Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram

2021 ◽  
pp. 112972982110455
Author(s):  
Xinpeng Wang ◽  
Yong Yang ◽  
Jing Dong ◽  
Xiaozheng Wang ◽  
Yuanyuan Zheng ◽  
...  
Keyword(s):  
Body Surface ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
The Body ◽  
P Wave ◽  
P Waves ◽  
Venous Access Device ◽  
Surface Electrocardiogram

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

Repositioning of Central Venous Access Devices using a High-Flow Flush Technique - a Clinical Practice and Cost Review

2017 ◽  
Vol 18 (5) ◽  
pp. 419-425 ◽  
Author(s):  
Timothy R. Spencer
Keyword(s):  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
High Flow ◽  
Cost Comparison ◽  
Central Venous ◽  
Access Service ◽  
Venous Access Device ◽  
Central Catheters

Background Malpositioned central venous access device (CVAD) tip locations can cause significant mechanical and chemical vessel-related injuries and complications if left in inappropriate positions. The aim of this study is to determine the use of a high-flow flush technique (HFFT) in successful correction of malpositioned catheters into the lower superior vena cava or cavoatrial junction and provide a cost comparison to interventional/fluoroscopic-based repositioning. Methods This is a retrospective chart and radiographic review of all inserted CVADs found malpositioned between 1996-2014 in a multi-specialty 1000-bed tertiary trauma center in Sydney, Australia. 7450 CVADs placed by a nurse-led vascular access service were reviewed. Catheters repositioned pre-2010 were excluded owing to radiology repositioning interventions. Results There were 3996 peripherally inserted central catheters (PICCs) and 3454 centrally inserted central catheters (CICCs) placed. Seventy-four were malpositioned post-2010. Of these, 53 devices were repositioned using the studied technique; 86% (46/53) of catheters were successfully repositioned on the first HFFT attempt. There was supportive evidence that device insertion side is important in potential catheter malposition. Conclusions Clinical outcomes suggest that CICCs and PICCs may be successfully repositioned utilizing this technique, with no adverse events associated and a prospective cost saving benefit when compared to interventional-based repositioning procedures.

scholarly journals Incidental Detection of Persistent Left Superior Vena Cava during Transvenous Pacing

2015 ◽  
Vol 3 (2) ◽  
pp. 52-54
Author(s):  
S Subash ◽  
Divya Gopal ◽  
Ashwini Thimmarayappa
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Venous Access ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Pacing Lead ◽  
Chest X Ray

ABSTRACT Patients with persistent left superior vena cava (PLSVC) are usually asymptomatic, but due to its anatomical defects, difficulties in establishing central venous access, pacemaker implantation and cardiothoracic surgery are common. We report a case of 65 years old patient who presented with complete heart block in cardiac critical care and, after emergency transvenous pacing, the chest X-ray showed unusual course of the transvenous pacing lead, which on further transthoracic echocardiographic (TTE) evaluation demonstrated dilated coronary sinus with PLSVC. How to cite this article Subash S, Gopal D, Thimmarayappa A. Incidental Detection of Persistent Left Superior Vena Cava during Transvenous Pacing. J Perioper Echocardiogr 2015; 3(2):52-54.

scholarly journals How I treat central venous access device–related upper extremity deep vein thrombosis

Blood ◽  
2017 ◽  
Vol 129 (20) ◽  
pp. 2727-2736 ◽  
Author(s):  
Anita Rajasekhar ◽  
Michael B. Streiff
Keyword(s):  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Postthrombotic Syndrome ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Access Device ◽  
Persistent Symptoms ◽  
Vena Cava Filters ◽  
Venous Access Device

AbstractCentral venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

Plazierung eines Pulmonaliskatheters über eine bis dahin unbekannte persistierende Vena cava superior sinistra

VASA ◽  
1999 ◽  
Vol 28 (1) ◽  
pp. 53-54 ◽  
Author(s):  
Stoiser ◽  
Vorbeck ◽  
Kofler ◽  
Locker ◽  
Burgmann
Keyword(s):  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Yield Potential ◽  
Clinical Complications ◽  
Vena Cava Superior ◽  
Left Subclavian Vein ◽  
Chest X Ray ◽  
Difficult Placement

This case report describes a patient with persistent left superior vena cava (LSVC) as discovered by difficult placement of a pulmonary artery catheter via the left subclavian vein. After positioning in wedge position, chest x-ray showed a catheter route suggestive of persistent LSVC. Since this abnormality may yield potential clinical complications, this possibility should be considered in every difficult central venous access.

scholarly journals Isolated Persistent Left Superior Vena Cava, Sick Sinus Syndrome, and Challenging Pacemaker Implantation

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Hatice S. Kemal ◽  
Aziz Gunsel ◽  
Levent Cerit ◽  
Murat Kocaoglu ◽  
Hamza Duygu
Keyword(s):  
Superior Vena Cava ◽  
Sick Sinus Syndrome ◽  
Superior Vena ◽  
Central Venous Access ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Venous Access ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Conduction Disturbances

Persistent left superior vena cava with absent right superior vena cava is a very rare venous anomaly and is known as isolated PLSVC. It is usually an asymptomatic anomaly and is mostly detected during difficult central venous access or pacemaker implantation, though it could also be associated with an increased incidence of congenital heart disease, arrhythmias, and conduction disturbances. Herein, we describe a dual-chamber pacemaker implantation in a patient with isolated PLSVC and sick sinus syndrome.

scholarly journals Avoiding harm: central venous access in Kartagener syndrome and other vascular anomalies

2021 ◽  
Vol 9 (41) ◽  
pp. 40-43
Author(s):  
Brad Snodgrass ◽  
Victoria Chu
Keyword(s):  
Patient Outcomes ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Central Venous ◽  
Kartagener Syndrome ◽  
Internal Jugular Vein Catheterization ◽  
The Right ◽  
Landmark Technique

Placement of internal jugular catheters is more likely to be complicated if a left-sided approach is used, assuming normal anatomy. Kartagener syndrome is the sine qua non of sidedness confusion and results in cognitive challenges that increase the risk of adverse patient outcomes. The altered anatomy can cause profound disorientation from our usual processes.  In normal circumstances the right-sided approach is used for placement of internal jugular catheters, but in Kartagener syndrome the left-sided approach should be preferred.  Surgical volume and use of ultrasound guided techniques are positively correlated with better outcomes.  Clinical experience may be a detriment to performance. Knowledge of these issues will help clinicians maintain vigilance and avoid error.    Keywords: Kartagener syndrome, central venous access, superior vena cava, landmark technique, internal jugular vein catheterization cognitive bias

The role of venography in the evaluation of malfunctioning central venous access ports (CVAPs)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18535-18535 ◽  
Author(s):  
E. Atallah ◽  
M. Salomon ◽  
C. A. Schiffer ◽  
B. El-Rayes
Keyword(s):  
Cancer Patients ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Common Finding ◽  
Fibrin Sheath ◽  
Catheter Tip ◽  
Catheter Fracture

18535 Background: Malfunction of CVAPs is common in cancer patients receiving chemotherapy. We evaluated the role of venography as a means of assessing the cause of malfunction. Methods: We reviewed and analyzed data available from cancer patients who had a venogram for a malfunctioning CVAP between 1/03 to 3/05. All patients in our institution who have a malfunctioning CVAP receive a trial of intracatheter thrombolytics. If the malfunction persists, then a venogram is performed through the catheter. Results: Seventy-seven patients were studied. The indication for evaluation was inability to aspirate blood (54%), pain (18%), swelling at site of injection (10%), difficult aspiration and infusion (6.5%) and others (11.5%). Forty-four patients had chest ports (31% left and 26% right side), while 33 patients had the CVAP placed in the upper extremity (24% right and 18% left arm). Fibrin sheath or thrombus was the most common finding in 44% of patients, and 41% of venograms were normal. Only two patients had soft tissue extravasation of contrast. Sites of extravasation were in the chest at the catheter/port junction and in the supraclavicular area secondary to a catheter fracture. In patients with aspiration failure, 68% had either a fibrin sheath or thrombus at the catheter tip, 14% had CVAP malposition as the only abnormality, 14% were normal and one patient had extravasation. The CVAP tips were optimally positioned in 70% of patients (distal superior vena cava (SVC), venocava-atrial junction or atrium), while 30% were in a suboptimal position (proximal SVC, brachiocephalic, azygous, or internal jugular vein). Suboptimally positioned CVAPs had a higher incidence of an associated abnormality compared to optimally positioned CVAPs (58% vs. 4% P = 0.001). Only five CVAPs were removed, for extravasation (1), cellulitis (2), and malposition (2). Conclusion: Although the incidence of extravasation was low, venography evaluation could be considered in patients with malfunctioning catheters receiving a vesicant drug to help prevent a potentially significant complication. CVAPs with suboptimally positioned tips had a higher rate of associated abnormalities, emphasizing the importance of proper tip position. No significant financial relationships to disclose.

Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters

2019 ◽  
Vol 24 (2) ◽  
pp. 21-26
Author(s):  
Omar Shwaiki ◽  
Sarah Khoncarly ◽  
James J. Buchino ◽  
Janice McDaniel
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Collateral Flow ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Sharp Recanalization ◽  
Central Catheters

Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

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