Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac 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.

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Evaluation of a central venous catheter tip placement for superior vena cava–subclavian central venous catheterization using a premeasured length

Medicine ◽

10.1097/md.0000000000009600 ◽

2018 ◽

Vol 97 (2) ◽

pp. e9600

Author(s):

Hyun-Jung Kwon ◽

Young-Il Jeong ◽

In-Gu Jun ◽

Young-Jin Moon ◽

Yu-Mi Lee

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Central Venous Catheterization ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous ◽

Venous Catheterization ◽

Catheter Tip

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Misplacement of a central venous catheter into azygos vein via the right internal jugular vein

The Journal of Vascular Access ◽

10.1177/1129729820950996 ◽

2020 ◽

pp. 112972982095099

Author(s):

Minjia Wang ◽

Liang Xu ◽

Yue Feng ◽

Shijin Gong

Keyword(s):

Central Venous Catheter ◽

Critically Ill Patients ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Venous Catheter ◽

Azygos Vein ◽

Central Venous ◽

Venous Catheterization ◽

Tip Position ◽

The Right

For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described.

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Central venous access

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.8.c114 ◽

2019 ◽

Vol 80 (8) ◽

pp. C114-C119

Author(s):

Joel Lockwood ◽

Neel Desai

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Catheter ◽

Seldinger Technique ◽

Haemodynamic Monitoring ◽

Central Venous ◽

Venous Catheterization

Central venous catheterization is the placement of a catheter in such a manner that its tip is positioned within the proximal third of the superior vena cava, the right atrium or the inferior vena cava. It is indicated when access for administration of drugs or extracorporeal blood circuits and haemodynamic monitoring or interventions is needed. When inserting a central venous catheter, appropriate preparation and asepsis, positioning of the patient, and the use of ultrasound should be considered. Compared to the landmark method of localization, ultrasound can account for anatomical variations, facilitate visualization of venous puncture, and safeguard against inadvertent arterial puncture. In the Seldinger technique, which is the primary mode of central venous catheterization, a needle is passed towards the chosen vessel. Once the needle is in the vein, a guidewire is introduced through the needle into the vessel and the needle is removed. Following a small skin incision at the base of the guidewire, a dilator is advanced over the guidewire and then taken out. Subsequent to this, the central venous catheter is railroaded over the guidewire into the vein and the guidewire is withdrawn. Complications of central venous catheterization can be mechanical, infectious or thrombotic.

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Persistent Left Superior Vena Cava in Pediatric Patients

The Journal of Vascular Access ◽

10.1177/112972980901000317 ◽

2009 ◽

Vol 10 (3) ◽

pp. 219-220 ◽

Cited By ~ 3

Author(s):

Marco Caruselli ◽

Gianmarco Piattellini ◽

Gianfranco Camilletti ◽

Roberto Giretti ◽

Raffaella Pagni

Keyword(s):

Superior Vena Cava ◽

Pediatric Patients ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Superior Vena ◽

Vena Cava ◽

Central Venous ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

Venous Catheterization

A persistent left superior vena cava (PLSVC) is a congenital anomaly of the systemic venous system. This anomaly is often discovered as an incidental result during central venous catheterization passing through the left subclavian or the left internal jugular vein. We report two cases of PLSVC in pediatric patients.

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Persistent Left Superior Vena Cava: An Incidental Finding During Central Venous Catheterization

Vascular and Endovascular Surgery ◽

10.1177/153857440503900111 ◽

2005 ◽

Vol 39 (1) ◽

pp. 109-111 ◽

Cited By ~ 18

Author(s):

Payman J. Danielpour ◽

Joshua K. Aalberg ◽

Margarita El-Ramey ◽

Manuel Sivina ◽

Henry Wodnicki

Keyword(s):

Superior Vena Cava ◽

Central Venous Catheterization ◽

Incidental Finding ◽

Superior Vena ◽

Vena Cava ◽

Central Venous ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

Venous Catheterization

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

The Journal of Vascular Access ◽

10.1177/1129729818757976 ◽

2018 ◽

Vol 19 (6) ◽

pp. 528-534 ◽

Cited By ~ 5

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.

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Persistent Left Superior Vena Cava: A Finding After Central Venous Catheterization

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002161 ◽

2021 ◽

Author(s):

Francisco Lopes Morgado ◽

Bárbara Saraiva ◽

Celestina Blanco Torres ◽

João Correia

Keyword(s):

Superior Vena Cava ◽

Central Venous Catheterization ◽

Superior Vena ◽

Vena Cava ◽

Central Venous ◽

Left Superior Vena Cava ◽

Anatomical Variant ◽

Persistent Left Superior Vena ◽

Venous Catheterization ◽

Catheter Tip

Introduction: Persistence of the left superior vena cava (LSVC) is a rare anatomical variant in the general population with an estimated incidence of 0.3-0.5% in healthy individuals. Its diagnosis can be made incidentally after imaging control of central venous catheter (CVC) or other types of devices placements. Patient and Methods: We present the case of a patient with an acute disease which required central venous catheterization for the administration of intravenous chemotherapy. Results: Central venous catheterization proved difficult and after imaging control it revealed an unusual position of the catheter tip. Additional study to verify catheter tip position was performed and computed tomography (CT-scan) revealed the presence of a persistent left superior vena cava. The patient was then submitted to the planned treatment without any record of complications associated with CVC. Conclusion: Although uncommon the persistence of the LSVC can have an important impact in clinical practice, particularly when more invasive procedures are required. Its recognition is relevant in order to minimize the potential complications inherent to these procedures.

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