Ultrasound aided repositioning of misplaced guidewire during subclavian vein catheterisation

2019 ◽  
Vol 20 (6) ◽  
pp. 769-770
Author(s):  
Ferdinando Longo ◽  
Chiara Piliego ◽  
Felice E Agrò
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Central Vein ◽  
Common Complication ◽  
Ultrasound Guided

Catheter misplacement is a common complication during central vein catheterisation, and during subclavian vein catheterisation, one of the most common misplacements of the catheter is the ipsilateral internal jugular vein. Facing this type of misplacement, we tried to find an ultrasound-guided method to reposition the guidewire during subclavian vein catheterisation in adults.

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

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

Supraclavicular approach to the subclavian vein – one well forgotten technique with impressive results

2019 ◽  
Vol 91 (3) ◽  
pp. 1-5
Author(s):  
Biser Borisov ◽  
Sergey Iliev
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Statistical Correlation ◽  
Central Vein ◽  
Chronic Complications ◽  
Supraclavicular Approach ◽  
Acute Complications ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Purpose: Insertion of temporary and tunneled catheters for hemodialysis in the internal jugular vein is a gold standard. On the other hand, the supraclavicular approach to the subclavian vein is described by Yoffa in 1965. Despite its old invention, the latter technique is well forgotten for unknown reasons. The aim of this study is to present our experience with the usage of the supraclavicular approach for insertion of temporary and tunneled catheters. Material and Methods: We provide our experience on insertion of 506 temporary and 501 tunneled catheters within a five-year period (from 1st January 2010 to 31st December 2014). We use 8 (eight) different places for catheters insertion, including the subclavian vein by the supraclavicular approach following the techniques of D. Yoffa and J. Gorchynski. The collected data include age, sex, reasons for hemodialysis, number of attempts for successful cannulation, number of acute (AC) and chronic (CC) complications, and dependence on the catheter insertion location. Results: The gender distribution shows 463 (46 %) women and 544 (54 %) men with median age of 60.0 (+/- 13.2) years. In the cases of temporary catheters: 104 (20.5%) are inserted in the subclavian vein by the supraclavicular approach (SCVSC), 70 (13.8%) – in the internal jugular vein (IJV); in the cases of tunneled ones – SCVSC – 281 (56%), and IJV – 207 (41%) catheters, respectively. We found significant statistical correlation (p < 0.05 and r = 0.23) between the acute complications and the insertion position – AC are more for IJV insertion, than in SCVSC. We did not find significant correlation between the insertion place and the chronic complications. Even central vein stenosis is more frequent in the IJV than in the SCVSC, but this is not significant (p > 0.05). Primary catheter patency of temporary and tunneled catheters is higher when they are inserted in the left veins. Conclusion: We conclude that the supraclavicular approach to the subclavian vein is easier, safer and a practically more convenient method than the cannulation of the IJV. The revisit of this approach demonstrates that it should be more widely used.

Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease

2008 ◽  
Vol 74 (11) ◽  
pp. 1111-1113
Author(s):  
Chandra Hassan ◽  
H.T. Girishkumar ◽  
Bala Thatigotla ◽  
Muhammad Asad ◽  
Mahalingam Sivakumar ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Jugular Vein ◽  
Venous Occlusion ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Hemodialysis Catheter ◽  
Ultrasound Assessment ◽  
Stage Renal Disease ◽  
End Stage

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

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