scholarly journals Inadvertent insertion of a venous catheter into the internal thoracic vein: a word of caution

2019 ◽  
Vol 18 ◽  
Author(s):  
Flavia Ramos Tristão ◽  
Ricardo César Rocha Moreira ◽  
Carlos Eduardo Del Valle ◽  
Giana Caroline Strack Neves
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Catheter Malfunction ◽  
The Right ◽  
Work Up ◽  
Internal Thoracic Vein ◽  
Rule Out

Abstract Central venous catheters are widely used in clinical practice and are linked to many types of complications, including incorrect positioning at the time the catheter is fitted. Here, the authors describe a case in which a fully implantable catheter was inadvertently positioned in the right internal thoracic vein. The complication was identified when the nursing team attempted to use the catheter. The right internal thoracic vein is within the radiographic projection of the right brachiocephalic vein and the superior vena cava, simulating correct catheter placement on an anteroposterior radiograph. In cases of central catheter malfunction during the immediate postoperative period, work-up should include oblique and lateral views, to rule out the complication described here without a need for computed tomography.

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.

scholarly journals Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter

2016 ◽  
Vol 57 (4) ◽  
pp. 288-294 ◽  
Author(s):  
Alfredo Ulloa-Ricardez ◽  
Lizett Romero-Espinoza ◽  
María de Jesús Estrada-Loza ◽  
Héctor Jaime González-Cabello ◽  
Juan Carlos Núñez-Enríquez
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous ◽  
Critically Ill Neonates ◽  
The Right ◽  
Intracardiac Thrombosis

scholarly journals Endovascular retrieval of two migrated stents from pulmonary artery by means of balloon catheter

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Saad Saeed Alqahtani ◽  
Ahmed Kandeel Elhadad ◽  
Rusha Abdulmohsen Sarhan ◽  
Saleh Mohamed Alwaleedi
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena ◽  
Balloon Catheter ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Venous Stenting ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
The Right

Long-term central venous catheters can be associated with central venous stenosis in up to 50% of cases. Central venous stenosis can be managed with central venous stenting which was demonstrated to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents into the right side of the heart or the pulmonary artery during stent deployment is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is the preferred alternative for the more invasive operative intervention, which may be very hazardous in these patients. We report an unusual case of a 52-year-old man on hemodialysis who underwent endovascular stenting to treat a tight stenosis of the right brachiocephalic vein and superior vena cava and suffered from stent migration to the left pulmonary artery, requiring removal by interventional radiologist.

scholarly journals Ultrasonography Versus Chest X-Ray to Confirm Proper Placement of Central Venous Catheter

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Mehrnaz Nikouyeh ◽  
Kiandokht Khorshidi ◽  
Mohammad Hassan Rouzegari ◽  
Rabee Sarram
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Underlying Disease ◽  
Central Venous ◽  
X Ray ◽  
Comparison Results ◽  
Chest X Ray ◽  
The Right

Background: Central venous catheter (CVC) is located within the proximal third of the superior vena cava, inferior vena cava, or the right atrium. The confirmation of right location of catheter’s tip is done by chest X-ray (CXR) routinely. Objectives: In this study, we compared the proper location of the tip of the catheter by ultrasonography with CXR. Patients and Methods: One hundred and seventeen patients were included in this study. The CVC was placed according to the underlying disease. The proper location of the catheter was checked by ultrasonography and then CXR was carried out. The results of both methods were recorded and finally the statistical analysis was performed for comparison. Results: The tip of the catheter was observed by ultrasonography in 111 patients, but in the six other ones, the tip of the catheter was not observed by ultrasonography and observed in CXR. Therefore, the sensitivity of ultrasonography was 94.9 % in this study. Conclusion: The results showed that ultrasonography shows the catheter in 94.9% of the cases, although the risk of exposure to X-ray does not exist. The cost and time for evaluation of the tip of the catheter is significantly less by using ultrasonography compared to CXR.

scholarly journals Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac Surgical Unit

1994 ◽  
Vol 22 (3) ◽  
pp. 267-271 ◽  
Author(s):  
J. S. Rutherford ◽  
A. F. Merry ◽  
C. J. Occleshaw
Keyword(s):  
Central Venous Catheterization ◽  
Main Bronchus ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Azygos Vein ◽  
Central Venous ◽  
Venous Catheterization ◽  
The Right ◽  
Surgical Unit

Central venous catheter (CVC) depth relative to the cephalic limit of the pericardial reflection (CLPR) was assessed retrospectively in 100 adult patients from chest radiographs taken after admission to the intensive care unit. A well known landmark proved to be considerably influenced by parallax; therefore we located the CLPR by a new landmark, the junction of the azygos vein and the superior vena cava, identified by the angle of the right main bronchus and the trachea. The majority (58) of CVC tips lay below the pericardial reflection on the first chest radiograph (CXR). Of these only two had been corrected by the time of the next routine CXR. No case of cardiac tamponade secondary to erosion by a CVC could be remembered, or identified from records of routine departmental audit meetings, for the last ten years. Nevertheless, reported incidents of this complication have often been fatal and vigilance is necessary in any patient with a CVC.

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.

scholarly journals Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041101
Author(s):  
Minwoo Kang ◽  
Jinkun Bae ◽  
Sujin Moon ◽  
Tae Nyoung Chung
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Chest Ct ◽  
Haemodynamic Monitoring ◽  
Operating Characteristics ◽  
Central Venous ◽  
Catheter Tip ◽  
The Right

ObjectivesThe tip-to-carina (TC) distance on a simple chest X-ray (CXR) has proven value in the determination of correct central venous catheter (CVC) positioning. However, previous studies have mostly focused on preventing the atrial insertion of the CVC tip, and not on appropriate positioning for accurate haemodynamic monitoring. We aimed to assess whether the TC distance could detect the passage of the CVC tip into the superior vena cava (SVC) and the right atrium (RA), and to accordingly suggest cut-off reference values for these two aspects.DesignRetrospective observational cohort study.SettingSingle urban tertiary level academic hospital.Participants479 patients who underwent CXR and chest CT scan after the insertion of a CVC with a 24-hour interval during the study period.InterventionThe TC distance was measured on CXR, and the position of the CVC tip was assessed on the chest CT images. The TC distance was described as a negative or positive number if the CVC tip was above or below the carina, respectively. Receiver-operating characteristics curve analyses were conducted to ascertain the TC distance to detect SVC entrance and RA insertion of CVC tip.ResultsThe TC distance could significantly detect both SVC entrance and RA insertion (p<0.001 for both; area under curve 0.987 and 0.965, respectively), with a reference range of −6.69 to 15.61 mm.ConclusionThe TC distance in CXR is a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate haemodynamic monitoring.

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.

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