Central Venous Catheterization in the Critically Ill Patient

1992 ◽  
Vol 8 (4) ◽  
pp. 677-686 ◽  
Author(s):  
Kim R. Agee ◽  
Robert A. Balk
Keyword(s):  
Critically Ill ◽  
Central Venous Catheterization ◽  
Critically Ill Patient ◽  
Central Venous ◽  
Venous Catheterization

Percutaneous Catheterization of the Axillary Vein in Infants and Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (4) ◽  
pp. 531-533
Author(s):  
Richard I. Metz ◽  
Steven E. Lucking ◽  
Frank C. Chaten ◽  
Thomas M. Williams ◽  
John J. Mickell
Keyword(s):  
Critically Ill ◽  
Central Venous Catheterization ◽  
Venous Pressure ◽  
Vena Cava ◽  
Infants And Children ◽  
Venous Stasis ◽  
Complication Rates ◽  
Axillary Vein ◽  
Central Venous ◽  
Venous Catheterization

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130°. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.

scholarly journals Mediastinal malposition of catheter after venous cut down

2018 ◽  
Vol 5 (4) ◽  
pp. 1577
Author(s):  
Md. Imran Nasir ◽  
Rekha Gupta ◽  
Sanjay Gupta ◽  
A. K. Attri
Keyword(s):  
Central Venous Catheterization ◽  
Case Reports ◽  
Feeding Tube ◽  
Anterior Mediastinum ◽  
Critically Ill Patient ◽  
Central Vein ◽  
Basilic Vein ◽  
Central Venous ◽  
Venous Catheterization ◽  
Infant Feeding Tube

Central venous catheterization is one of the very essential tool of modern intensive care. Apart from monitoring the critically ill patient, it helps in administration of antibiotics, parenteral nutrition, chemotherapy, fluids and drug delivery. Peripheral inserted central catheter (PICC) by surgically isolating basilic vein or venous cut down, is considered one of the safe technique to access central veins. The advantage of this procedure is that traumatic complications like pneumothorax, hemothorax and arterial puncture are less as compared to directly placing central catheters. Malposition (intracaval or extracaval) is one of the commonly encountered complication associated with central venous catheterization. Extracaval is rarely encountered and there are isolated case reports in the literature where catheter tip is found outside the central vein into the surrounding structures. Knowledge of such complications is important else these remain unrecognized resulting in delayed treatment and poor outcome. Here, we report a unique case, wherein tip of infant feeding tube inserted from basilic vein was found in anterior mediastinum resulting bilateral hemothorax and pleural effusion.

Venous Thromboembolism in Neurocritical Care Patients

2019 ◽  
Vol 35 (11) ◽  
pp. 1226-1234 ◽  
Author(s):  
Tanuwong Viarasilpa ◽  
Nicha Panyavachiraporn ◽  
Jack Jordan ◽  
Seyed Mani Marashi ◽  
Meredith van Harn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Critically Ill ◽  
Neurocritical Care ◽  
Central Venous Catheterization ◽  
Multivariable Analysis ◽  
Central Venous ◽  
Neurological Intensive Care Unit ◽  
Venous Catheterization

Background: Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients. Methods: We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation–perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded. Results: Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, P = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; P < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P = .007). Conclusions: Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.

Complications of central venous catheterization in critically ill children

2001 ◽  
Vol 2 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Juan Casado-Flores ◽  
Juana Barja ◽  
Ricardo Martino ◽  
Ana Serrano ◽  
Alberto Valdivielso
Keyword(s):  
Critically Ill ◽  
Central Venous Catheterization ◽  
Critically Ill Children ◽  
Central Venous ◽  
Venous Catheterization

scholarly journals Ultrahangvezérelt centrálisvéna-biztosítás korrigálatlan coagulopathiában

2015 ◽  
Vol 156 (27) ◽  
pp. 1085-1090
Author(s):  
Géza Reusz ◽  
Csilla Langer ◽  
Tibor Hevessy ◽  
Ákos Csomós
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Catheterization ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Venous Catheterization ◽  
Clopidogrel Therapy

Introduction: Correction of coagulopathy prior to central venous catheterization is a standard practice. Before ultrasound-guided procedures, routine correction of coagulopathy is controversial as mechanical complications are rare. Aim: To evaluate the safety of ultrasound-guided central venous access in critically ill patients with coagulopathy. Method: In this retrospective study the authors included all ultrasound-guided central venous catheterizations performed in their Intensive Care Unit between February 2011 and January 2013. They defined coagulopathy as INR or APTT ratio above 1.5, platelet count below 100 G/l, and anticoagulation or clopidogrel therapy. Data obtained from ultrasound register and patient records were used. Results: 310 ultrasound-guided central venous catheterizations were performed. Coagulopathy was observed in 134 cases (43.2%) and corrected in 10 cases prior to catheterization. There were no bleeding complications (complication rate in uncorrected coagulopathy: 0%, 95% confidence interval: 0-3.0%). Conclusions: Coagulopathy is common in critically ill patients, but its routine correction prior to ultrasound-guided central venous catheterization seems unnecessary. Orv. Hetil., 2015, 156(27), 1085–1090.

scholarly journals Objective Assessment Metrics for Central Line Simulators: An Exploration of Causal Factors

2020 ◽  
Vol 64 (1) ◽  
pp. 2008-2012
Author(s):  
Jessica M. Gonzalez-Vargas ◽  
Dailen C. Brown ◽  
Jason Z. Moore ◽  
David C. Han ◽  
Elizabeth H. Sinz ◽  
...  
Keyword(s):  
Central Venous Catheterization ◽  
Objective Assessment ◽  
Central Line ◽  
Expert Interviews ◽  
Central Venous ◽  
Patient Case ◽  
Causal Factors ◽  
Venous Catheterization ◽  
Assessment Metrics ◽  
Automated Feedback

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees’ performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

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