A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

2020 ◽  
pp. 112972982094345
Author(s):  
Maryanne Z A Mariyaselvam ◽  
Vikesh Patel ◽  
Adam Sawyer ◽  
James A Richardson ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Patient Harm ◽  
Central Venous ◽  
Exact Test ◽  
The United Kingdom ◽  
Catheter Tip ◽  
Never Event ◽  
Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

scholarly journals Insertion of Central Venous Catheters through Arm Veins

1975 ◽  
Vol 3 (2) ◽  
pp. 101-104 ◽  
Author(s):  
Jean Lumley ◽  
W. J. Russell
Keyword(s):  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
The Other ◽  
Central Venous ◽  
Catheter Tip ◽  
Arm Vein

The position of the tip of a central venous catheter inserted through an arm vein is not influenced by the arm or by the vein chosen. There may be some advantage in inserting the catheter with the arm at the patient's side, although there seems to be no benefit from turning the patient's head towards the side of insertion. Because the most common malposition from an apparently uneventful insertion is due to the catheter tip entering the internal jugular vein, neck compression has been established as a useful test. If the catheter tip is well into the internal jugular vein, compression on that side of the neck should cause a rise in the recorded pressure of 10 or more cm H2O. This rise should not occur on compression of the other side of the neck. We wish to emphasize that it is important to confirm radiographically the position of the catheter tip.

Recurrent central venous catheter migration in a patient with brittle asthma

2019 ◽  
Vol 21 (4) ◽  
pp. 533-535
Author(s):  
Emily R Hignell ◽  
Julian Phelps
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
High Index ◽  
Central Venous ◽  
Premature Failure ◽  
Catheter Migration ◽  
Catheter Tip ◽  
History Of ◽  
High Index Of Suspicion

Central venous catheters are widely used in intensive care and critically unwell patients, and reporting of unusual complications is in the interest of those using them on a regular basis. Recognised complications involve vascular, cardiac and pulmonary systems and include the risk of infection. Described is a case with a recurrent complication of device failure secondary to migration of the central venous catheter tip as a result of recurrent coughing episodes. The approach to inserting central catheters and diagnosing the cause for the migration is discussed. This case directly demonstrated looping and significant movement of a polyurethane catheter as a result of coughing. On two occasions, this resulted in the tip migration and the catheter becoming kinked, causing premature failure of the central venous catheter. This has only been seen before with silicone catheters. There should be high index of suspicion for migration of central venous catheters in patients with history of cough. Recommendations include maintaining a high index of suspicion for migration of central venous catheters in patients with history of cough and insertion of larger French size catheters in patient groups prone to severe coughing episodes. Ways to optimise initial central venous catheter placement using intracavitary electrocardiogram should be considered along with the use of interventional radiology in complex cases and those with recurrent complications.

Precision in Central Venous Catheter Tip Placement: A Review of the Literature

2010 ◽  
Vol 15 (3) ◽  
pp. 112-125 ◽  
Author(s):  
Russell Hostetter ◽  
Nadine Nakasawa ◽  
Kim Tompkins ◽  
Bradley Hill
Keyword(s):  
Central Venous Catheter ◽  
Selection Criteria ◽  
Weighted Average ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Landmark Technique ◽  
The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

Risk factor identification and predictive models for central line requirements for patients on vasopressors

2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Single Agent ◽  
Composite Endpoint ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

scholarly journals A Novel Objective Approach Towards Physicians' Knowledge and Practice Patterns to Optimize Central Venous Catheter Placement: A Cross-sectional Study

2020 ◽  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Clinical Practices ◽  
Central Venous ◽  
Cross Sectional ◽  
Study Objective ◽  
Catheter Tip

Study objective: Central venous catheterization is an essential component of intensive care of critically ill patients, and proper positioning of the catheter is essential to prevent position-related complications. This study was conducted by using digital tape measurement to objectively assess clinician preferences for central venous catheter positioning based on specific position levels and landmarks on post-procedural chest radiographs. Design: A cross-sectional study using electronic questionnaire survey. Setting: Single academic teaching hospital participated in this study. Participants: The study enrolled 276 physicians from multiple clinical disciplines. Interventions: None. Measurements: A seven-level reference system labeled on a sample chest radiograph was used to identify the acceptable lower and upper limits and landmarks used to determine the optimal central venous catheter tip position as well as the pattern of clinical practices based on the specialty and level of experience of participants. Main results: Among the 276 respondents, the ratio of cumulative acceptance for the lower and upper catheter tip limit was 62% and 66.3% within a 4-cm range below or above the carina, respectively. Intensive care unit (ICU) physicians showed a greater tendency to choose a catheter tip 4 cm below and 6 cm above the carina (p = 0.004 and 0.002, respectively) as did experienced physicians (p = 0.007 and < 0.001, respectively). The commonest reason for catheter tip withdrawal was arrhythmia (50% of cases). Physicians in the ICU and experienced physicians were more concerned about the risk of cardiac perforation than other respondents (p < 0.001 and < 0.001, respectively). The carina was the most commonly used landmark in 71.7% of all physicians, although 50% of radiologists also used other landmarks. Conclusions: The acceptable limit of the catheter tip is 4 cm above and below the carina (-4 to +4), as determined on chest radiography, without a need for tip adjustment.

A New Formula-Based Measurement Guide for Optimal Positioning of Central Venous Catheters

2004 ◽  
Vol 9 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Phllip Lum
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Access Site ◽  
Insertion Sites ◽  
Tip Position ◽  
A Prospective Study ◽  
New Formula ◽  
Percutaneous Insertion

Abstract Purpose: To validate the formula-based central venous catheter (CVC) length measurement “tailored” to individual's height and access site for predicting optimum SVC tip position. Method: A prospective study of 3 percutaneous insertion sites (PICC, SCC and JC). Formula-based “LUM'S CVC MEASUREMENT GUIDE” was used to determine the catheter length. Results: Overall, 97% (373) of the total 382 insertions were successfully placed with CVC tip in the distal SVC (SVC between carina and atrio-cava junction) location. Conclusion: The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition.

Sign in / Sign up

Export Citation Format

Share Document