Peripherally Inserted Central Venous Catheters Are Not Superior to Central Venous Catheters in the Acute Care of Surgical Patients on the Ward

We report a case series of anaphylaxis to chlorhexidine-coated central venous catheters (CVCs) when used in cardiac surgical patients in our institution. Our experience, together with increasing reports of anaphylaxis to chlorhexidine-coated CVCs from other sources indicates that chlorhexidine-coated CVCs are not without additional risk. Attempts to lower rates of catheter-related bloodstream infection has led to the widespread adoption of chlorhexidine-coated CVCs in the perioperative and critical care setting, including for routine cardiac surgery. However, closer scrutiny indicates that there is lack of strong evidence demonstrating a meaningful reduction in rates of sepsis or serious morbidity, especially with CVC dwell times of less than seven days. Given the lack of clear benefit, we recommend non-coated CVCs for routine cardiac surgery, with even consideration for chlorhexidine-coated CVCs when specifically indicated for patients at high risk of CVC infection.

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Intra- and Extra-pericardial Lengths of the Superior Vena Cava in Vivo: Implication for the Positioning of Central Venous Catheters

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300315 ◽

2005 ◽

Vol 33 (3) ◽

pp. 384-387 ◽

Cited By ~ 13

Author(s):

T. D. Kwon ◽

K. H. Kim ◽

H. G. Ryu ◽

C. W. Jung ◽

J. M. Goo ◽

...

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous Catheters ◽

Surgical Patients ◽

Right Atrial ◽

Central Venous ◽

Insertion Depth

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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