A retrospective analysis of the real-time ultrasound-guided supraclavicular approach for the insertion of a tunneled central venous catheter in pediatric patients

2021 ◽  
pp. 112972982110080
Author(s):  
Kazuhiko Nakame ◽  
Tatsuru Kaji ◽  
Shun Onishi ◽  
Masakazu Murakami ◽  
Ayaka Nagano ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Central Venous Catheter ◽  
Real Time ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Background Information ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Supraclavicular Approach ◽  
Venous Catheterization

Purpose: Tunneled central venous catheter (tCVC) placement plays an important role in the management of pediatric patients. We adopted a real-time ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation. We evaluated the outcomes of tCVC placement via a US-guided supraclavicular approach. Methods: A retrospective study was performed for patients who underwent US-guided central venous catheterization of the internal jugular vein (IJV group) and brachiocephalic vein (BCV group) in our institution. The background information and outcomes were reviewed using medical records. Results: We evaluated 85 tCVC placements (IJV group: n = 59, BCV group: n = 26). Postoperative complications were recognized in 19 patients in the IJV group (catheter-related bloodstream infection (CRBSI), n = 14 (1.53 per 1000 catheter days); occlusion, n = 1 (1.7%, 1.09 per 1000 catheter days); accidental removal, n = 3 (5.2%, 0.33 per 1000 catheter days); and other, n = 1 (1.7%, 1.09 per 1000 catheter days)) and five patients in the BCV group (CRBSI, n = 2 (0.33 per 1000 catheter days); catheter damage, n = 1 (3.8%, 1.67 per 1000 catheter days); and accidental removal, n = 2 (7.7%, 0.33 per 1000 catheter days)). In the BCV group, despite that, the incidence of postoperative complications was lower ( p = 0.205) and the period of placement was significantly longer in comparison to the IJV group ( p = 0.024). Conclusion: US-guided placement of tunneled CVC though the BCV results in a low rate of postoperative complications despite longer CVC indwelling times compared to IJV insertion. Our results suggest that BCV insertion of tunneled CVC in children may offer advantages in terms of device performance and patient safety.

Supradiaphragmatic central venous catheter malposition detection using the parasternal long-axis echocardiographic view and dextrose 50% contrast solution: A pilot study

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110517
Author(s):  
Mohd Jazman Che Rahim ◽  
Shaik Farid Abdull Wahab ◽  
Mohd Hashairi Fauzi ◽  
Chandran Nadarajan ◽  
Siti Azrin Ab Hamid
Keyword(s):  
Pilot Study ◽  
Central Venous Catheter ◽  
Blood Sugar ◽  
Venous Catheter ◽  
Capillary Blood ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Perfect Agreement ◽  
Catheter Malposition ◽  
Contrast Solution

Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators’ diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p < .0001). The RVI-PLAX CEUS was not able to detect two central venous catheter malpositions (one atrial malposition and one left brachiocephalic vein venous catheter malposition). The capillary blood sugar was significantly elevated (8.96 mmol/L vs. 9.75 mmol/L) after D50% flush ( p < 0.005) with no complications reported within 30 minutes after the D50% flush. Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.

Novel Educational Module for Subclavian Central Venous Catheter Insertion Using Real-Time Ultrasound Guidance

2015 ◽  
Vol 72 (6) ◽  
pp. 1217-1223 ◽  
Author(s):  
Andrew W.L. Bayci ◽  
Jimmi Mangla ◽  
Christina S. Jenkins ◽  
Felicia A. Ivascu ◽  
James M. Robbins
Keyword(s):  
Central Venous Catheter ◽  
Real Time ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Educational Module

scholarly journals Epidemiology of central venous catheter related blood stream infections in pediatric patients

2006 ◽  
Vol 49 (2) ◽  
pp. 157
Author(s):  
Jung Hyun Kim ◽  
Ho Sun Eun ◽  
Kyung Min Choi ◽  
Dong Soo Kim ◽  
Dong Eun Young
Keyword(s):  
Central Venous Catheter ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous ◽  
Blood Stream Infections

A brachiocephalic vein abnormality causing a ‘twisted’ central venous catheter

1995 ◽  
Vol 20 (2) ◽  
pp. 105-107
Author(s):  
R. Kessler ◽  
L. Tavernier ◽  
M.Y. Yeung ◽  
E. Weitzenblum
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Brachiocephalic Vein ◽  
Central Venous

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

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
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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