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

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

Download Full-text

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

Journal of the Association for Vascular Access ◽

10.2309/j.java.2019.002.001 ◽

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.

Download Full-text

Thrombogenic superior vena cava syndrome from long-standing central venous access in a 5-year-old patient treated with balloon-expandable stents

Journal of Radiology Case Reports ◽

10.3941/jrcr.v12i4.3339 ◽

2018 ◽

Vol 12 (4) ◽

Author(s):

Clifford Matthew Hawkins ◽

Dabin Ji ◽

Anne Elizabeth Gill ◽

Robert Mitchell Ermentrout

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Central Venous ◽

Vena Cava Syndrome

Download Full-text

Superior Vena Cava Duplication: The Red Herring of Central Line Placement

Case Reports in Surgery ◽

10.1155/2019/6401236 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Karin Gunther ◽

Carmen Lam ◽

David Siegel

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Catheter ◽

Venous Access ◽

The United States ◽

Central Line ◽

Central Venous ◽

Central Venous Access Lines

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs.

Download Full-text

Challenges in the Accurate Identification of the Ideal Catheter Tip Location

Journal of the Association for Vascular Access ◽

10.2309/java.15-4-3 ◽

2011 ◽

Vol 15 (4) ◽

pp. 196-201 ◽

Cited By ~ 9

Author(s):

Nadine Nakazawa

Keyword(s):

Chest Radiograph ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Accurate Identification ◽

Landing Zone ◽

Catheter Tip ◽

The Right ◽

The Ideal

Abstract The chest radiograph has been the primary tool to identify the catheter tip location after bedside placement of central venous access devices (CVADs), especially with peripherally inserted central catheters. The targeted ideal landing zone for a CVAD has evolved over time to the lower third of the superior vena cava, near the juncture of the right atrium. This article will discuss the evolution in the narrowing of the ideal targeted zone for landing the CVAD tip, and the issues around perception of “seeing” the catheter tip in the chest radiograph that can be imprecise and inaccurate. A brief overview of emerging technologies that capitalize on individual patient's internal physiologic characteristics to better identify this ideal landing zone will be presented.

Download Full-text

Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

World Journal of Surgical Oncology ◽

10.1186/1477-7819-9-173 ◽

2011 ◽

Vol 9 (1) ◽

Cited By ~ 65

Author(s):

Stephen P. Povoski ◽

Hooman Khabiri

Keyword(s):

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Venous Anatomy ◽

Central Venous ◽

Central Venous Access Device ◽

Left Superior Vena Cava ◽

Device Placement ◽

Venous Access Device

Download Full-text

Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit

The Journal of Vascular Access ◽

10.1177/112972981001100208 ◽

2010 ◽

Vol 11 (2) ◽

pp. 128-131

Author(s):

Vasileios Zochios ◽

Michael Gilhooly ◽

Simon Fenner

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Maxillofacial Surgery ◽

Vena Cava ◽

Venous Catheter ◽

Venous Access ◽

Central Venous Catheters ◽

Central Venous

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.

Download Full-text