Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks: Avoiding the Right Atrium

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

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Central venous pressure monitoring in critical care settings

British Journal of Nursing ◽

10.12968/bjon.2021.30.4.230 ◽

2021 ◽

Vol 30 (4) ◽

pp. 230-236

Author(s):

Barry Hill ◽

Catherine Smith

Keyword(s):

Critical Care ◽

Central Venous Pressure ◽

Right Atrium ◽

Venous Pressure ◽

Vena Cava ◽

Alternative Methods ◽

Haemodynamic Monitoring ◽

Haemodynamic Instability ◽

Central Venous ◽

The Right

Patients who present with acute cardiovascular compromise require haemodynamic monitoring in a critical care unit. Central venous pressure (CVP) is the most frequently used measure to guide fluid resuscitation in critically ill patients. It is most often done via a central venous catheter (CVC) positioned in the right atrium or superior or inferior vena cava as close to the right atrium as possible. The CVC is inserted via the internal jugular vein, subclavian vein or via the femoral vein, depending on the patient and their condition. Complications of CVC placement can be serious, so its risks and benefits need to be considered. Alternative methods to CVC use include transpulmonary thermodilution and transoesophageal Doppler ultrasound. Despite its widespread use, CVP has been challenged in many studies, which have reported it to be a poor predictor of haemodynamic responsiveness. However, it is argued that CVP monitoring provides important physiologic information for the evaluation of haemodynamic instability. Nurses have central roles during catheter insertion and in CVP monitoring, as well as in managing these patients and assessing risks.

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ECG-guided central venous catheter positioning: does it detect the pericardial reflection rather than the right atrium?

European Journal of Anaesthesiology ◽

10.1017/s0265021504008038 ◽

2004 ◽

Vol 21 (8) ◽

pp. 600-605 ◽

Cited By ~ 1

Author(s):

W. Schummer ◽

C. Schummer ◽

A. Müller ◽

J. Steenbeck ◽

J. Fuchs ◽

...

Keyword(s):

Central Venous Catheter ◽

Right Atrium ◽

Venous Catheter ◽

Central Venous ◽

The Right

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Bloodstream infections among patients using central venous catheters in intensive care units

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692007000300014 ◽

2007 ◽

Vol 15 (3) ◽

pp. 453-459 ◽

Cited By ~ 14

Author(s):

Eni Rosa Aires Borba Mesiano ◽

Edgar Merchán-Hamann

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Analytical Study ◽

Hospital Costs ◽

Bloodstream Infections ◽

Federal District ◽

Central Venous Catheters ◽

Central Venous ◽

Catheter Group ◽

The Right

Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (p<1x10-8) as well as the right subclavian access and double-lumen catheters. Patients with neurological disorders and those submitted to tracheotomy were the most affected. We suggest the organization of a "catheter group" aiming to standardize procedures related to the use of catheters in order to reduce the hospitalization term and hospital costs.

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Placement of neonatal central venous catheter tips: is the right atrium so dangerous?

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/fn.87.2.f155-a ◽

2002 ◽

Vol 87 (2) ◽

pp. 155F -a-156 ◽

Cited By ~ 5

Author(s):

D W Cartwright

Keyword(s):

Central Venous Catheter ◽

Right Atrium ◽

Venous Catheter ◽

Central Venous ◽

The Right

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SURGICAL RETRIEVAL OF MIGRATED ENDOVASCULAR STENT FROM THE RIGHT ATRIUM

10.36106/ijar/6101355 ◽

2021 ◽

pp. 1-2

Author(s):

Deepak Jaiswal ◽

Hrishikesh Parashi ◽

Mohammed Nadeem Nazim

Keyword(s):

Right Atrium ◽

Unusual Case ◽

Stent Migration ◽

Brachiocephalic Vein ◽

Endovascular Stent ◽

Endovascular Stenting ◽

Central Venous ◽

Central Venous Stenosis ◽

The Right ◽

Vein Stenosis

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 60-year-old man on hemodialysis who underwent endovascular stenting for right brachiocephalic vein stenosis and experienced stent migration to the right atrium, requiring surgical treatment.

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