Management of a malpositioned central venous catheter in the accessory hemiazygos vein

Malposition of a central venous catheter (CVC) in the accessory hemiazygos vein is an uncommon but potentially fatal complication; however, there is limited information regarding the preferred removal technique. We report a patient, a 57-year-old woman, who presented with overdose of her prescribed sedatives, who experienced this catheter complication after CVC insertion in the left internal jugular vein. The CVC was placed without resistance but routine postplacement chest X-ray showed abnormal coursing of the catheter close to the descending aorta. We used non-enhanced CT as an adjunct to safely identify the catheter position and assess for any bleeding during removal. CT images taken after retraction of the catheter tip by 10 cm showed no bleeding and we were able to remove the catheter safely. We recommend using CT as an adjunct to safely remove malpositioned catheters and reduce the risk of further complication.

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Contrast enhanced ultrasound vs chest X-ray to determine correct central venous catheter position

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2013.10.001 ◽

2014 ◽

Vol 32 (1) ◽

pp. 78-81 ◽

Cited By ~ 21

Author(s):

Francesca Cortellaro ◽

Luca Mellace ◽

Stefano Paglia ◽

Giorgio Costantino ◽

Sara Sher ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Contrast Enhanced Ultrasound ◽

Central Venous ◽

Catheter Position ◽

X Ray ◽

Contrast Enhanced ◽

Chest X Ray

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Evaluation of the Efficacy of Ultrasound in Detecting Correct Placement of Central Venous Catheter and Determining the Elimination of the Need for Chest Radiography

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1723747 ◽

2021 ◽

Vol 05 (01) ◽

pp. 018-022

Author(s):

Suvendu Panda ◽

S.K. Rojalin Baby ◽

Rajesh Thosani

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Cross Sectional ◽

X Ray ◽

Correct Placement ◽

Venous Catheterization ◽

Catheter Tip ◽

Chest X Ray ◽

American Society

Abstract Background and Aims Ultrasound guidance of central venous catheter (CVC) insertion improves the safety and efficacy of its placement, but still it may not ensure correct placement of catheter tip. In our study, we aimed to identify the correct placement of CVC tip and to detect mechanical complications, by visualizing it in real time with the help of sonography and comparing this to the chest X-ray findings. Patients and Methods This was a cross-sectional observational study conducted on 80 patients with American Society of Anesthesiologists grades 1 and 2, in the age group of 18 to 65 years, who required central venous catheterization in intensive care unit. The CVC tip placement was identified with ultrasound and then the finding was compared with postinsertion chest X-ray. Results In only 9 out of the 80 patients (11.3%) malposition was detected on ultrasound and was corrected immediately, whereas in remaining 71 patients (88.8%) no intervention was required. It was observed that all the patients had correct position of CVC tip on postprocedural chest X-ray. Accidental arterial cannulation occurred in two (2.5%) patients in whom right internal jugular vein was cannulated and in two (2.5%) patients who had arrhythmia. Conclusion Ultrasonography (USG) examination can be used as a diagnostic tool method for confirmation of CVC tip and identification of cannulation-related complications. Thus, we can say that USG might obviate the need for post-CVC insertion chest X-ray.

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Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Journal of Anaesthesiology Clinical Pharmacology ◽

10.4103/0970-9185.117114 ◽

2013 ◽

Vol 29 (3) ◽

pp. 397 ◽

Cited By ~ 11

Author(s):

AchuthanNair Venugopal ◽

RachelCherian Koshy ◽

SumodM Koshy

Keyword(s):

Central Venous Catheter ◽

Case Reports ◽

Venous Catheter ◽

Review Of The Literature ◽

Central Venous ◽

X Ray ◽

Catheter Tip ◽

Chest X Ray

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A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

The Journal of Vascular Access ◽

10.1177/1129729820943457 ◽

2020 ◽

pp. 112972982094345

Author(s):

Maryanne Z A Mariyaselvam ◽

Vikesh Patel ◽

Adam Sawyer ◽

James A Richardson ◽

Jonathan Dean ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous Catheters ◽

Patient Harm ◽

Central Venous ◽

Exact Test ◽

The United Kingdom ◽

Catheter Tip ◽

Never Event ◽

Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

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Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip

Journal of Vascular Surgery ◽

10.1016/s0741-5214(98)70200-9 ◽

1998 ◽

Vol 28 (1) ◽

pp. 59-66 ◽

Cited By ~ 27

Author(s):

Ted R. Kohler ◽

Thomas R. Kirkman

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Catheter Failure

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Precision in Central Venous Catheter Tip Placement: A Review of the Literature

Journal of the Association for Vascular Access ◽

10.2309/java.15-3-3 ◽

2010 ◽

Vol 15 (3) ◽

pp. 112-125 ◽

Cited By ~ 21

Author(s):

Russell Hostetter ◽

Nadine Nakasawa ◽

Kim Tompkins ◽

Bradley Hill

Keyword(s):

Central Venous Catheter ◽

Selection Criteria ◽

Weighted Average ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position ◽

Landmark Technique ◽

The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

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Pericardial parenteral nutrition infusion following acute angulation of a neonatal polyurethane central venous catheter tip

Clinical Nutrition ◽

10.1016/s0261-5614(97)80039-8 ◽

1997 ◽

Vol 16 (5) ◽

pp. 263-264 ◽

Cited By ~ 2

Author(s):

A. Cade ◽

J.W.L. Puntis

Keyword(s):

Central Venous Catheter ◽

Parenteral Nutrition ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip

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Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

BMJ Open Quality ◽

10.1136/bmjoq-2020-001222 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001222

Author(s):

Enyo A Ablordeppey ◽

Byron Powell ◽

Virginia McKay ◽

Shannon Keating ◽

Aimee James ◽

...

Keyword(s):

Central Venous Catheter ◽

Acute Care ◽

Imaging Modality ◽

Phase 1 ◽

Venous Catheter ◽

Point Of Care Ultrasound ◽

Central Venous ◽

X Ray ◽

Chest X Ray ◽

Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

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A Novel Objective Approach Towards Physicians' Knowledge and Practice Patterns to Optimize Central Venous Catheter Placement: A Cross-sectional Study

10.22514/sv.2020.16.0052 ◽

2020 ◽

Keyword(s):

Intensive Care ◽

Central Venous Catheter ◽

Venous Catheter ◽

Cross Sectional Study ◽

Sectional Study ◽

Clinical Practices ◽

Central Venous ◽

Cross Sectional ◽

Study Objective ◽

Catheter Tip

Study objective: Central venous catheterization is an essential component of intensive care of critically ill patients, and proper positioning of the catheter is essential to prevent position-related complications. This study was conducted by using digital tape measurement to objectively assess clinician preferences for central venous catheter positioning based on specific position levels and landmarks on post-procedural chest radiographs. Design: A cross-sectional study using electronic questionnaire survey. Setting: Single academic teaching hospital participated in this study. Participants: The study enrolled 276 physicians from multiple clinical disciplines. Interventions: None. Measurements: A seven-level reference system labeled on a sample chest radiograph was used to identify the acceptable lower and upper limits and landmarks used to determine the optimal central venous catheter tip position as well as the pattern of clinical practices based on the specialty and level of experience of participants. Main results: Among the 276 respondents, the ratio of cumulative acceptance for the lower and upper catheter tip limit was 62% and 66.3% within a 4-cm range below or above the carina, respectively. Intensive care unit (ICU) physicians showed a greater tendency to choose a catheter tip 4 cm below and 6 cm above the carina (p = 0.004 and 0.002, respectively) as did experienced physicians (p = 0.007 and < 0.001, respectively). The commonest reason for catheter tip withdrawal was arrhythmia (50% of cases). Physicians in the ICU and experienced physicians were more concerned about the risk of cardiac perforation than other respondents (p < 0.001 and < 0.001, respectively). The carina was the most commonly used landmark in 71.7% of all physicians, although 50% of radiologists also used other landmarks. Conclusions: The acceptable limit of the catheter tip is 4 cm above and below the carina (-4 to +4), as determined on chest radiography, without a need for tip adjustment.

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