Challenges in the Accurate Identification of the Ideal Catheter Tip Location

2011 ◽  
Vol 15 (4) ◽  
pp. 196-201 ◽  
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.

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.

Thrombosis of the Superior Vena Cava Due to a Hickman Catheter: Successful Management by rt-PA Thrombolysis

2017 ◽  
Vol 18 (6) ◽  
pp. e92-e94
Author(s):  
Giuseppe Zaccone ◽  
Paolo D. Pafundi ◽  
Augusto Veneziani ◽  
Alessandro Verbo ◽  
Rosa Colli
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Recombinant Tissue Plasminogen Activator ◽  
Venous Access ◽  
Duration Of Treatment ◽  
Hickman Catheter ◽  
Catheter Tip ◽  
The Right

Introduction Venous thrombosis is a frequent complication of long-term venous access. Its management is well defined in most cases, but some specific clinical situations have not yet been definitively standardized. Thrombosis may occur at the catheter tip and involve the superior vena cava (SVC) and/or the right atrium (RA). In such cases, while the need for a rapid intervention to relieve the venous obstruction and avoid embolism is obvious, the best management is still to be established. Case description We report the case of a 25-year-old woman with symptomatic thrombosis of SVC and RA, associated with a Hickman catheter, which was successfully treated by recombinant tissue plasminogen activator (rt-PA). Conclusions According to the literature, thrombolytic therapy with rt-PA may be considered the treatment of choice in symptomatic thrombosis of SVC secondary to long-term catheter, uncertainty still exists about dosage, optimal rate of infusion, and optimal duration of treatment, as well as the criteria for choosing local versus systemic infusion.

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.

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.

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.

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.

Deployment of Direct Intrahepatic Portocaval Shunt (DIPS) from a Femoral Access

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Portal Vein ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Hepatic Veins ◽  
Portocaval Shunt ◽  
Femoral Access ◽  
Direct Puncture ◽  
The Right ◽  
Brachiocephalic Veins

The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in management of esophageal varices bleeding in patients with liver cirrhosis when endoscopic manuvers fail to control it. Ascites refractory to optimal medical therapy is another indication for TIPS procedure. Occasionally, TIPS cannot be performed due to vascular anatomical difficulties such as occluded central venous access, small hepatic veins, or portal vein occlusion. Direct intrahepatic portocaval shunt (DIPS) can be considered as an alternative option in such circumstances. DIPS is typically performed utilizing jugular access with direct puncture from the inferior vena cava (IVC) to the right portal vein. However, the interventionalist may be challenged by jugular or brachiocephalic veins occlusion. This chapter discusses perfroming DIPS procedure utilizing femoral access in a patient with bilateral occluded brachiocephalic veins and thrombosed right portal vein.

Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier

2011 ◽  
Vol 31 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Geng Tian ◽  
Bin Chen ◽  
Li Qi ◽  
Yan Zhu
Keyword(s):  
Infection Rate ◽  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Superior Vena ◽  
Vena Cava ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Tip

Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).

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.

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