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Pittiruti M, Bilancia A, Ortiz Miluy G, D'Arrigo S. A comparison between two radiological criteria for verifying tip location of central venous catheters. J Vasc Access 2024; 25:551-556. [PMID: 36203365 DOI: 10.1177/11297298221126818] [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
INTRODUCTION Current guidelines recommend intraprocedural methods-such as Intra-Cavitary ECG (IC-ECG) and echocardiography-for verifying the location of the tip of central venous catheters. Nonetheless, there are clinical conditions which may require to verify tip location by less accurate methods such as Chest X-Ray (CXR). We have compared the feasibility and accuracy of two radiological methods for tip location-the Sweet Spot Criterion (SSC) and the Carina Criterion (CC)-using IC-ECG as reference. METHODS In this retrospective multicenter study, we reviewed the radiology databases of three hospitals, examining all CXRs performed on patients after insertion of Peripherally Inserted Central Catheters (PICCs), as long as the tip location had been successfully performed during the procedure by IC-ECG. Tip location was verified using SSC and CC, comparing the two methods in terms of feasibility and accuracy. RESULTS We reviewed the CXR of 1116 PICCs successfully inserted by IC-ECG. CC was not feasible in 0.5% (impossible visualization of the carina) and difficult in 1.5%; in 97.7% of cases, the position of the tip was adequate (1-5 cm below the carina), in 0.6% too high (<1 cm), in 1.2% too low (6-9 cm). On the other hand, because of unclear visualization of radiological landmarks, SSC was not feasible in 0.9% and difficult in 10.5%; though, according to SSC the tip location was always acceptable (in 94.2% the tip was in the middle of the spot, in 2.5% close to the superior border, and in 2.3% close to the inferior border); no tip was visualized outside of the spot. CONCLUSION CC and SSC were similar in terms of feasibility (99.5% vs 99.1%) and accuracy (98.1% vs 100%), though CC was subjectively perceived to be easier and more rapid to perform.
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Affiliation(s)
- Mauro Pittiruti
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | | | - Sonia D'Arrigo
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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Park H, Seo TS, Song MG, Yang WJ. Feasibility and Safety of a Technique Intended to Place the Catheter Tip in the Right Atrium without Abutment Against the Cardiac Wall during Implantation of the Totally Implantable Venous Access Port. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:161-170. [PMID: 38362390 PMCID: PMC10864156 DOI: 10.3348/jksr.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 02/17/2024]
Abstract
Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction.
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Prasad P, Vachharajani TJ. Non-Fluoroscopic Techniques to Insert a Tunneled Hemodialysis Catheter. Kidney Int Rep 2023; 8:2191-2193. [PMID: 38025226 PMCID: PMC10658409 DOI: 10.1016/j.ekir.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Pallavi Prasad
- Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Tushar J. Vachharajani
- Department of Medicine, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
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Messina Alvarez AA, Bilal MA, Manasrah N, Chaudhary A. Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review. Cureus 2023; 15:e37695. [PMID: 37206520 PMCID: PMC10191201 DOI: 10.7759/cureus.37695] [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: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Cardiac tamponade is the fluid accumulation within the pericardial sac that compresses the heart and decreases cardiac output. More than 20% of the cases are surgical or non-surgical iatrogenic causes. Cardiac tamponade has been described as a rare complication of central venous catheter placement with an incidence in adults as low as less than 1% but with significantly high mortality of more than 60%. The purpose of this article is to review the incidence, clinical manifestations, pathophysiology, diagnosis, and management of cardiac tamponade after central venous catheter placement as well as different methods to prevent this fatal complication from occurring.
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Affiliation(s)
| | - Mohammad A Bilal
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Ahmed Chaudhary
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
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Muacevic A, Adler JR, Almeida J, Gonçalves L, Madeira I, Costa A. "Optimal" Central Venous Catheter Tip Position Does Not Increase Catheter Duration: A Retrospective Cohort Study. Cureus 2022; 14:e32627. [PMID: 36660530 PMCID: PMC9845532 DOI: 10.7759/cureus.32627] [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: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Central venous cannulation provides venous access in different settings. Multiple guidelines and checklists still recommend confirmation of central venous catheter (CVC) tip position using a chest radiograph. The rationale is to detect and prevent complications thus optimizing CVC placement. Our primary hypothesis is that confirmation of catheter tip position by chest radiograph is not associated with increased catheter duration. Methods A retrospective cohort study was conducted with 921 patients included. Demographic, procedure and catheter data was obtained from adult patients that placed a CVC in the operating room. The catheter tip was independently classified as "optimal" or "malpositioned" independently by two researchers. Results Data from 921 CVC placements was collected. Patients who had a post-procedure chest radiograph (n=682, 74.0%) differed from those who did not in terms of co-morbidities (p=0.030), indication for CVC (p=0.023), duration of placement (p<0.001), number of punctured veins (p=0.036) and use of ultrasound (p<0.001). There was substantial agreement between researchers when classifying CVC tip as "optimal" or "malpositioned" (κ=0.632, p<0.001). No statistically significant difference was found between duration or complications of "optimal" CVCs compared to unknown tip/"malpositioned" CVCs. This study showed a 99% rate of clinically redundant chest radiographs according to Pikwer's criteria for radiographic examination. Conclusion No difference was found regarding catheter duration or complications when comparing "optimal" and unknown/"malpositioned" tip. This study illustrates some consequences of post-procedure radiographs and reinforces that the risks/benefits should be weighed and that chest radiograph should not be done by routine.
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Muacevic A, Adler JR, Tekgul ZT. Assessment of the Tip Position of Central Venous Catheters Inserted Using Peres' Height Formula. Cureus 2022; 14:e31988. [PMID: 36589175 PMCID: PMC9797751 DOI: 10.7759/cureus.31988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The tip of a central venous catheter (CVC) should be positioned in the proximity of the cavo-atrial junction (CAJ) where the lower third of the superior vena cava (SVC) and the upper right atrium (RA) are located to prevent life-threatening complications. This study aimed to determine the accuracy of Peres' height formula in predicting the correct insertion depth of CVC. Methods: A total of 332 patients were enrolled in this prospective observational study. All CVCs were inserted using Peres' formula. The 'correct' tip position of CVC was the placement of the CVC tip 1 cm above and 1 cm below the carina in CXR. Rates of correct placements for each side and site of catheter insertions, gender, and body mass index (BMI) differences were evaluated. RESULTS The correct placement rate of all catheters was 74.4%. There were statistically significant correlations between the correct placement of right-sided jugular and subclavian catheters (p<0.001) and left-sided jugular and subclavian catheters (p=0.014). There was a statistically significant difference in male patients (p=0.047). Higher BMI resulted in a lower rate of correct placement with no statistically significant difference (p=0.457). CONCLUSIONS Peres' formula can be easily used to determine the correct position of CVC tips with a success rate in the Turkish population. However, practitioners should be aware of the low accuracy rate of Peres' formula in female patients (68.5%) and patients with BMI over 35 kg/m2 (62.5%).
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Kim SK, Ahn JH, Lee YK, Hwang BY, Lee MK, Kim IS. Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks. J Clin Med 2022; 11:jcm11133692. [PMID: 35806977 PMCID: PMC9267543 DOI: 10.3390/jcm11133692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.
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Affiliation(s)
- Sun Key Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Bo Young Hwang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Min Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
| | - Il Seok Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea; (S.K.K.); (Y.K.L.); (B.Y.H.); (M.K.L.)
- Correspondence: ; Tel.: +82-10-4706-6356
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Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. J Intensive Care Med 2022; 37:1215-1222. [PMID: 35723623 DOI: 10.1177/08850666221076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention. This study aims to evaluate local practices of mechanical complication frequency, type, and subsequent intervention(s) related to mechanical AE with an emphasis on catheter malpositioning. Methods: This is a retrospective review of CVC placements in a tertiary hospital setting from 1/2013 to 12/2013. Pneumothorax and CVC positioning were evaluated on post-insertion chest x-ray (CXR). Malposition was defined as unintended placement of the catheter in a vessel other than the intended superior vena cava on CXR. Catheter reposition was defined as radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included pneumothorax and thoracostomy rate, CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Result: Among 2045 eligible CVC insertions, pneumothoraces occurred in 14 (0.7%; 95%CI 0.38, 1.17) and malpositions were identified in 275 (13.4%; 95% CI 12.3, 15.3). The proportion of pneumothoraces that required tube thoracostomy was 57%. The proportion of CVCs with malposition that were removed or replaced within 24h was 32.7%. "Malpositioned" catheters that were left in place by the clinical team (n = 185) had an average catheter duration of 8.2 days (95% CI 7.2, 9.3) versus 7.2 days (95% CI 6.17, 8.23) for catheters that were replaced after initial malposition (p = 0.14, t test). The incidence of venous thrombosis in repositioned "malpositioned" catheters was 7.8% versus 4.9% for "malpositioned" catheters that were left in place. Conclusions: Clinically significant catheter malposition and pneumothorax after CVC insertion are low. In this study, replaced and non-replaced "malpositioned" catheters had similar catheter duration and rates of complications, challenging the current dogma of CVC malposition practice.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Huang
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian Holley
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Willman
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Griffey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel L Theodoro
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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Corradi F, Guarracino F, Santori G, Brusasco C, Tavazzi G, Via G, Mongodi S, Mojoli F, Biagini RUD, Isirdi A, Dazzi F, Robba C, Vetrugno L, Forfori F. Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography. Crit Care 2022; 26:113. [PMID: 35449059 PMCID: PMC9027702 DOI: 10.1186/s13054-022-03985-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. METHODS A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. RESULTS As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view. CONCLUSIONS The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy. .,Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, PI, Italy.
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
| | - Guido Tavazzi
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Silvia Mongodi
- Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Mojoli
- Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Anaesthesia, Intensive Care and Pain Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandro Isirdi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Federico Dazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Stringer BJ, Shumway SB, Willden JP, Kuck K. Analysis of skew of visible laser reflections in a living sheep heart. JOURNAL OF BIOPHOTONICS 2022; 15:e202100317. [PMID: 34985813 DOI: 10.1002/jbio.202100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
Limited methods exist to confirm the position of cardiovascular devices in the heart. In our earlier work, an optical fiber was enclosed in a central catheter and guided to known positions in the superior vena cava and right atrium in the heart of a living sheep. The tissues were illuminated with two wavelengths of visible light and the reflections were analyzed using frequency domain techniques. In this follow-up work, the data were reanalyzed using statistical estimates of skew and kurtosis as a function of anatomic position. Skew values from a 520 nm laser were able to determine catheter tip position near the cavoatrial junction as validated against known positions previously determined with electrocardiogram and contrast-enhanced video fluoroscopy. This method successfully confirmed the location of the catheter tip at the cavoatrial junction in 84% of 840 trials. Further research with refined apparatus and algorithms on additional animal subjects is strongly suggested.
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Affiliation(s)
- Bradley J Stringer
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Spencer B Shumway
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kai Kuck
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
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Pediatric central venous access devices: practice, performance, and costs. Pediatr Res 2022; 92:1381-1390. [PMID: 35136199 PMCID: PMC9700519 DOI: 10.1038/s41390-022-01977-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Healthcare delivery is reliant on a functional central venous access device (CVAD), but the knowledge surrounding the burden of pediatric CVAD-associated harm is limited. METHODS A prospective cohort study at a tertiary-referral pediatric hospital in Australia. Children <18 years undergoing insertion of a CVAD were screened from the operating theatre and intensive care unit records, then assessed bi-weekly for up to 3 months. Outcomes were CVAD failure and complications, and associated healthcare costs (cost of complications). RESULTS 163 patients with 200 CVADs were recruited and followed for 6993 catheter days, with peripherally inserted central catheters most common (n = 119; 60%). CVAD failure occurred in 20% of devices (n = 30; 95% CI: 15-26), at an incidence rate (IR) of 5.72 per 1000 catheter days (95% CI: 4.09-7.78). CVAD complications were evident in 43% of all CVADs (n = 86; 95% CI: 36-50), at a rate of 12.29 per 1000 catheter days (95% CI: 9.84-15.16). CVAD failure costs were A$826 per episode, and A$165,372 per 1000 CVADs. Comparisons between current and recommended practice revealed inconsistent use of ultrasound guidance for insertion, sub-optimal tip-positioning, and appropriate device selection. CONCLUSIONS CVAD complications and failures represent substantial burdens to children and healthcare. Future efforts need to focus on the inconsistent use of best practices. IMPACT Current surveillance of central venous access device (CVAD) performance is likely under-estimating actual burden on pediatric patients and the healthcare system. CVAD failure due to complication was evident in 20% of CVADs. Costs associated with CVAD complications average at $2327 (AUD, 2020) per episode. Further investment in key diverse practice areas, including new CVAD types, CVAD pathology-based occlusion and dislodgment strategies, the appropriate use of device types, and tip-positioning technologies, will likely lead to extensive benefit.
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Central Venous Catheters for Hemodialysis-the Myth and the Evidence. Kidney Int Rep 2021; 6:2958-2968. [PMID: 34901568 PMCID: PMC8640568 DOI: 10.1016/j.ekir.2021.09.009] [Citation(s) in RCA: 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: 01/21/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hemodialysis-central venous catheter (HD-CVC) insertion is a most often performed procedure, with approximately 80% of patients with end-stage kidney disease in the United States initiating kidney replacement therapy through a HD-CVC. Certain adverse events arising from HD-CVC placement, including catheter-related bloodstream infections (CR-BSIs), thrombosis, and central vein stenosis, can complicate the clinical course of patients and lead to considerable financial impact on the health care system. Medical professionals with different training backgrounds are responsible for performing this procedure, and therefore, comprehensive operator guidelines are crucial to improve the success rate of HD-CVC insertion and prevent complications. In this review article, we not only discuss the basic principles behind the use of HD-CVCs but also address frequently asked questions and myths regarding catheter asepsis, length selection, tip positioning, and flow rate assessment.
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Stringer BJ, Shumway SB, Willden JP, Kuck K. Joint time-frequency analysis of visible laser reflections in a sheep heart. JOURNAL OF BIOPHOTONICS 2021; 14:e202000464. [PMID: 33934517 DOI: 10.1002/jbio.202000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber-based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser-based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction. The time series data were postoperatively analyzed using methods of joint time-frequency analysis and validated against catheter positions determined with fluoroscopy and ECG. The system was successful in distinguishing the location of the superior vena cava from the right atrium.
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Affiliation(s)
- Bradley J Stringer
- Verum TCS, LLC, Ridgefield, Washington, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Kai Kuck
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
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Huseynova RA, A. Bin Mahmoud L, AlHemiad M, Almuhaini M, Huseynov O. Early pericardial effusion as complication of umbilical venous catheter insertion in extreme preterm baby: A case report. Clin Case Rep 2021; 9:2109-2112. [PMID: 33936648 PMCID: PMC8077324 DOI: 10.1002/ccr3.3957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
Reminder essential clinical practice: Pericardial effusion is a rare fatal condition, however potentially reversible when grasped in time. It should always be thought out in neonate with a central line who develops unexplained cardiorespiratory failure.
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Affiliation(s)
| | | | | | - Muath Almuhaini
- King Saud Medical City King Saud Medical CityRiyadhSaudi Arabia
| | - Oqtay Huseynov
- Azerbaijan Medical University Nariman NarimanovBakuAzerbaijan
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Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres' Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24:527-530. [PMID: 32963434 PMCID: PMC7482340 DOI: 10.5005/jp-journals-10071-23478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Central venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmia's, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications. Objective To compare Peres’ formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach. Materials and methods A total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups—Peres’ group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups. Results About 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups. Conclusion Radiological landmark formula is superior to Peres’ formula for measuring optimal depth of insertion of right internal jugular venous catheter. How to cite this article Manudeep AR, Manjula BP, Dinesh Kumar US. Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24(7):527–530.
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Affiliation(s)
- A R Manudeep
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - B P Manjula
- Department of Anesthesia, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - U S Dinesh Kumar
- Deparatment of Cardiothoracic and Vascular Anaesthesia, JSS Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020; 24:498-499. [PMID: 32963427 PMCID: PMC7482338 DOI: 10.5005/jp-journals-10071-23510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020;24(7):498-499.
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Affiliation(s)
- Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mehta N, Desai SM, Dhakad V, Patel D, Saldanha E. External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study. Indian J Surg Oncol 2020; 11:418-422. [PMID: 33013121 DOI: 10.1007/s13193-020-01103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy drugs are the integral part of cancer treatment. Their administration is optimized by central venous access devices. We present our prospective study of chemoport implantation by external jugular vein cutdown technique. We studied 100 patients who underwent chemoport insertion over a span of 3 years for various solid and haematological malignancies via external jugular vein cutdown method. Outcomes such as type of disease, anaesthesia, choice of venous access, catheter tip position, length of the procedure, time to start chemotherapy and morbidity data were analysed. The Hundred /100 intravenous devices were implanted in 66% females and 33% males. Most common indication was breast cancer (64% of patients). A total of 80% of patients underwent procedure under local anaesthesia. Chemoports were inserted on the right side in 84 and left side in the remaining 16. The average surgical time was 32 min. The overall success rate was 97% with no intraoperative complications. Three postoperative complications were encountered due to displacement of catheter or wound infection. External jugular vein cutdown approach is a safe, reliable method for venous access device implantation. This approach has a high success rate and has minimal complications and can be easily learnt.
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Affiliation(s)
- Nikhil Mehta
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Sanjay M Desai
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Vinod Dhakad
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Dhruv Patel
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Elroy Saldanha
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
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Thonon H, Espeel F, Frederic F, Thys F. Overlooked guide wire: a multicomplicated Swiss Cheese Model example. Analysis of a case and review of the literature. Acta Clin Belg 2020; 75:193-199. [PMID: 30931817 DOI: 10.1080/17843286.2019.1592738] [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: 10/27/2022]
Abstract
Objectives: Central venous catheter (CVC) implementation is now usual in emergency department. The most common complications are misplacement, bleeding, pleural perforation, thrombosis and sepsis. Forgetting a guide wire in the patient's body after catheterization is an underestimated complication of this procedure; only 76 cases are described. Even if the majority of patients remained asymptomatic, severe complications can happened even years later. This article's aim is to identify the sequence of elements that led to the event occurrence and to suggest recommendations of good practice to minimize complications related to central catheter placement.Method: After reviewing all the complications related to central venous catheterization and their frequencies, we analyse from a case report and a review of the literature the sequence of elements that led to the medical error. We use an Ishikawa diagram to show our results and the links between them.Results: Our Ishikawa diagram shows that material, human resources, procedural and radiological involvement factors are the main elements on which we can act to reduce the complications rate after central venous catheterization. We advocate for the establishment of standardized procedures before, during and after the technical gesture.Conclusions: Because of human nature, errors will always be possible when taking care of a patient. However, we propose good practice recommendations to avoid the repetition of a forgetting guide wire after central venous catheterization.
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Affiliation(s)
- Henri Thonon
- Emergency department, CHU UCL Namur, Yvoir, Belgium
| | - Florence Espeel
- Emergency Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Ficart Frederic
- Patient safety manager, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - Frédéric Thys
- Emergency department, CHU UCL Namur, Yvoir, Belgium
- Université Catholique de Louvain (UCL), Belgium
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19
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[Ultrasound visualization of the guidewire and positioning of the central venous catheter : A prospective observational study]. Anaesthesist 2020; 69:489-496. [PMID: 32409857 DOI: 10.1007/s00101-020-00794-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND After insertion of a central venous catheter (CVC) the catheter position must be controlled and a pneumothorax ruled out. OBJECTIVE The aim was to examine whether the use of two standard acoustic windows known from emergency sonography examination techniques is feasible to 1) verify the correct intravenous localization and direction of the guidewire before final CVC insertion and 2) correctly predict the required CVC length for positioning of the catheter tip in the lower third of the superior vena cava. MATERIAL AND METHODS This single center prospective observational study included adult patients (age ≥18 years) with an indication for CVC insertion after institutional ethics approval was obtained. Puncture sites were restricted to bilateral internal jugular and subclavian veins and except for duplicate examinations no further exclusion criteria were defined. After vessel puncture and insertion of the guidewire, the vena cava was displayed by an additional ultrasound examiner (sector scanner 1.5-3.6 MHz) using the transhepatic or subcostal acoustic window to localize the guidewire. For positioning of the CVC tip, the required catheter length in relation to the cavoatrial junction was measured using the guidewire marks during slow retraction and consecutive disappearance of the J‑shaped guidewire tip from each acoustic window. From the resulting insertion length of the guidewire 4 cm was subtracted for the transhepatic and 2 cm for the subcostal window under the assumption that this length correlates to the distance from the cavoatrial junction. The CVC was finally inserted and a chest radiograph was performed for radiological verification of the CVC position. RESULTS Of 100 included patients, 94 could finally be analyzed. The guidewire could be identified in the vena cava in 91 patients (97%) within a time period of 2.2 ± 1.9 min. In three patients, the wire could not be visualized, although two catheters had the correct position, while one catheter was incorrectly positioned in the opposite axillary vein. In the second study part, positioning of the CVC was evaluated in 44 of the 94 patients. In 5 of these 44 patients, the correct direction and disappearance of the guidewire from the acoustic window could also be reliably visualized; however, with the left subclavian vein as the puncture site, the respective catheters were up to 6 cm too short for correct positioning. Thus, these 5 patients were excluded from this analysis. In the remaining 39 patients, the position of the CVC tip was optimally located in the lower third of the superior vena cava according to the chest radiograph in 20 patients (51%), while it was relatively too high in 5 patients (13%) and too low (entrance of the right atrium) in 9 patients. In the other 5 patients, disappearance of the guidewire from the acoustic window was not definitely detectable. CONCLUSION The presented intraprocedural ultrasound-based method using two standard acoustic windows is reliable for verification of the correct intravenous location and direction of the guidewire even before dilatation of the vessel puncture site for insertion of the catheter. Furthermore, the method allows the clinically acceptable measurement of the required length for catheter positioning. A chest radiograph can be waived provided the ultrasound examination (identification of the guidewire and exclusion of puncture-related complications such as pneumothorax) is unambiguous.
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Optimal Prediction of the Central Venous Catheter Insertion Depth Targeting the Cavoatrial Junction. World J Surg 2020; 44:2170-2174. [PMID: 32144470 DOI: 10.1007/s00268-020-05449-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Central venous catheters should be positioned at the cavoatrial junction or the right atrium. If catheters are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the length between the clavicular notch and the carina, the catheter tip can be placed near the carina. Based on this, we aim to make a formula to place a catheter tip near the cavoatrial junction. METHODS This prospective nonrandomized interventional study included patients who needed a central venous catheter from June 2017 to July 2018. The location of the cavoatrial junction was identified using a fluoroscopic technique. The following variables were measured: L1, the length between the needle insertion point and the clavicular notch; L2, the length between the clavicular notch and the carina; and α, the length between the carina and the cavoatrial junction. RESULTS A total of 70 patients were enrolled. The mean age was 65.5 ± 11.6 years, and 62.9% were male. The mean L1 and L2 were 7.6 ± 1.4 and 7.0 ± 1.4 cm, respectively. The mean α was 4.4 ± 1.5 cm (95% CI 4.1-4.8), and it was not affected by demographic factors, such as sex, age, height or weight. CONCLUSIONS Central venous catheters in adult patients can be placed near the cavoatrial junction using a simple formula: the distance between the insertion point and the clavicular notch + the distance between the clavicular notch to the carina + 4.4 cm.
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Zhu SS, Zhao J, Zhou XY, Gao W, Pan MH, Yu WW, Hao HX, Zhang HJ, Yu DX, Wang QY, Huang P, Yin YX, Wang L. Influence of arm position change from adduction to abduction on intracavitary electrocardiogram. J Vasc Access 2019; 22:292-298. [PMID: 31808719 DOI: 10.1177/1129729819891565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the influence of arm movements from adduction to abduction on intracavitary electrocardiogram and the position of a catheter tip. METHODS Overall, 192 peripherally inserted central catheter lines were placed under intracavitary electrocardiogram guidance and 188 of them were enrolled in the study. The catheter was first placed at a time point corresponding to the peak P wave with the arm in adduction. The arm was then abducted to 90° without changing catheter insertion length. During the procedure, basal electrocardiogram, intracavitary electrocardiogram, and radiographs with the arm in adduction and abduction were recorded. Amplitude wave changes and catheter movements were measured on electrocardiogram records and radiographs, respectively. RESULTS In 188 cases, the P wave displayed typical changes, and 97.8% (184/188) catheters were successfully placed correctly. At the peak P wave, the amplitude of the peak P wave was 8.64 times greater than that of the basal P wave, and the P/R ratio was 0.61. When the arm was abducted to 90°, the amplitude of the P wave dropped to 57% of its peak, P/R decreased from 0.61 to 0.34, and the catheter tip moved cephalad 1.00 and 0.77 vertebral body units in male and female patients, respectively. CONCLUSION Peripherally inserted central catheter moves toward the heart when the arm position changes from abduction to adduction. Peripherally inserted central catheter tip placement at the peak P wave with patient's arm in adduction is accurate and can prevent the catheter from advancing too low. R wave can function as a reference for observing P wave changes during peripherally inserted central catheter placement.
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Affiliation(s)
- Shu-Shu Zhu
- Department of PICC Clinic, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China.,School of Nursing, Shandong University, Jinan, China
| | - Jing Zhao
- Department of Gynecology, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Xin-Yu Zhou
- School of Nursing, Shandong University, Jinan, China
| | - Wei Gao
- Department of PICC Clinic, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Ming-Hao Pan
- School of Nursing, Shandong University, Jinan, China
| | - Wei-Wei Yu
- Department of PICC Clinic, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Hai-Xia Hao
- Department of PICC Clinic, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Hai-Jun Zhang
- Department of Vascular & Intervention, Tenth People's Hospital of Tongji University, Shanghai, China
| | - De-Xin Yu
- Department of Radiology, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Qing-Yan Wang
- Department of Health Care, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Ping Huang
- Department of Gynecology, Qilu Hospital, Shandong Univerisity, Jinan, Shandong, China
| | - Yu-Xia Yin
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Lei Wang
- Department of Nursing, Beijing Hospital, National Center of Gerontology, Beijing, China
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Kwon TD, Kim KH, Ryu HG, Jung CW, Goo JM, Bahk JH. Intra- and Extra-pericardial Lengths of the Superior Vena Cava in Vivo: Implication for the Positioning of Central Venous Catheters. Anaesth Intensive Care 2019; 33:384-7. [PMID: 15973923 DOI: 10.1177/0310057x0503300315] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To reduce the possibility of cardiac tamponade, a rare but lethal complication of central venous catheters, the tip of the central venous catheter should be located above the cephalic limit of the pericardial reflection, not only above the superior vena cava-right atrium junction. This study was performed to measure the superior vena cava lengths above and below the pericardial reflection in cardiac surgical patients. Cardiac surgical patients (n=61; 27 male), whose age [mean±SD (range)] was 47±15 (15–75) years, were studied. The intrapericardial and extrapericardial lengths, and the length of the medial duplicated part were measured separately. The whole vertical lengths of the superior vena cava on either side were calculated respectively by adding the intra-and extrapericardial and medial duplication lengths. The lateral extrapericardial was 29.1±6.5 (Mean±SD) (9–49) mm (range), and lateral extrapericardial length was 32.6±6.9 (20–53) mm. The medial extrapericardial length was 23.3±5.0 (11–39) mm, medical duplicated length was 7.2±3.3 (4–20) mm, and medial intrapericardial was 28.3±7.0 (20–52) mm. The averaged superior vena cava length of both sides was 60.3±9.0 (44.5–90) mm. Almost half of the superior vena cava was found to be within the pericardium and half out. This information may be helpful in deciding how far a central venous catheter should be withdrawn beyond the superior vena cava-right atrial junction during right atrial electrocardiographic guided insertion, and in the prediction of optimal central venous catheter insertion depth.
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Affiliation(s)
- T D Kwon
- Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Calabrese M, Montini L, Arlotta G, La Greca A, Biasucci DG, Bevilacqua F, Antoniucci E, Scapigliati A, Cavaliere F, Pittiruti M. A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients. J Vasc Access 2018; 20:516-523. [DOI: 10.1177/1129729818819422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction:The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable P wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called f waves as a surrogate of the P wave.Methods:We studied 18 atrial fibrillation patients requiring simultaneously a central venous catheter and a trans-esophageal echocardiography. An intracavitary electrocardiographic trace was recorded with the catheter tip in three different positions defined by trans-esophageal echocardiography imaging: in the superior vena cava, 2 cm above the cavo-atrial junction; at the cavo-atrial junction; and in the right atrium, 2 cm below the cavo-atrial junction. Three different criteria of measurement of the f wave pattern in the TQ tract were used: the mean height of f waves (method A); the height of the highest f wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).Results:There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the f waves was significantly higher than in the other two positions. All three methods were effective in discriminating the tip position at the cavo-atrial junction, though method B proved to be the most accurate.Conclusion:A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the f waves is an accurate indicator of the location of the tip at the cavo-atrial junction.
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Affiliation(s)
- Maria Calabrese
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Montini
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Arlotta
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio La Greca
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele G Biasucci
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bevilacqua
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrica Antoniucci
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Scapigliati
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Cavaliere
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
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Batihan G, Ceylan KC, Kaya SO. Rare complication of central venous catheter placement: bilateral hydrothorax. BMJ Case Rep 2018; 11:11/1/e226699. [PMID: 30567279 DOI: 10.1136/bcr-2018-226699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.
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Affiliation(s)
- Guntug Batihan
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Izmir, Turkey
| | - Kenan C Ceylan
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Izmir, Turkey
| | - Seyda Ors Kaya
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Izmir, Turkey
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Jarineshin H, Sharifi M, Kashani S. Comparing the conventional 15 cm and the C-length approaches for central venous catheter placement. J Cardiovasc Thorac Res 2018; 10:221-226. [PMID: 30680081 PMCID: PMC6335980 DOI: 10.15171/jcvtr.2018.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/16/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: The present guidelines recommend placing the catheter tip in the superior vena cava (SVC) above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the Central venous catheter (CVC) at the suggested vascular zone. Methods: This was an interventional study on two hundred patients undergoing Coronary artery bypass surgery (CABG) operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a C-length method was applied for measuring the depth of catheter tip placement from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used. Results: In the first group (15 cm) 100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was +4.22±2.10 cm. In the second (C-Length) group 52% of the catheters were below C-line with an average distance of +0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone of placement (P<0.001). Conclusion: The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.
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Affiliation(s)
- Hashem Jarineshin
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Maryam Sharifi
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
| | - Saeid Kashani
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran
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The "rapid atrial swirl sign" for assessing central venous catheters: Performance by medical residents after limited training. PLoS One 2018; 13:e0199345. [PMID: 30011285 PMCID: PMC6047781 DOI: 10.1371/journal.pone.0199345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/30/2018] [Indexed: 02/08/2023] Open
Abstract
Rationale Central venous catheter (CVC) placement is a standard procedure in critical care. Ultrasound guidance during placement is recommended by current guidelines, but there is no consensus on the best method for evaluating the correct CVC tip position. Recently, the “rapid atrial swirl sign” (RASS) has been investigated in a limited number of studies. Objectives We performed a prospective diagnostic accuracy study of focused echocardiography for the evaluation of CVC tip position in our medical ICU and IMC units. Methods We performed a prospective diagnostic accuracy study in 100 patients admitted to the Intensive Care Unit and Intermediate Care Unit at our center. The first 10 subjects were assessed by one staff physician investigator (reference cohort), the remaining 90 patients by different residents (test cohort). All patients received a post-procedural chest radiograph (CXR) as gold standard. CVC placement was assessed with focused echocardiography performed by residents after a short training session. A rapid opacification of the right atrium (RASS) after injection of 10 mL of normal saline was regarded as “positive”, flush after more than two seconds was defined as “delayed”, no flush was a “negative” test result. Measurements and main results Overall sensitivity of the RASS was 100% (95% CI 73.54–100%), specificity was 94.32% (CI 87.24–98.13%). Positive and negative predictive values were 70.59% (CI 44.04–89.09%) and 100% (CI 95.65–100%), respectively. Median time for echocardiographic testing was 5 minutes (1–28) in the whole cohort, CXRs were available after 49.5 minutes (13–254). Interrater agreement of the RASS was 0.77 (Cohen’s kappa), Measurement of CVC tip position was not different between two observers. Test characteristics were similar among differently experienced residents. Conclusions Presence of the RASS by focused echocardiography showed excellent sensitivity and specificity and was equally performed by residents after minimal training. In patients with a positive RASS, routine CXR can be safely omitted, reducing time, costs and radiation exposure. A negative RASS should lead to a search for misplaced catheters. Clinical trial registration The study was registered with www.clinicaltrials.gov (NCT02661607).
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Chaskar V, Karnik PP, Dave NM, Garasia M. Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study. Turk J Anaesthesiol Reanim 2018; 46:116-120. [PMID: 29744246 DOI: 10.5152/tjar.2018.32748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients. Methods Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis. Results Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully. Conclusion Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.
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Affiliation(s)
- Vaishali Chaskar
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | | | - Nandini Malay Dave
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
| | - Madhu Garasia
- Department of Anaesthesiology, Seth G.S. Medical College, K.E.M. Hospital, Mumbai, India
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Stringer BJ, Shumway SB, Holbrook MD, Copeland CG, Gosch AA, Kück K. Dual-wavelength reflectance spectroscopy of the superior vena cava: A method for placing central venous catheters at the cavoatrial junction. JOURNAL OF BIOPHOTONICS 2018; 11:e201700018. [PMID: 28772008 DOI: 10.1002/jbio.201700018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/09/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
There are a limited number of methods to guide and confirm the placement of a peripherally inserted central catheter (PICC) at the cavoatrial junction. The aim of this study was to design, test and validate a dual-wavelength, diode laser-based, single optical fiber instrument that would accurately confirm PICC tip location at the cavoatrial junction of an animal heart, in vivo. This was accomplished by inserting the optical fiber into a PICC and ratiometrically comparing simultaneous visible and near-infrared reflection intensities of venous and atrial tissues found near the cavoatrial junction. The system was successful in placing the PICC line tip within 5 mm of the cavoatrial junction.
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Affiliation(s)
- Bradley J Stringer
- Verum TCS, LLC, Salt Lake City, Utah
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | | | - Matthew D Holbrook
- Verum TCS, LLC, Salt Lake City, Utah
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | - Alexander A Gosch
- Verum TCS, LLC, Salt Lake City, Utah
- Department of Plant and Wildlife Sciences, Brigham Young University, Provo, Utah
| | - Kai Kück
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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Excellent inter-observer agreement between radiologist and nurse: tracheal carina-based identification of peripherally inserted central catheter tip position. J Vasc Access 2018; 19:28-33. [PMID: 29027181 DOI: 10.5301/jva.5000799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction: Accurate identification of position of a central venous catheter tip is important to reduce catheter-related complications. Nevertheless, inter-observer bias limits the accuracy of traditional method for determining tip position on chest x-ray (CXR) images. The aim of this study was to explore a simple and objective method for assessing position of peripherally inserted central catheter (PICC) tip on CXR image. Methods: Tracheal carina was used as the landmark to identify positions of catheter tips. The central vein (CV) was located between 3 cm above and 4 cm below tracheal carina. The vertical distance from catheter tips to tracheal carina was measured independently by a nurse and re-assessed by a radiologist. Inter-observer agreement was expressed as percentage in agreement and kappa coefficient. Results: Six hundred and twelve CXR images of catheters taken from 612 patients were included. The inter-observer agreement between nurse and radiologist was 97.88% (kappa = 0.934) for all catheter tips evaluated, and 98.40% (kappa = 0.923) for catheter tips with regard to CV, innominate vein, and right atrium. Most discrepancies (9/13) between observers occurred when catheter tips were positioned in a border region between different anatomical parts. Conclusions: Inter-observer agreement between nurse and radiologist is excellent. Our results demonstrate that the measurement of distance between catheter tip and tracheal carina performed by a nurse provide a convenient and reliable way to determine position of PICC tip. Our study also suggests that nurses can be trained to handle PICCs, especially when properly located catheters are applied in critically ill patients during emergency setting.
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Kwon HJ, Jeong YI, Jun IG, Moon YJ, Lee YM. Evaluation of a central venous catheter tip placement for superior vena cava-subclavian central venous catheterization using a premeasured length: A retrospective study. Medicine (Baltimore) 2018; 97:e9600. [PMID: 29480861 PMCID: PMC5943868 DOI: 10.1097/md.0000000000009600] [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
Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system. To evaluate the placement of the tip of the CVC in subclavian central venous catheterizations using the C-length, we reviewed the medical records and chest radiographs of 122 adult patients in whom CVC catheterization was performed (from January 2012 to December 2014) via the right subclavian vein using the C-length. The tips of all subclavian CVCs were placed in the SVC using the C-length. No subclavian CVC entered the right atrium. Tip placement was not affected by demographic characteristics such as age, sex, height, weight, and body mass index. The evidence indicates that the C-length on chest radiographs can be used to determine the available insertion length and place the right subclavian CVC tip into the SVC.
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Sertic AJ, Connolly BL, Temple MJ, Parra DA, Amaral JG, Lee KS. Perforations associated with peripherally inserted central catheters in a neonatal population. Pediatr Radiol 2018; 48:109-119. [PMID: 28986615 DOI: 10.1007/s00247-017-3983-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/14/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are increasingly used in neonates but perforations can result in devastating complications such as pericardial and pleural effusions. Identifying risk factors may guide surveillance and reduce morbidity and mortality. OBJECTIVE To determine the risk factors for PICC perforation in neonates. MATERIALS AND METHODS Retrospective case:control (1:2) study of neonates admitted between 2004-2014. Charts and imaging were reviewed for clinical and therapeutic risk factors. RESULTS Among 3,454 PICCs, 15 cases of perforation (incidence 0.4%, 5 pericardial effusions, 10 pleural effusions) were matched to 30 controls, based on gestation and insertion date. Timing of perforations post-insertion was median 4 days for pericardial effusions and 21.5 days for pleural effusions. A risk factor for pericardial effusion was lower weight at PICC insertion compared with controls. There were no statistically significant differences between cases and controls in catheter material, insertion site, PICC size and lumen number. Among upper limb PICCs, pericardial effusions were associated with tip positions more proximal to the heart at insertion (P=0.005) and at perforation (P=0.008), compared with controls. Pleural effusions were associated with tip positions more distal from the heart at perforation (P=0.008). Within 48 h before perforation, high/medium risk infusions included total parenteral nutrition (100% cases vs. 56.7% controls, P=0.002) and vancomycin (60% cases vs. 23.3% controls, P=0.02). CONCLUSION PICC-associated pericardial effusions and pleural effusions are rare but inherent risks and can occur at any time after insertion. Risk factors and etiologies are multifactorial, but PICC tip position may be a modifiable risk factor. To mitigate this risk, we have developed and disseminated guidelines for target PICC positions and routinely do radiographs to monitor PICCs for migration and malposition in our NICU. The increased knowledge of risk profiles from this study has helped focus surveillance efforts and facilitate early recognition and treatment.
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Affiliation(s)
- Andrew J Sertic
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bairbre L Connolly
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael J Temple
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dimitri A Parra
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joao G Amaral
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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De Carvalho BR, Eagar GM. Immediate post-insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration. J Med Imaging Radiat Oncol 2017; 62:324-329. [DOI: 10.1111/1754-9485.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Gerard M Eagar
- Department of Radiology; Tauranga Hospital; Tauranga New Zealand
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Single-Operator Ultrasound-Guided Central Venous Catheter Insertion Verifies Proper Tip Placement*. Crit Care Med 2017; 45:e994-e1000. [DOI: 10.1097/ccm.0000000000002500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax. Crit Care Med 2017; 45:1192-1198. [PMID: 28422778 DOI: 10.1097/ccm.0000000000002451] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. We hypothesize that a combination of transthoracic echocardiography and lung ultrasound is noninferior to chest radiograph when used to accurately assess central venous catheter positioning and screen for pneumothorax. SETTING All operating rooms and surgical and trauma ICUs at the institution. DESIGN Single-center, prospective noninferiority study. PATIENTS Patients receiving ultrasound-guided subclavian or internal jugular central venous catheters. INTERVENTIONS During ultrasound-guided central venous catheter placement, correct positioning of central venous catheter was accomplished by real-time visualization of the guide wire and positive right atrial swirl sign using the subcostal four-chamber view. After insertion, pneumothorax was ruled out by the presence of lung sliding and seashore sign on M-mode. MEASUREMENTS AND MAIN RESULTS Data analysis was done for 137 patients. Chest radiograph ruled out pneumothorax in 137 of 137 patients (100%). Lung ultrasound was performed in 123 of 137 patients and successfully screened for pneumothorax in 123 of 123 (100%). Chest radiograph approximated accurate catheter tip position in 136 of 137 patients (99.3%). Adequate subcostal four-chamber views could not be obtained in 13 patients. Accurate positioning of central venous catheter with ultrasound was then confirmed in 121 of 124 patients (97.6%) as described previously. CONCLUSIONS Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound can reduce central venous catheter insertion to use time, exposure to radiation, and improve patient safety.
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Bedford E, Waterhouse D. Service development of a nurse-led community-based PICC insertion service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S22-S27. [PMID: 28132552 DOI: 10.12968/bjon.2017.26.2.s22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients receiving intravenous therapy require reliable venous access. Typically patients with poor peripheral access or requiring long-term treatment from an outpatient antibiotic therapy (OPAT) service need to receive secondary care input for safe central line placement, and radiological confirmation of the correct line tip placement where necessary, if treatment is to proceed as planned. Technological developments that enable accurate ultrasound-guided vein selection and electrocardiograph (ECG)-guided central line tip placement have eliminated the need for radiological or fluoroscopic confirmation of correct tip placement for peripherally placed central catheters (PICCs). This article outlines the development of an out-of-hospital nurse-led PICC insertion service using the Sherlock 3CG® Tip Confirmation System (C.R Bard) to meet the needs of patients requiring long-term intravenous treatment from an OPAT service, and its impact on reducing treatment delays and the need for secondary care intervention.
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Affiliation(s)
| | - Dee Waterhouse
- Formerly Head of Nursing (IV Services), Mastercall Healthcare
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A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery. Pediatr Crit Care Med 2016; 17:e413-9. [PMID: 27472252 DOI: 10.1097/pcc.0000000000000878] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications. DESIGN A 1:1 randomized controlled trial. SETTING Baskent University Medical Center. PATIENTS Pediatric patients scheduled for cardiac surgery. INTERVENTIONS Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months. MEASUREMENTS AND MAIN RESULTS The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all). CONCLUSIONS Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and subclavian vein access. The risk of infectious complications was significantly higher with internal jugular vein access.
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Chan TY, England A, Meredith SM, McWilliams RG. Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs. Br J Radiol 2016; 89:20150965. [PMID: 27404224 DOI: 10.1259/bjr.20150965] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the variability in identifying the cavoatrial junction (CAJ) on chest X-rays (CXRs) amongst radiologists. METHODS 23 radiologists (13 consultants and 10 trainees) assessed 25 posteroanterior erect CXRs (including 8 duplicates) and marked the positions of the CAJ. Differences in the CAJ position both within and between observers were evaluated and reported as limits of agreement (LOA), repeatability coefficients (RCs) and intraclass correlation coefficients and were displayed graphically with Bland-Altman plots. RESULTS The mean difference for within-observer assessments was -0.2 cm (95% LOA, -1.5 to +1.1 cm) and between observers, it was -0.3 cm (95% LOA, -2.5 to +1.8 cm). Intraobserver RCs were marginally lower for consultants than for trainees (1.1 vs 1.5). RCs between observers were comparable (2.1 vs 2.2) for consultants and trainees, respectively. CONCLUSION This study detected a large interobserver variability of the CAJ position (up to 4.3 cm). This is a significant finding considering that the length of the superior vena cava is reported to be approximately 7 cm. We conclude that there is poor consensus regarding the CAJ position amongst radiologists. ADVANCES IN KNOWLEDGE No comparisons exist between radiologists in determining CAJ position from CXRs. This report provides evidence of the large observer variability amongst radiologists and adds to the discussion regarding the use of CXRs in validating catheter tip location systems.
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Affiliation(s)
- Tze Y Chan
- 1 Department of Radiology, Royal Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Andrew England
- 2 Directorate of Radiography, University of Salford, Manchester, UK
| | - Sara M Meredith
- 1 Department of Radiology, Royal Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Richard G McWilliams
- 1 Department of Radiology, Royal Liverpool University Hospital NHS Trust, Liverpool, UK
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Abstract
Catheter-related thrombosis is a relatively common complication of central venous catheter insertion. Central venous catheter use is ubiquitous in the critical care setting and often in patients with multiple risk factors for venous thromboembolism. With a trend towards increased use of peripherally inserted central catheters, the incidence of catheter-related thrombosis is likely to increase further. Despite the scale of the problem, there is a paucity of evidence-based guidelines concerning the management of patients with catheter-related thrombosis, particularly in critically unwell patients. This has led to heterogeneity in clinical practice. In this review, we describe the risk factors for developing catheter-related thrombosis and provide practical advice for clinicians on how to recognise, diagnose and treat this common problem.
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Affiliation(s)
- Caroline Wall
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - John Moore
- Department of Critical Care, Manchester Royal Infirmary, Manchester, UK
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
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Oliver G, Jones M. The importance of adequate CVC securement to prevent infection. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S32-3. [PMID: 27126762 DOI: 10.12968/bjon.2016.25.8.s32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gemma Oliver
- Nurse Consultant IV Care, East Kent Hospitals University Foundation Trust
| | - Matt Jones
- Consultant Anaesthetist, East Kent Hospitals University Foundation Trust
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Darstellbarkeit der Vena cava superior im rechten supraklavikulären Schallfenster. Anaesthesist 2016; 65:190-7. [DOI: 10.1007/s00101-016-0146-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/21/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Flood S, Bodenham A. Central venous cannulation: ultrasound techniques. ANAESTHESIA & INTENSIVE CARE MEDICINE 2016. [DOI: 10.1016/j.mpaic.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 163:S1-40. [PMID: 26369828 DOI: 10.7326/m15-0744] [Citation(s) in RCA: 329] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.
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Affiliation(s)
- Vineet Chopra
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A. Flanders
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Saint
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott C. Woller
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomi P. O'Grady
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasia Safdar
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott O. Trerotola
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Saran
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Moureau
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wiseman
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mauro Pittiruti
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie A. Akl
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Y. Lee
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Courey
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi Swaminathan
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack LeDonne
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Becker
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L. Krein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J. Bernstein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.
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Álvarez-Baena L, Duque P, Ramos R, Zarain Obrador L, Fernández-Quero L. [Unilateral pleural effusion caused by vessel perforation due to peripherally inserted central catheter: Indocyanine green as a diagnostic tool]. ACTA ACUST UNITED AC 2015; 63:54-7. [PMID: 26025285 DOI: 10.1016/j.redar.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
A peripherally inserted central catheter (PICC) was inserted into a 44-year-old man to provide parenteral nutrition in a protein-calorie malnutrition secondary to a benign pyloric stenosis. On the fifth day while monitoring the catheter, the patient presented with a massive whitish pleural effusion after undergoing gastric endoscopy in order to treat pyloric stenosis. Chylothorax was initially suspected, and the patient was admitted to a recovery unit. Indocyanine green was administered through the PICC, obtaining a greenish discoloration in the pleural effusion 30 min later. This led to the diagnosis of a pleural effusion caused by a vessel perforation due to the PICC, leading to parenteral nutrition extravasation. Thoraco-abdominal computed tomography was performed, which confirmed an innominate vein perforation due to the PICC. PICC insertion may be associated with severe complications, such as central vessel perforation, and therefore the correct position of a central catheter should be always checked. Intravenous computed tomography contrast is the gold standard for central vascular perforation diagnosis. However if a pleural effusion occurs in this context, it is possible to use a dye, which administered intravenously can lead us to the correct diagnosis in situ. Indocyanine green was used for this purpose in this case.
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Affiliation(s)
- L Álvarez-Baena
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - P Duque
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Ramos
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Zarain Obrador
- Departamento de Cirugía General y Aparato Digestivo II, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Fernández-Quero
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
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46
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Pittiruti M, Lamperti M. Late Cardiac Tamponade in Adults Secondary to Tip Position in the Right Atrium: An Urban Legend? A Systematic Review of the Literature. J Cardiothorac Vasc Anesth 2015; 29:491-5. [DOI: 10.1053/j.jvca.2014.05.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 11/11/2022]
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Choi YJ, Hahm KD, Kwon K, Lee EH, Ro YJ, Yang HS. [Bedside prediction of right subclavian venous catheter insertion length]. Rev Bras Anestesiol 2014; 64:419-24. [PMID: 25437699 DOI: 10.1016/j.bjan.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). METHOD In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. RESULTS L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45±0.68cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient=0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm)=-0.037+0.036×Height (cm)+0.903×I-T-IC (cm) (adjusted r(2)=0.64). CONCLUSION The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.
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Affiliation(s)
- Yoon Ji Choi
- Departamento de Anestesiologia e Medicina da Dor, Seoul Paik Hospital, College of Medicine, Inje University, Seul, República da Coreia
| | - Kyung-Don Hahm
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia.
| | - Koo Kwon
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Eun-Ho Lee
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Young Jin Ro
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
| | - Hong Seuk Yang
- Departamento de Anestesiologia e Medicina da Dor, Asan Medical Center, University of Ulsan College of Medicine, Seul, República da Coreia
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48
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Oliver G, Jones M. ECG or X-ray as the ‘gold standard’ for establishing PICC-tip location? ACTA ACUST UNITED AC 2014; 23 Suppl 19:S10-6. [DOI: 10.12968/bjon.2014.23.sup19.s10] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Matt Jones
- Consultant Anaesthetist and Vascular Access Lead, East Kent Hospitals University NHS Foundation Trust
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49
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Useful Equation for Proper Estimate of Left Side Peripherally Inserted Central Venous Catheter Length in Relation to the Height. J Vasc Access 2014; 16:42-6. [DOI: 10.5301/jva.5000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Direct measurement of venous length is easy to cause contamination during bedside insertion of peripherally inserted central venous catheter (PICC). It is necessary to provide an equation for proper estimate of catheter length in case of bedside insertion of PICC in relation to patient height. Methods For 165 PICC cases through left arm vein in 151 adult patients (male: female = 72:79), the cubital crease to carina length (CCL) was calculated as follows: CCL = (distance from cubital crease to puncture point) + (length of PICC inside body) – (distance from carina to catheter tip on post-procedural chest radiograph). We analyzed the relationship between CCL and height with regression analysis and suggest a new equation of CCL based on height. Results The mean CCL through the left arm vein was 47.1 ± 2.6 cm in male and 44.0 ± 2.9 cm in female. CCL was significantly correlated with patient height. Equation of CCL (cm) based on height was as follows: CCL = height* 0.19 + 14. Conclusions The equation of our study would provide a new equation for proper estimation of catheter length in case of bedside insertion of left arm PICC in relation to height and be helpful for optimal positioning of catheter tip of PICC.
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Johnston AJ, Holder A, Bishop SM, See TC, Streater CT. Evaluation of the Sherlock 3CG Tip Confirmation System on peripherally inserted central catheter malposition rates. Anaesthesia 2014; 69:1322-30. [DOI: 10.1111/anae.12785] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A. J. Johnston
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - A. Holder
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - S. M. Bishop
- John Farman Intensive Care Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - T. C. See
- Department of Radiology; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - C. T. Streater
- Vascular Access Unit; Addenbrooke's Hospital; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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