Intraoperative Fluoroscopy for Central Venous Catheter Tip Position- "Use It When U Have It Modality"

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%.

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Towards Optimal Central Venous Catheter Tip Position

Yearbook of Intensive Care and Emergency Medicine ◽

10.1007/978-3-540-77290-3_54 ◽

2008 ◽

pp. 581-590 ◽

Cited By ~ 1

Author(s):

W. Schummer ◽

Y. Sakr ◽

C. Schummer

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position

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

The Journal of Vascular Access ◽

10.1177/1129729818757976 ◽

2018 ◽

Vol 19 (6) ◽

pp. 528-534 ◽

Cited By ~ 5

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.

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Impact of Phase of Respiration on Central Venous Catheter Tip Position

The Journal of Vascular Access ◽

10.5301/jva.5000135 ◽

2013 ◽

Vol 14 (4) ◽

pp. 383-387 ◽

Cited By ~ 11

Author(s):

Patrick P. Pan ◽

Bjorn I. Engstrom ◽

Matthew P. Lungren ◽

Danielle M. Seaman ◽

Mark L. Lessne ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position

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1320: IS IT REALLY A MALPOSITION? THE CENTRAL VENOUS CATHETER TIP POSITION CONTROVERSY CONTINUES

Critical Care Medicine ◽

10.1097/01.ccm.0000645196.40553.d4 ◽

2020 ◽

Vol 48 (1) ◽

pp. 637-637

Author(s):

Enyo Ablordeppey ◽

Rebecca Doctor ◽

Brett Wakefield ◽

Valerie Lew ◽

Anne Drewry ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position

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Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography

The Journal of Vascular Access ◽

10.1177/1129729818758998 ◽

2018 ◽

Vol 19 (5) ◽

pp. 461-466 ◽

Cited By ~ 1

Author(s):

Manuel F Struck ◽

Sebastian Ewens ◽

Wolfram Schummer ◽

Thilo Busch ◽

Michael Bernhard ◽

...

Keyword(s):

Computed Tomography ◽

Central Venous Catheter ◽

Injury Severity ◽

Venous Catheter ◽

Trauma Patients ◽

Trauma Resuscitation ◽

Central Venous ◽

Catheter Tip ◽

Tip Position ◽

Multiple Trauma Patients

Purpose: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. Methods: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°. Results: During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005–1.074, p = 0.024). Conclusion: Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

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