Safe Placement of Central Venous Catheters

2011 ◽  
Vol 26 (6) ◽  
pp. 392-396 ◽  
Author(s):  
William T. McGee ◽  
Patrick T. Mailloux ◽  
Richard T. Martin
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Prospective Trial ◽  
Vena Cava ◽  
Pericardial Tamponade ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Insertion Depth ◽  
Simple Method

Introduction. To develop a simple method for safely placing central venous catheters (CVCs) outside the heart from the subclavian or internal jugular vein in compliance with Food and Drug Administration (FDA) and manufacturer guidelines. Methods. Patients requiring CVCs were enrolled into this prospective trial. Central venous catheters were inserted into the subclavian or internal jugular vein from either the right or left side to a depth of 15 cm. Chest radiographs were obtained immediately after insertion of the catheter to check tip placement and to evaluate for mechanical complications. Results. Operators successfully placed 201 of 210 (96%) CVCs outside the heart. Six of these required repositioning. Nine catheter tips were located in an intracardiac position. No cases of pneumothorax, hemothorax, or pericardial tamponade occurred. One case of delayed hydrothorax due to superior vena cava injury occurred. Conclusions. Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines.

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

scholarly journals Late Perforation of Superior Vena Cava and Effusion Caused by Central Venous Catheter

1981 ◽  
Vol 9 (3) ◽  
pp. 286-288 ◽  
Author(s):  
A. Criado ◽  
A. Mena ◽  
R. Figueredo ◽  
E. Reig ◽  
F. Avello
Keyword(s):  
Pleural Effusion ◽  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Left Internal Jugular Vein ◽  
Central Venous

A patient developed right-side pleural effusion secondary to perforation of the superior vena cava by a catheter which had been inserted seven days previously through the left internal jugular vein.

scholarly journals Intra- and Extra-pericardial Lengths of the Superior Vena Cava in Vivo: Implication for the Positioning of Central Venous Catheters

2005 ◽  
Vol 33 (3) ◽  
pp. 384-387 ◽  
Author(s):  
T. D. Kwon ◽  
K. H. Kim ◽  
H. G. Ryu ◽  
C. W. Jung ◽  
J. M. Goo ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Surgical Patients ◽  
Right Atrial ◽  
Central Venous ◽  
Insertion Depth

To reduce the possibility of cardiac tamponade, a rare but lethal complication of central venous catheters, the tip of the central venous catheter should be located above the cephalic limit of the pericardial reflection, not only above the superior vena cava-right atrium junction. This study was performed to measure the superior vena cava lengths above and below the pericardial reflection in cardiac surgical patients. Cardiac surgical patients (n=61; 27 male), whose age [mean±SD (range)] was 47±15 (15–75) years, were studied. The intrapericardial and extrapericardial lengths, and the length of the medial duplicated part were measured separately. The whole vertical lengths of the superior vena cava on either side were calculated respectively by adding the intra-and extrapericardial and medial duplication lengths. The lateral extrapericardial was 29.1±6.5 (Mean±SD) (9–49) mm (range), and lateral extrapericardial length was 32.6±6.9 (20–53) mm. The medial extrapericardial length was 23.3±5.0 (11–39) mm, medical duplicated length was 7.2±3.3 (4–20) mm, and medial intrapericardial was 28.3±7.0 (20–52) mm. The averaged superior vena cava length of both sides was 60.3±9.0 (44.5–90) mm. Almost half of the superior vena cava was found to be within the pericardium and half out. This information may be helpful in deciding how far a central venous catheter should be withdrawn beyond the superior vena cava-right atrial junction during right atrial electrocardiographic guided insertion, and in the prediction of optimal central venous catheter insertion depth.

scholarly journals Azygos vein cannulation after catheterisation of the left internal jugular vein in a toddler

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227930 ◽  
Author(s):  
Georgios Kampouroglou ◽  
Georgios Noutsos ◽  
Panagiotis Skandalakis ◽  
Petros Mirilas
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Azygos Vein ◽  
Left Internal Jugular Vein ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
Catheter Tip

Central venous catheterisation is routinely performed in paediatric patients to facilitate therapeutic management when long-term vascular access is needed. Misplacement of the catheter tip in thoracic vessels other than the superior vena cava has been described, along with related complications. Hereby, a case of a 15-month-old child is presented with a fully functional Hickman catheter introduced via the left internal jugular vein. The tip of the catheter was misplaced into the azygos vein. Intraoperative spot fluoroscopic images and anatomical explanations for the course of the catheter are presented. An understanding of the aetiology of the radiological appearance may help to increase recognition of such cases and avoid complications.

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.

Transvenous removal of pacing and ICD leads: single italian referral center experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Segreti ◽  
M Giannotti Santoro ◽  
A Di Cori ◽  
F Fiorentini ◽  
G Zucchelli ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Lead Removal ◽  
Entry Site ◽  
Referral Center ◽  
Icd Leads ◽  
Low Incidence ◽  
Wide Experience

Abstract Introduction Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center. Methods Since January 1997 to December 2019, we managed 2769 consecutive patients (2100 men, mean age 65.5 years) with 5086 leads (mean pacing period 73.6 months, range 1–576). PL were 3998 (1828 ventricular, 1704 atrial, 466 coronary sinus leads), DL were 1088 (1067 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 79% (systemic 27%, local 52%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools; an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach. Results Removal was attempted in 5076 leads because the technique was not applicable in 10 PL. Among these, 4952 leads were completely removed (97.6%), 49 (1.0%) partially removed, 75 (1.4%) not removed. Among 4989 exposed leads, 818 were removed by manual traction (16.4%), 3664 by mechanical dilatation using the venous entry site (73.4%), 48 by femoral approach (FA) (1.0%) and 335 by JA (6.7%). All the free-floating leads were completely removed, 25.3% by FA and 74.7% by JA. Major complications occurred in 20 cases (0.72%): cardiac tamponade (19 cases, 4 deaths), hemotorax (1 death). Conclusions Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads. Funding Acknowledgement Type of funding source: None

Persistent Left Superior Vena Cava in Pediatric Patients

2009 ◽  
Vol 10 (3) ◽  
pp. 219-220 ◽  
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.

scholarly journals Arterial Placement of Central Venous Catheters

2020 ◽  
Vol 15 (3) ◽  
pp. 45-48
Author(s):  
Benjamin Wierstra ◽  
Selena Au ◽  
Paul Cantle ◽  
Kenton Rommens
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Posterior Wall ◽  
Arterial Injury ◽  
Central Venous Catheters ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Carotid Injury ◽  
Radiologie Interventionnelle ◽  
The Common

Arterial misplacement of central venous catheters can often be avoided with the use of real-time ultrasound-guided procedural competency.  However, misplacement can still occur and is more likely to occur when the internal jugular vein is located directly above the common carotid injury.  The resultant injury to the common carotid artery occurs through the posterior wall of the internal jugular vein.  Arterial injury may also occur when the subclavian vein is attempted in a non-ultrasound-guided fashion.  Optimal management requires a coordinated evaluation of the catheter misplacement by Interventional Radiology and Vascular Surgery to ensure maximum patient safety during catheter removal.  This article reviews the literature around this topic and provides a summary of the best approach to safely remove the misplaced catheter. Resume Le mauvais positionnement artériel des cathéters veineux centraux peut souvent être évité grâce à l'utilisation de compétences procédurales guidées par ultrasons en temps réel.  Cependant, un mauvais positionnement peut toujours se produire et est plus susceptible de se produire lorsque la veine jugulaire interne est située directement au-dessus de la lésion carotidienne commune.  La lésion de l'artère carotide commune qui en résulte se produit à travers la paroi postérieure de la veine jugulaire interne.  Une lésion artérielle peut également se produire lorsque la veine sous-clavière n'est pas guidée par un ultrason.  Une gestion optimale nécessite une évaluation coordonnée du mauvais positionnement du cathéter par la radiologie interventionnelle et la chirurgie vasculaire afin de garantir une sécurité maximale au patient lors du retrait du cathéter.  Cet article passe en revue la littérature sur ce sujet et fournit un résumé de la meilleure approche pour retirer en toute sécurité le cathéter mal placé.  

Sign in / Sign up

Export Citation Format

Share Document