Minimal guidewire length for central venous catheterization of the right subclavian vein: A CT-based consecutive case series

2021 ◽  
pp. 112972982199398
Author(s):  
Maria Adrian ◽  
Pär Bengtsson ◽  
Ola Borgquist ◽  
Gracijela Bozovic ◽  
Thomas Kander
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous ◽  
Vessel Length ◽  
The Wire ◽  
Tip Position ◽  
The Right ◽  
Vein Catheterization

Background: Central venous catheter (CVC) misplacement occurs frequently after right subclavian vein catheterization. It can be avoided by using ultrasound to confirm correct guidewire tip position in the lower superior vena cava prior to CVC insertion. However, retraction of the guidewire during the CVC insertion may dislocate the guidewire tip from its desired and confirmed position, thereby resulting in CVC misplacement. The aim of this study was to determine the minimal guidewire length required to maintain correct guidewire tip position in the lower superior vena cava throughout an ultrasound-guided CVC placement in the right subclavian vein. Methods: One hundred adult patients with a computed tomography scan of the chest were included. By using multiplanar reconstructions from thin-sliced images, the distance from the most plausible distal puncture site of the right subclavian vein to the optimal guidewire tip position in the lower superior vena cava was measured (vessel length). In addition, measurements of equipment in common commercial over-the-wire percutaneous 15–16 cm CVC kits were performed. The 95th percentile of the vessel length was used to calculate the required minimal guidewire length for each CVC kit. Results: The 95th percentile of the vessel length was 153 mm. When compared to the calculated minimal guidewire length, the guidewires were up to 108 mm too short in eight of eleven CVC kits. Conclusion: After confirmation of a correct guidewire position, retraction of the guidewire tip above the junction of the brachiocephalic veins should be avoided prior to CVC insertion in order to preclude dislocation of the catheter tip towards the right internal jugular vein or the left subclavian vein. This study shows that many commercial over-the-wire percutaneous 15–16 cm CVC kits contain guidewires that are too short for right subclavian vein catheterization, i.e., guidewire retraction is needed prior to CVC insertion.

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

2021 ◽  
pp. 152660282198933
Author(s):  
Pablo V. Uceda ◽  
Julio Peralta Rodriguez ◽  
Hernán Vela ◽  
Adelina Lozano Miranda ◽  
Luis Vega Salvatierra ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Esophageal Varices ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Dialysis Patients ◽  
Central Venous ◽  
Endovascular Recanalization ◽  
Flow Through ◽  
The Right

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation

2018 ◽  
Vol 19 (6) ◽  
pp. 528-534 ◽  
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.

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

Pacemaker implantation via occluded superior vena cava

2017 ◽  
Vol 4 (45) ◽  
pp. 23-25
Author(s):  
Aleksander Maciąg
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Lead Extraction ◽  
Pocket Infection ◽  
The Right ◽  
Diagnostic Catheter

The author describes the case of the superior vena cava occlusion detected during the new implantation of the pacemaker after lead extraction due to pocket infection. New electrode was implanted via the right subclavian vein. The occlusion in the superior vena cava was overcome with a guidewire (0.32 F) and a diagnostic catheter (JR2).

Complication of Right Subclavian Vein Catheterization: Superior Vena Cava Perforation

2013 ◽  
Vol 19 (2) ◽  
pp. 103-105
Author(s):  
Burcin Celik ◽  
Serhat Kocamanoglu ◽  
Yasemin Bilgin Buyukkarabacak ◽  
Esra Sarihasan
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Vein Catheterization

Persistent Left Superior Vena Cava Identified After Cannulation of the Right Subclavian Vein

2002 ◽  
Vol 95 (2) ◽  
pp. 305-307 ◽  
Author(s):  
Ruben J. Azocar ◽  
Punam Narang ◽  
Daniel Talmor ◽  
Alan Lisbon ◽  
A. Murat Kaynar
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
The Right

scholarly journals Successful implantation of a permanent pacemaker through a persistent left superior vena cava by using a right subclavian approach

2011 ◽  
Vol 68 (9) ◽  
pp. 792-794 ◽  
Author(s):  
Zoran Jovic ◽  
Zdravko Mijailovic ◽  
Slobodan Obradovic ◽  
Dragan Tavciovski ◽  
Radomir Matunovic ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Passive Electrode ◽  
Pacemaker Leads ◽  
The Right

Introduction. Persistent left superior vena cava, a rare congenital abnormality, can complicate placement of pacemaker leads through the subclavian vein. A left-sided approach is usually preferable in such cases. Case report. We reported a case in which we began a single-chamber pacemaker implantation procedure via a right subclavian approach (because of scarring beneath the left clavicle) and then discovered intraoperatively that the patient had a persistent left superior vena cava. After a few attempts, we succeeded in placing the head of the electrode in the septum, near the top of the right ventricle, and the rest of the procedure was completed without complication. Conclusion. To our knowledge, this is the first reported case of pacemaker implantation, with passive electrode, through a persistent left superior vena cava via the right subclavian vein. This case demonstrates that such an approach, when necessary, can be used successfully.

Persistent Left Superior Vena Cava Identified After Cannulation of the Right Subclavian Vein

2002 ◽  
Vol 95 (2) ◽  
pp. 305-307
Author(s):  
Ruben J. Azocar ◽  
Punam Narang ◽  
Daniel Talmor ◽  
Alan Lisbon ◽  
A. Murat Kaynar
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
The Right

An unexpected position of the dialyses catheter during routine x-ray examination: a case of the double superior vena cava

Open Medicine ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. 845-848
Author(s):  
Bruno Atalić ◽  
Goran Sabo ◽  
Jurica Toth
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Dialysis Catheter ◽  
Central Venous ◽  
X Ray ◽  
The Right ◽  
Expected Position

AbstractThis paper presents a case of a 55 year old male patient, who after hospitalization at the Intensive Care Unit, due to acute renal failure, at first had a central venous catheter inserted through his right subclavian vein, and then a dialysis catheter inserted through his left subclavian vein. A routine X-ray examination confirmed that the central venous catheter was visualised in the expected position of the right atrium, which was reached via superior vena cava. The dialysis catheter was not visualised in the expected position of the right atrium, but in the surprising location of the left ventricle, with its line continuously passing by the left sternal edge instead of crossing the middle line in order to enter the superior vena cava, thus raising a concern over its misplacement and possible side-effects (abstract image photo). Due to the absence of pneumo- or haemato-thorax, as the most common signs of the venous rupture, the possible explanation was an anatomical variation. Dialysis catheter displacement in the left internal thoracic vein was proposed as another possibility. Literature research explained it as a case of double superior vena cava, which was confirmed by analysis of the computerised tomography pulmonary angiogram.

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