Ultrasound-guided central venous tip confirmation via right external jugular vein using a right supraclavicular fossa view

Introduction: Ultrasound-guided central venous catheter tip confirmation has a potential to precisely locate the central venous catheter, preventing its misplacement, using real-time guidance. This observational study sought to determine the accuracy of central venous catheter tip positioning via the external jugular vein via a supraclavicular fossa view under ultrasound guidance. Methods: In total, 77 patients scheduled for central venous catheter insertion via the right external jugular vein were enrolled. The depth of central venous catheter insertion was determined by advancing the tip of the guidewire to the junction of the superior vena cava and right pulmonary artery, using a right supraclavicular fossa view ultrasound method. We determined the reference insertion depth to the carina using a postoperative chest x-ray photograph method. We then compared insertion depths obtained by the ultrasound and x-ray photograph methods and body-height formula. Results: In total, 62 patients were able to advance the guidewire and underwent ultrasound-guided central venous catheter insertion. In four patients, we corrected for misplaced guidewires. According to Bland–Altman plots, the insertion depth was 0.88 cm shorter for the ultrasound method (95% limits of agreement, −1.66 to 3.41 cm) and 0.90 cm shorter for the formulaic method (95% limits of agreement, −2.77 to 4.56 cm), compared with the x-ray photograph method. The x-ray photograph method had significantly positive correlations with the ultrasound (r = 0.73) and formulaic methods (r = 0.27). Conclusion: A right supraclavicular fossa view improves the accuracy of central venous catheter tip positioning and prevents central venous catheter misplacement via the right external jugular vein.

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Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?

CHEST Journal ◽

10.1016/j.chest.2018.02.017 ◽

2018 ◽

Vol 154 (1) ◽

pp. 148-156 ◽

Cited By ~ 16

Author(s):

Jason Chui ◽

Rasha Saeed ◽

Luke Jakobowski ◽

Wanyu Wang ◽

Basem Eldeyasty ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Catheter Insertion ◽

Choosing Wisely ◽

Central Venous Catheter Insertion ◽

Ultrasound Guided ◽

Central Venous ◽

X Ray ◽

Chest X Ray ◽

Routine Chest

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Central venous catheter care for the patients with cancer: ultrasound-guided insertion should be strongly recommended for internal jugular vein catheterization

Annals of Oncology ◽

10.1093/annonc/mdt387 ◽

2013 ◽

Vol 24 (11) ◽

pp. 2928-2929 ◽

Cited By ~ 5

Author(s):

L. Cavanna ◽

G. Civardi ◽

P. Mordenti ◽

D. Vallisa ◽

R. Bertè ◽

...

Keyword(s):

Central Venous Catheter ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Ultrasound Guided ◽

Central Venous ◽

Patients With Cancer ◽

Internal Jugular Vein Catheterization ◽

Vein Catheterization ◽

Catheter Care

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A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

Birat Journal of Health Sciences ◽

10.3126/bjhs.v2i3.18943 ◽

2018 ◽

Vol 2 (3) ◽

pp. 277-281

Author(s):

Lalit Kumar Rajbanshi ◽

Sambhu Bahadur Karki ◽

Batsalya Arjyal

Keyword(s):

Real Time ◽

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Anatomical Landmark ◽

Ultrasound Guided ◽

Central Venous ◽

Catheter Tip ◽

Landmark Technique

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

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Malposition of central venous catheter in the jugular venous arch via external jugular vein -a case report-

Korean Journal of Anesthesiology ◽

10.4097/kjae.2015.68.2.175 ◽

2015 ◽

Vol 68 (2) ◽

pp. 175

Author(s):

SoWoon Ahn ◽

Ju Ho Lee ◽

Chunghyun Park ◽

Yong-woo Hong ◽

Duk-Hee Chun

Keyword(s):

Case Report ◽

Central Venous Catheter ◽

Jugular Vein ◽

Venous Catheter ◽

External Jugular Vein ◽

Central Venous

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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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Reviving an Old Technique Forgotten: Insertion Central Venous Catheter by External Jugular Vein: Description of Technical and Series of Cases

Annals of Clinical and Laboratory Research ◽

10.21767/2386-5180.100243 ◽

2018 ◽

Vol 06 (03) ◽

Author(s):

Juan Esteban Gomez Tobar ◽

Adolfo Leon Trochez Zuleta

Keyword(s):

Central Venous Catheter ◽

Jugular Vein ◽

Venous Catheter ◽

External Jugular Vein ◽

Central Venous

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Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

The Journal of Vascular Access ◽

10.1177/1129729819882602 ◽

2019 ◽

Vol 21 (4) ◽

pp. 440-448 ◽

Cited By ~ 1

Author(s):

Timothy R Spencer ◽

Amy J Bardin-Spencer

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Ultrasound Guided ◽

Central Venous ◽

Clinical Simulation ◽

Venous Catheterization ◽

Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

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