Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter

Introduction: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. Methods: An observational prospective case–control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery. Each intervention was crosschecked with ultrasound-guided positioning via right supraclavicular fossa view and chest radiography. Ultrasound-guided supraclavicular venipuncture of the right subclavian vein and guidewire advancement were performed. A B-mode view of the superior vena cava and the right pulmonary artery was obtained to visualize the J-tip of the guidewire. The central venous catheter was advanced over the guidewire and the electrocardiography was derived from the J-tip of the guidewire protruding from the central venous catheter tip. Electrocardiography was read for increased p- and atrial fibrillation waves, respectively, and insertion depth was compared with the ultrasound method. Results: Electrocardiography indicated significantly increasing fibrillation and p-waves, respectively, in all patients and ultrasound-guided central venous catheter positioning confirmed a tip position within the lower third of the superior vena cava. Conclusion: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.

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Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

Iranian Journal of Radiology ◽

10.5812/iranjradiol.100437 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Mehrnaz Nikouyeh ◽

Kiandokht Khorshidi ◽

Mohammad Hassan Rouzegari ◽

Rabee Sarram

Keyword(s):

Central Venous Catheter ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Underlying Disease ◽

Central Venous ◽

X Ray ◽

Comparison Results ◽

Chest X Ray ◽

The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

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Surgical treatment for thrombi within the superior vena cava and right atrium associated with central venous catheter-related bloodstream infection

Tenri Medical Bulletin ◽

10.12936/tenrikiyo.15.86 ◽

2012 ◽

Vol 15 (1) ◽

pp. 86-90

Author(s):

Yuki Hori ◽

Naoki Kanemitsu ◽

Keiichi Hirose ◽

Daisuke Nakatsuka ◽

Jin Ikarashi ◽

...

Keyword(s):

Surgical Treatment ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Superior Vena Cava ◽

Right Atrium ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous ◽

Catheter Related Bloodstream Infection

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980-90 Superior Vena Cava Versus Right Atrium Central Venous Catheter Placement Avoids Thrombosis: The Role of Transesophageal Echocardiography in Diagnosis and Evaluation — A Prospective Study

Journal of the American College of Cardiology ◽

10.1016/0735-1097(95)92556-k ◽

1995 ◽

Vol 25 (2) ◽

pp. 264A

Author(s):

Dan Gilon ◽

David Schechter ◽

Azaria J.J.T. Rein ◽

Zvi Gimon ◽

Paul Drakos ◽

...

Keyword(s):

Central Venous Catheter ◽

Prospective Study ◽

Right Atrium ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous ◽

Central Venous Catheter Placement ◽

A Prospective Study

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An unexpected position of the dialyses catheter during routine x-ray examination: a case of the double superior vena cava

Open Medicine ◽

10.2478/s11536-013-0185-2 ◽

2013 ◽

Vol 8 (6) ◽

pp. 845-848

Author(s):

Bruno Atalić ◽

Goran Sabo ◽

Jurica Toth

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Dialysis Catheter ◽

Central Venous ◽

X Ray ◽

The Right ◽

Expected Position

AbstractThis paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at first had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confirmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confirmed by analysis of the computerised tomography pulmonary angiogram.

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Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study

BMJ Open ◽

10.1136/bmjopen-2020-041101 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041101

Author(s):

Minwoo Kang ◽

Jinkun Bae ◽

Sujin Moon ◽

Tae Nyoung Chung

Keyword(s):

Central Venous Catheter ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Chest Ct ◽

Haemodynamic Monitoring ◽

Operating Characteristics ◽

Central Venous ◽

Catheter Tip ◽

The Right

ObjectivesThe tip-to-carina (TC) distance on a simple chest X-ray (CXR) has proven value in the determination of correct central venous catheter (CVC) positioning. However, previous studies have mostly focused on preventing the atrial insertion of the CVC tip, and not on appropriate positioning for accurate haemodynamic monitoring. We aimed to assess whether the TC distance could detect the passage of the CVC tip into the superior vena cava (SVC) and the right atrium (RA), and to accordingly suggest cut-off reference values for these two aspects.DesignRetrospective observational cohort study.SettingSingle urban tertiary level academic hospital.Participants479 patients who underwent CXR and chest CT scan after the insertion of a CVC with a 24-hour interval during the study period.InterventionThe TC distance was measured on CXR, and the position of the CVC tip was assessed on the chest CT images. The TC distance was described as a negative or positive number if the CVC tip was above or below the carina, respectively. Receiver-operating characteristics curve analyses were conducted to ascertain the TC distance to detect SVC entrance and RA insertion of CVC tip.ResultsThe TC distance could significantly detect both SVC entrance and RA insertion (p<0.001 for both; area under curve 0.987 and 0.965, respectively), with a reference range of −6.69 to 15.61 mm.ConclusionThe TC distance in CXR is a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate haemodynamic monitoring.

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