Central Venous Catheter Tip Placement: Determination of Posterior Malposition—A Case Study

2006 ◽  
Vol 11 (2) ◽  
pp. 85-89
Author(s):  
Mary B. Markovich
Keyword(s):  
Central Venous Catheter ◽  
Chest Radiograph ◽  
Vascular Access ◽  
Accurate Determination ◽  
Venous Catheter ◽  
Central Venous ◽  
Single View ◽  
Catheter Tip

Abstract Methods for determining central venous catheter (CVC) tip placement vary among facilities. In most institutions, a single-view, anterior chest radiograph is used to visualize and evaluate the CVC catheter for malposition and/or position of the catheter tip. However, this method does not identify the posterior malposition of the catheter tip, which, on the anterior view, may appear correctly placed. In this article, the author (a) identifies the need for double-view chest radiographs for accurate determination of CVC tip placement and (b) emphasizes the importance of expertise of vascular access practitioners in the determination of catheter-tip placement and the identification of malposition and complication of CVC placement.

(F)utility of “routine” postprocedural chest radiograph after hemodialysis catheter (central venous catheter) insertion

2020 ◽  
pp. 112972982090725 ◽  
Author(s):  
Malvinder S Parmar
Keyword(s):  
Central Venous Catheter ◽  
Chest Radiograph ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Asymptomatic Patients ◽  
Catheter Tip ◽  
Rule Out

A routine postprocedural chest radiograph had been a safe, checklist-based final step of the procedure, since the start of central venous catheter insertion for hemodialysis to check the position of the catheter tip and to rule out complications. However, the chest radiograph is a suboptimal method to rule out complications like pneumothorax and is not a reliable test to confirm its position. Although it is relatively inexpensive, it is labor-intensive and exposes patient to unnecessary radiation exposure, cost, and often results in delayed use of the catheter. Various studies question the value of a routine chest radiograph as a screening test to rule out the mechanical complications of catheter insertion. We, in this brief viewpoint, present evidence to support the futility of a routine postprocedural chest radiograph in majority of asymptomatic patients and support Choosing Wisely Initiative to avoid low-value studies. However, it should be considered under specific indications, as discussed.

A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

2020 ◽  
pp. 112972982094345
Author(s):  
Maryanne Z A Mariyaselvam ◽  
Vikesh Patel ◽  
Adam Sawyer ◽  
James A Richardson ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Patient Harm ◽  
Central Venous ◽  
Exact Test ◽  
The United Kingdom ◽  
Catheter Tip ◽  
Never Event ◽  
Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

Precision in Central Venous Catheter Tip Placement: A Review of the Literature

2010 ◽  
Vol 15 (3) ◽  
pp. 112-125 ◽  
Author(s):  
Russell Hostetter ◽  
Nadine Nakasawa ◽  
Kim Tompkins ◽  
Bradley Hill
Keyword(s):  
Central Venous Catheter ◽  
Selection Criteria ◽  
Weighted Average ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Landmark Technique ◽  
The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

Hemodynamics Alterations Induced by Central Venous Catheter in Vascular Access for Hemodialysis

2021 ◽  
Author(s):  
Saulo Gonçalves ◽  
Mário Silva ◽  
Matheus Costa ◽  
Thabata Lucas ◽  
Rudolf Huebner
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Venous Catheter ◽  
Central Venous

scholarly journals A Novel Objective Approach Towards Physicians' Knowledge and Practice Patterns to Optimize Central Venous Catheter Placement: A Cross-sectional Study

2020 ◽  
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Clinical Practices ◽  
Central Venous ◽  
Cross Sectional ◽  
Study Objective ◽  
Catheter Tip

Study objective: Central venous catheterization is an essential component of intensive care of critically ill patients, and proper positioning of the catheter is essential to prevent position-related complications. This study was conducted by using digital tape measurement to objectively assess clinician preferences for central venous catheter positioning based on specific position levels and landmarks on post-procedural chest radiographs. Design: A cross-sectional study using electronic questionnaire survey. Setting: Single academic teaching hospital participated in this study. Participants: The study enrolled 276 physicians from multiple clinical disciplines. Interventions: None. Measurements: A seven-level reference system labeled on a sample chest radiograph was used to identify the acceptable lower and upper limits and landmarks used to determine the optimal central venous catheter tip position as well as the pattern of clinical practices based on the specialty and level of experience of participants. Main results: Among the 276 respondents, the ratio of cumulative acceptance for the lower and upper catheter tip limit was 62% and 66.3% within a 4-cm range below or above the carina, respectively. Intensive care unit (ICU) physicians showed a greater tendency to choose a catheter tip 4 cm below and 6 cm above the carina (p = 0.004 and 0.002, respectively) as did experienced physicians (p = 0.007 and < 0.001, respectively). The commonest reason for catheter tip withdrawal was arrhythmia (50% of cases). Physicians in the ICU and experienced physicians were more concerned about the risk of cardiac perforation than other respondents (p < 0.001 and < 0.001, respectively). The carina was the most commonly used landmark in 71.7% of all physicians, although 50% of radiologists also used other landmarks. Conclusions: The acceptable limit of the catheter tip is 4 cm above and below the carina (-4 to +4), as determined on chest radiography, without a need for tip adjustment.

Complications of nutritional support

2013 ◽  
pp. 171-180
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Central Venous Catheter ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Right Atrium ◽  
Nutritional Support ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Central Catheters

Venous catheter-related problems Other complications of parenteral nutrition Problems with enteral tubes Re-feeding syndrome ● Above all else, ‘if the gut works, use it’. Only consider IV feeding if patients are likely to be without enteral nutrition for 〉5d. ● Central venous catheter feeding (i.e. catheter tip in SVC, IVC, or right atrium) preferred to avoid thrombophlebitis from hyperosmolar feeds. Well-managed central catheters can be left ...

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