Indwelling Central Venous Catheters for the Critically Ill Patients

Abstract Background Peripherally inserted central venous catheters (PICC) are increasingly used in critically ill patients for the ease of access, long-term medication and total parenteral nutrition administration. There is a perception of equivalent utility of PICC lines with a lower incidence of complications as compared to central venous lines. Despite the perception of relative safety, complications can occur. Case Presentation We describe a case of a patient who developed increasing signs and symptoms of sepsis, shortness of breath, and hypoxemia following combined liver and renal transplant 11 days following the initial procedure. Computerised tomography of neck and chest demonstrated pneumo-mediastinum, extensive retropharyngeal and subcutaneous emphysema. The patient returned to theatre on post-operative day 12, for flexible bronchoscopy, video-assisted thoracoscopic surgery and mediastinal washout. Following a further clinical and imaging review, an un-anticipated diagnosis of extravasated peripherally inserted central venous cannula (PICC) as a causative factor of multiple pathologies was made. PICC line was removed. Mediastinal and thoracoscopic examinations were performed and drains inserted. The patient returned to the intensive care unit for ongoing supportive management, with a gradual improvement of sepsis and resolution of mediastinal air distribution. Conclusions Peripherally inserted central venous catheters have an ease of insertion and appreciable favourable health economic outcomes. Recent reviews however have demonstrated an increased risk of catheter tip malposition, in addition to increased risk of thrombosis as compared to central venous lines. Due to the characteristic mobility of these devices, mediastinal and intra-thoracic extravasation of these catheters can occur with consequent severe morbidity. Awareness of the tip position and accompanying clinical and radiological enquiry, must be performed both in the differential diagnosis of chest pathology and prior to use of PICC lines in critically ill patients.

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Endemic Multidrug-ResistantPseudomonas aeruginosain Critically Ill Patients

Infection Control and Hospital Epidemiology ◽

10.1086/502303 ◽

2004 ◽

Vol 25 (10) ◽

pp. 825-831 ◽

Cited By ~ 43

Author(s):

Bryan Ortega ◽

A. B. Johan Groeneveld ◽

Constance Schultsz

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Multidrug Resistant ◽

Central Venous Catheters ◽

Lung Injury Score ◽

Polymorphism Analysis ◽

Central Venous ◽

Resistant Strains

AbstractObjective:To describe the epidemiology of endemic multidrug-resistantPseudomonas aeruginosacolonizations and infections in critically ill patients.Design:Prospective study on bacterial strain typing and retrospective cohort study of charts of patients in the intensive care unit (ICU).Patients:Fifty-three patients withP. aeruginosaisolated from clinical cultures in 2001 were selected, divided into those withP. aeruginosain vitro resistant to at least two classes of antibiotics (multidrug-resistant, n = 18) and those susceptible to all or resistant to only one antibiotic (susceptible, n = 35).Results:Risk factors for multidrug-resistantP. aeruginosaincluded maxillary sinusitis, long-dwelling central venous catheters, prolonged use of certain antibiotics, a high lung injury score, and prolonged mechanical ventilation and duration of stay. The frequency of colonization (approximately 50%) versus infection (ie, ventilator-associated pneumonia) did not differ between the groups. On amplified fragment-length polymorphism analysis, 64% of the multidrug-resistant strains had been potentially transmitted via cross-colonization and 36% had probably originated endogenously. ICU mortality was 22% in the multidrug-resistant group and 23% in the susceptible group, although the duration of mechanical ventilation was longer in the former.Conclusions:Patients with sinusitis who stayed in the ICU longer, were ventilated longer because of acute lung injury, received antibiotics for longer durations, and had long-dwelling central venous catheters ran an elevated risk of acquiring multidrug-resistantP. aeruginosa.These patients did not have a higher mortality than patients with susceptibleP. aeruginosa.Prevention of the emergence of multidrug-resistant strains requires changes in infection control measures and antibiotic policies in our ICU.

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Difficult Internal Jugular Central Venous Cannulation Using J-Tip Guidewire with Indwelling Peripherally Inserted Central Venous Catheters

Case Reports in Anesthesiology ◽

10.1155/2019/5134575 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Preeti Anand ◽

Minal Joshi ◽

Khaja Ahmed ◽

Joel Yarmush

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Critically Ill ◽

Critically Ill Patients ◽

Central Venous Catheters ◽

Venous Cannulation ◽

Central Venous Cannulation ◽

Central Venous ◽

Cardioverter Defibrillator

Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.

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