcium concentration during Regional Citrate Anticoagulation. ASAIO J 2020; 65:898-901. [PMID: 30418191 DOI: 10.1097/mat.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
During citrate-based Continuous Renal Replacement Therapy (CRRT), an infusion of calcium is necessary to replace the calcium lost in the effluent. The replacement takes place through a central venous catheter (CVC) that is primed with saline solution. Thus, we hypothesized a potential systemic anticoagulation caused by the unchelated citrate reaching the patient at the start of CRRT because of 0.42 ml of line dead space. In this pilot study, two subpopulations of 7 patients who underwent Continuous Veno-Venous Hemodiafiltration (150 ml/min of blood flow, 1500 ml/h dialysate flow, 1500 ml/h of citrate predilution) were studied. One had the CVC primed with saline, the second with calcium chloride 10%. Calcium replacement rate was 6.3 ± 0.2 ml/h. Ionized calcium concentration was studied over time in the two groups and in the group with saline priming we detected a transient period of hypocalcemia (ionized calcium concentration [iCa] < 1.00 mmol/l for the first 2 hours). In the subpopulation with the calcium priming, this was not present. No significant effect on filter life emerged. Priming of the catheter with calcium seems effective in avoiding a potential issue regarding citrate accumulation at the start of CRRT. More studies are needed to assess the clinical significance of this finding.
Collapse
|
35
|
Hatton GE, Kao LS. In Depth: Determining Optimal Central Venous Catheter Length During Insertion. World J Surg 2020; 44:2175. [PMID: 32342132 DOI: 10.1007/s00268-020-05517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gabrielle E Hatton
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX, 77030, USA.,Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 4.264, Houston, TX, 77030, USA. .,Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, University of Texas Health Science Center, Houston, TX, 77030, USA.
| |
Collapse
|
36
|
G N C, Sankar S, Kale SB, Ramasamy P. Intrathoracic Pressure Waveform Transduced From Central Venous Catheter Tip: To Remove or Reposition the Catheter? J Cardiothorac Vasc Anesth 2020; 34:1999-2001. [PMID: 32127279 DOI: 10.1053/j.jvca.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Chennakeshavallu G N
- Division of Cardiothoracic and Vascular Anesthesia, Meenakshi Multi Speciality Hospital, Tamil Nadu, India
| | - Sruthi Sankar
- Division of Cardiothoracic and Vascular Anesthesia, Meenakshi Multi Speciality Hospital, Tamil Nadu, India
| | - Suresh Babu Kale
- Division of Cardiothoracic and Vascular Surgery, Meenakshi Multi Speciality Hospital, Tamil Nadu, India
| | - Punithakumar Ramasamy
- Division of Cardiothoracic and Vascular Surgery, Meenakshi Multi Speciality Hospital, Tamil Nadu, India
| |
Collapse
|
37
|
An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.594025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
|
39
|
Chen W, Chiang M, Wang P, Wei K, Tung S, Chang T, Hung C. Esophageal perforation caused by a central venous catheter: A case report and literature review. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Wei‐Ming Chen
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
- Department of Health and NutritionChia Nan University of Pharmacy and Science Tainan Taiwan
- College of MedicineChang Gung University Taoyuan Taiwan
| | - Ming‐Shih Chiang
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
| | - Po‐Chang Wang
- Division of Cardiology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
| | - Kuo‐Liang Wei
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
- College of MedicineChang Gung University Taoyuan Taiwan
| | - Shui‐Yi Tung
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
- College of MedicineChang Gung University Taoyuan Taiwan
| | - Te‐Sheng Chang
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
- College of MedicineChang Gung University Taoyuan Taiwan
| | - Chao‐Hung Hung
- Division of Gastroenterology and Hepatology, Department of Internal MedicineChiayi Chang Gung Memorial Hospital Chiayi Taiwan
- College of MedicineChang Gung University Taoyuan Taiwan
- Division of Hepatogastroenterology, Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan
| |
Collapse
|
40
|
Aithal G, Muthuswamy G, Latif Z, Bhaskaran V, Haji Sani HS, Shindhe S, Manap NBA, Vadaje KS, Dato Paduka Buntar WS, Daiwajna RG. An Alternate In-Plane Technique of Ultrasound-Guided Internal Jugular Vein Cannulation. J Emerg Med 2019; 57:852-858. [DOI: 10.1016/j.jemermed.2019.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
|
41
|
Tristão FR, Moreira RCR, Valle CED, Neves GCS. Inadvertent insertion of a venous catheter into the internal thoracic vein: a word of caution. J Vasc Bras 2019; 18:e20190097. [PMID: 31807130 PMCID: PMC6880616 DOI: 10.1590/1677-5449.190097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Central venous catheters are widely used in clinical practice and are linked to many types of complications, including incorrect positioning at the time the catheter is fitted. Here, the authors describe a case in which a fully implantable catheter was inadvertently positioned in the right internal thoracic vein. The complication was identified when the nursing team attempted to use the catheter. The right internal thoracic vein is within the radiographic projection of the right brachiocephalic vein and the superior vena cava, simulating correct catheter placement on an anteroposterior radiograph. In cases of central catheter malfunction during the immediate postoperative period, work-up should include oblique and lateral views, to rule out the complication described here without a need for computed tomography.
Collapse
Affiliation(s)
- Flavia Ramos Tristão
- Hospital Nossa Senhora das Graças - HNSG, Serviço de Cirurgia Vascular Prof. Dr. Elias Abrão, Curitiba, PR, Brasil
| | - Ricardo César Rocha Moreira
- Hospital Nossa Senhora das Graças - HNSG, Serviço de Cirurgia Vascular Prof. Dr. Elias Abrão, Curitiba, PR, Brasil
| | - Carlos Eduardo Del Valle
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Ultrassonografia Vascular com Doppler, Curitiba, PR, Brasil
| | - Giana Caroline Strack Neves
- Hospital Nossa Senhora das Graças - HNSG, Serviço de Cirurgia Vascular Prof. Dr. Elias Abrão, Curitiba, PR, Brasil
| |
Collapse
|
42
|
Velioğlu Y, Yüksel A, Sınmaz E. Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:499-507. [PMID: 32082916 PMCID: PMC7018162 DOI: 10.5606/tgkdc.dergisi.2019.17972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/31/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to present clinical characteristics, peri-procedural outcomes, early and late complications, and management strategies in patients undergoing totally implantable venous access port insertion through percutaneous subclavian vein. METHODS A total of 2,084 port devices were inserted to 2,000 cancer patients (1,066 males, 934 females; mean age 58.4±12.7 years; range, 18 to 88 years) through subclavian vein using percutaneous landmark method between March 2012 and June 2018. Medical data including demographic features, primary diagnosis, technical success, procedural time, duration of device use, reasons for the device removal, and early and late complications were retrospectively analyzed. RESULTS The most common type of cancer was colon cancer in males and breast cancer in females. Technical success rate of the procedure was 98.5%. Right subclavian vein was accessed in the majority of patients (92.4%). Early complications including inadvertent arterial puncture, catheter malposition, superficial hematoma, and pneumothorax occurred in 143 patients (6.9%), while late complications including infection, catheter occlusion, venous thrombosis, wound problems, catheter migration and embolization and pinch-off syndrome was developed in 118 patients (5.7%). Inadvertent arterial puncture in 63 patients (3%) was the most common early complication, while infection in 44 patients (2.1%) was the most common late complication. A total of 192 devices were removed due to the completion of chemotherapy or development of complications. CONCLUSION Our study confirmed the safety and tolerability of totally implantable venous access port insertion through percutaneous subclavian vein with high technical success and low complication rates.
Collapse
Affiliation(s)
- Yusuf Velioğlu
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ahmet Yüksel
- Department of Cardiovascular Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Emrah Sınmaz
- Department of Thoracic Surgery, Bursa Ali Osman Sönmez Oncology Hospital
| |
Collapse
|
43
|
Hignell ER, Phelps J. Recurrent central venous catheter migration in a patient with brittle asthma. J Vasc Access 2019; 21:533-535. [PMID: 31526101 DOI: 10.1177/1129729819874993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Central venous catheters are widely used in intensive care and critically unwell patients, and reporting of unusual complications is in the interest of those using them on a regular basis. Recognised complications involve vascular, cardiac and pulmonary systems and include the risk of infection. Described is a case with a recurrent complication of device failure secondary to migration of the central venous catheter tip as a result of recurrent coughing episodes. The approach to inserting central catheters and diagnosing the cause for the migration is discussed. This case directly demonstrated looping and significant movement of a polyurethane catheter as a result of coughing. On two occasions, this resulted in the tip migration and the catheter becoming kinked, causing premature failure of the central venous catheter. This has only been seen before with silicone catheters. There should be high index of suspicion for migration of central venous catheters in patients with history of cough. Recommendations include maintaining a high index of suspicion for migration of central venous catheters in patients with history of cough and insertion of larger French size catheters in patient groups prone to severe coughing episodes. Ways to optimise initial central venous catheter placement using intracavitary electrocardiogram should be considered along with the use of interventional radiology in complex cases and those with recurrent complications.
Collapse
Affiliation(s)
| | - Julian Phelps
- Anaesthetic Department, Gloucester Royal Hospital, UK
| |
Collapse
|
44
|
Faraj J, Choudhary A, Ritter JC. Covered Stenting as Bail-Out Technique for Central Venous Catheter Malposition Within the Brachiocephalic Trunk. Vasc Endovascular Surg 2019; 54:65-68. [DOI: 10.1177/1538574419873175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.
Collapse
Affiliation(s)
- Joseph Faraj
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Anwar Choudhary
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jens C. Ritter
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
45
|
An 85-year-old Woman with Altered Mental Status and Hypotension. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e32. [PMID: 31410409 PMCID: PMC6683595 DOI: 10.22114/ajem.v0i0.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
46
|
Siew KSW, Hieu HQ, Loch A. ‘Transvenous’ pleurocentesis. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919869779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A middle-aged woman had a central venous catheter insertion for fluid resuscitation presented with tachypnea and oxygen desaturation 6 h later. Diagnosis was made based on the chest X-ray performed 6 h after the catheter placement. Thereafter, the patient received appropriate treatment.
Collapse
Affiliation(s)
- Kelvin Shenq Woei Siew
- Cardiology Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Huynh Quoc Hieu
- Cardiology Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alexander Loch
- Cardiology Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
47
|
Abstract
Uses of central venous access devices (CVADs) include the administration of vital fluids and medications. Implanted ports are a type of CVAD that is used when long-term vascular access is required. The device is discreet and associated with a low risk of catheter-related bloodstream infection. This article describes the different types and components of ports and how to select them. It explains how to insert ports, and provides guidance on accessing and de-accessing them
Collapse
Affiliation(s)
- Jane Hodson
- Lead IV Practitioner, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
48
|
Dralle H, Kols K, Agha A, Sohn M, Gockel I, Lainka M. [Arterial malpositioning of a port catheter]. Chirurg 2019; 90:149-152. [PMID: 30734079 DOI: 10.1007/s00104-018-0765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - K Kols
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hans-Böckler-Allee 3, 30173, Hannover, Deutschland.
| | - A Agha
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - M Sohn
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - I Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - M Lainka
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Gefäßchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| |
Collapse
|
49
|
Pazeli JM, Vieira ALS, Vicentino RS, Pazeli LJ, Lemos BC, Saliba MMR, Mello PA, Costa MD. Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students. Crit Ultrasound J 2018; 10:34. [PMID: 30564947 PMCID: PMC6298909 DOI: 10.1186/s13089-018-0115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US). Materials and methods Six medical students without experience with US were given 4 h of theoretical–practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients. They also simulated a puncture of the IJV at a demarcated point, where a TT was theoretically performed. Results Adequate images were obtained from 95% of the patients; the IJV, on the right side, was more commonly found in the anterolateral position in relation to the CCA (38%). On the left side, the most commonly position observed was the anterior (36%). The caliber of the IJV relative to the CCA greatly varied. The success rate in the IJV puncture simulation, observed with US, by the TTs was 55%. Conclusion The training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.
Collapse
Affiliation(s)
- José Muniz Pazeli
- FAME - Barbacena's School of Medicina, Barbacena, Brazil. .,Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | - Ana Luisa Silveira Vieira
- FAME - Barbacena's School of Medicina, Barbacena, Brazil.,Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Luisa Jabour Pazeli
- SUPREMA - School of Medical Sciences and Health of Juiz de Fora, Juiz de Fora, Brazil
| | | | | | | | | |
Collapse
|
50
|
Song F, Huang D, Chen Y, Xiao Z, Su K, Wen J, Guo W, Wang Z, Wu Y, Wang S, Qin T. Bedside ultrasound diagnosis of a malpositioned central venous catheter: A case report. Medicine (Baltimore) 2018; 97:e0501. [PMID: 29642224 PMCID: PMC5908571 DOI: 10.1097/md.0000000000010501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Central venous catheter (CVC) placement is commonly performed in intensive care unit. And CVC placement is associated with risks including CVC malposition, pneumothorax. Many of the previously reported cases are about catheter misplacement detected by bedside ultrasound, chest x-ray (CXR) and computed tomography. In this case, malposition was detected by bedside ultrasound incidentally particularly with no clinical manifestation. PATIENT CONCERNS An 88-year-old male with severe diabetic peripheral neuropathy secondary to type 2 diabetes mellitus was admitted for further treatment. DIAGNOSES We cannulated a single-lumen CVC via the right subclavian vein, and the tip ended up in the internal jugular vein on the same side. With bedside ultrasound, we discovered the malposition though it was mistaken by aspiration of venous blood. Later, CXR revealed malposition of the tip once again. INTERVENTIONS Since the patient was asymptomatic and the catheter was functioning normally, the catheter was used for the following 20 days without complications. Ultimately, we carefully performed the catheter removal. OUTCOMES After the inserted catheter was removed, we attempted a new CVC through the left internal jugular vein. After the procedure, bedside ultrasound and CXR confirmed the correct position of CVC. Following successful replacement of the central catheter, no further complications were observed. LESSONS Bedside ultrasound offers safety and effectiveness during insertion of CVC. It also exhibits promptness and accuracy compared to post-intervention radiological imaging.
Collapse
Affiliation(s)
- Feier Song
- Department of Cardiology, Guangdong Cardiovascular Institue, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Daozheng Huang
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Ying Chen
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Zhiyuan Xiao
- Department of Critical Care Medicine, Yunnan Cancer Hospital
| | - Ke Su
- Department of Critical Care Medicine, Zhongshan Dongsheng Hospital, Guangzhou, Guangdong Province, China
| | - Jianyi Wen
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Weixin Guo
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Zhonghua Wang
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Yan Wu
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| |
Collapse
|