Venoconstriction of hepatic capacitance vessels during hemorrhage in cats: afferent mechanisms

1994 ◽  
Vol 267 (1) ◽  
pp. H1-H10 ◽  
Author(s):  
C. V. Greenway ◽  
I. R. Innes ◽  
G. D. Scott
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Central Venous ◽  
Venae Cavae ◽  
Hepatic Volume ◽  
Capacitance Vessels ◽  
Hemorrhage Volume ◽  
The Right ◽  
Carotid Arterial ◽  
Volume Decrease

Cats anesthetized with pentobarbital sodium were hemorrhaged (1 ml.min-1.kg body wt-1) until arterial pressure declined to 55 mmHg. Hepatic volume was recorded by plethysmography. Hemorrhage volume was 21.1 +/- 4.7 (SD) ml/kg, and hepatic volume declined by 4.0 +/- 1.7 ml/kg. These responses were markedly reduced by four procedures that prevented decreases in carotid arterial and central venous pressures and eliminated vagal conduction. When any three of these four procedures were carried out, the remaining stimulus caused a significant increase in the size of the hepatic volume decrease. The results suggest that arterial receptors (baro- and/or chemoreceptors) in the carotid arterial bed or brain and venous baroreceptors in the right atrium and superior and inferior venae cavae are involved in hepatic capacitance responses to hemorrhage. The responses were linearly related to the stimuli, and hepatic blood volume changed by 1.7 +/- 1.1 and 0.030 +/- 0.016 ml/kg for each 1-mmHg change in venous and carotid arterial pressures, respectively. The maximal responses to these afferent stimuli applied individually were not significantly different (-4.2 +/- 1.8 ml/kg) and were not additive, suggesting overlapping redundant systems. The possibility of baroreceptors in superior vena cava has not previously been documented.

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

2021 ◽  
pp. 152660282198933
Author(s):  
Pablo V. Uceda ◽  
Julio Peralta Rodriguez ◽  
Hernán Vela ◽  
Adelina Lozano Miranda ◽  
Luis Vega Salvatierra ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Esophageal Varices ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Dialysis Patients ◽  
Central Venous ◽  
Endovascular Recanalization ◽  
Flow Through ◽  
The Right

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.

Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation

2018 ◽  
Vol 19 (6) ◽  
pp. 528-534 ◽  
Author(s):  
Folkert Steinhagen ◽  
Maximilian Kanthak ◽  
Guido Kukuk ◽  
Christian Bode ◽  
Andreas Hoeft ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
The Right

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.

scholarly journals Avoiding harm: central venous access in Kartagener syndrome and other vascular anomalies

2021 ◽  
Vol 9 (41) ◽  
pp. 40-43
Author(s):  
Brad Snodgrass ◽  
Victoria Chu
Keyword(s):  
Patient Outcomes ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Central Venous ◽  
Kartagener Syndrome ◽  
Internal Jugular Vein Catheterization ◽  
The Right ◽  
Landmark Technique

Placement of internal jugular catheters is more likely to be complicated if a left-sided approach is used, assuming normal anatomy. Kartagener syndrome is the sine qua non of sidedness confusion and results in cognitive challenges that increase the risk of adverse patient outcomes. The altered anatomy can cause profound disorientation from our usual processes.  In normal circumstances the right-sided approach is used for placement of internal jugular catheters, but in Kartagener syndrome the left-sided approach should be preferred.  Surgical volume and use of ultrasound guided techniques are positively correlated with better outcomes.  Clinical experience may be a detriment to performance. Knowledge of these issues will help clinicians maintain vigilance and avoid error.    Keywords: Kartagener syndrome, central venous access, superior vena cava, landmark technique, internal jugular vein catheterization cognitive bias

scholarly journals 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

2016 ◽  
Vol 57 (4) ◽  
pp. 288-294 ◽  
Author(s):  
Alfredo Ulloa-Ricardez ◽  
Lizett Romero-Espinoza ◽  
María de Jesús Estrada-Loza ◽  
Héctor Jaime González-Cabello ◽  
Juan Carlos Núñez-Enríquez
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous ◽  
Critically Ill Neonates ◽  
The Right ◽  
Intracardiac Thrombosis

scholarly journals Endovascular retrieval of two migrated stents from pulmonary artery by means of balloon catheter

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Saad Saeed Alqahtani ◽  
Ahmed Kandeel Elhadad ◽  
Rusha Abdulmohsen Sarhan ◽  
Saleh Mohamed Alwaleedi
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena ◽  
Balloon Catheter ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Venous Stenting ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
The Right

Long-term central venous catheters can be associated with central venous stenosis in up to 50% of cases. Central venous stenosis can be managed with central venous stenting which was demonstrated to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents into the right side of the heart or the pulmonary artery during stent deployment is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is the preferred alternative for the more invasive operative intervention, which may be very hazardous in these patients. We report an unusual case of a 52-year-old man on hemodialysis who underwent endovascular stenting to treat a tight stenosis of the right brachiocephalic vein and superior vena cava and suffered from stent migration to the left pulmonary artery, requiring removal by interventional radiologist.

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

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.

scholarly journals Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac Surgical Unit

1994 ◽  
Vol 22 (3) ◽  
pp. 267-271 ◽  
Author(s):  
J. S. Rutherford ◽  
A. F. Merry ◽  
C. J. Occleshaw
Keyword(s):  
Central Venous Catheterization ◽  
Main Bronchus ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Azygos Vein ◽  
Central Venous ◽  
Venous Catheterization ◽  
The Right ◽  
Surgical Unit

Central venous catheter (CVC) depth relative to the cephalic limit of the pericardial reflection (CLPR) was assessed retrospectively in 100 adult patients from chest radiographs taken after admission to the intensive care unit. A well known landmark proved to be considerably influenced by parallax; therefore we located the CLPR by a new landmark, the junction of the azygos vein and the superior vena cava, identified by the angle of the right main bronchus and the trachea. The majority (58) of CVC tips lay below the pericardial reflection on the first chest radiograph (CXR). Of these only two had been corrected by the time of the next routine CXR. No case of cardiac tamponade secondary to erosion by a CVC could be remembered, or identified from records of routine departmental audit meetings, for the last ten years. Nevertheless, reported incidents of this complication have often been fatal and vigilance is necessary in any patient with a CVC.

Dual Inferior Venae Cavae with Mitral Stenosis

2009 ◽  
Vol 17 (4) ◽  
pp. 419-421
Author(s):  
Sandeep P Tambe ◽  
Prabhat Kumar Sinha ◽  
Ashok N Bhupali
Keyword(s):  
Inferior Vena Cava ◽  
Mitral Stenosis ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Aneurysmal Dilatation ◽  
Ipsilateral Side ◽  
Venae Cavae ◽  
The Right

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.

scholarly journals Inadvertent insertion of a venous catheter into the internal thoracic vein: a word of caution

2019 ◽  
Vol 18 ◽  
Author(s):  
Flavia Ramos Tristão ◽  
Ricardo César Rocha Moreira ◽  
Carlos Eduardo Del Valle ◽  
Giana Caroline Strack Neves
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Catheter Malfunction ◽  
The Right ◽  
Work Up ◽  
Internal Thoracic Vein ◽  
Rule Out

Abstract Central venous catheters are widely used in clinical practice and are linked to many types of complications, including incorrect positioning at the time the catheter is fitted. Here, the authors describe a case in which a fully implantable catheter was inadvertently positioned in the right internal thoracic vein. The complication was identified when the nursing team attempted to use the catheter. The right internal thoracic vein is within the radiographic projection of the right brachiocephalic vein and the superior vena cava, simulating correct catheter placement on an anteroposterior radiograph. In cases of central catheter malfunction during the immediate postoperative period, work-up should include oblique and lateral views, to rule out the complication described here without a need for computed tomography.

Minimal guidewire length for central venous catheterization of the right subclavian vein: A CT-based consecutive case series

2021 ◽  
pp. 112972982199398
Author(s):  
Maria Adrian ◽  
Pär Bengtsson ◽  
Ola Borgquist ◽  
Gracijela Bozovic ◽  
Thomas Kander
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous ◽  
Vessel Length ◽  
The Wire ◽  
Tip Position ◽  
The Right ◽  
Vein Catheterization

Background: Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein. Methods: One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15–16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit. Results: The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits. Conclusion: After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15–16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.

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