Inadvertent ultrasound-guided insertion of a central venous catheter into a carotid artery: the value of pressure transduction and blood gas analysis as additional tests to check position

2016 ◽  
Author(s):  
Taskin Hazarika
Keyword(s):  
Carotid Artery ◽  
Central Venous Catheter ◽  
Blood Gas Analysis ◽  
Venous Catheter ◽  
Gas Analysis ◽  
Blood Gas ◽  
Ultrasound Guided ◽  
Central Venous

scholarly journals A new technique for measuring fistula flow using venous blood gas oxygen saturation in patients with a central venous catheter

2019 ◽  
Vol 13 (2) ◽  
pp. 184-187
Author(s):  
Silverio Rotondi ◽  
Lida Tartaglione ◽  
Maria Luisa Muci ◽  
Marzia Pasquali ◽  
Nicola Pirozzi ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Oxygen Saturation ◽  
Venous Blood ◽  
Venous Catheter ◽  
Gas Analysis ◽  
Surgical Revision ◽  
Blood Gas ◽  
Manual Compression ◽  
Central Venous ◽  
Before And After

Abstract Background Doppler ultrasound (DU) monitoring early after arteriovenous fistula (AVF) creation allows the identification of low blood flow (Qa) requiring prompt revision, but it is costly (needs skilled operators and technical instruments) and is not available in all dialysis units. Therefore alternative first-line methods to measure Qa would be welcomed. We reasoned that once an AVF is created, an increment in central venous oxygen saturation (ScvO2) is predictable and proportional to Qa. Methods Accordingly, in patients receiving dialysis through a central venous catheter (CVC) in whom an AVF was created, we measured, by means of blood gas analysis, the ScvO2 increment before and after manual compression of the arteriovenous shunt and verified its correlation with DU-measured Qa. Results We sampled blood gas in 18 patients with CVC and AVF before and after 30 s manual compression of the AVF. ScvO2 averaged 70.5 ± 3% before and 65.2 ± 3% after AVF closure, with an average drop of 5.1 ± 3% (range 1–12). AVF Qa, which was measured within 24 h by means of DU, averaged 635 ± 349 mL/min (range 50–1300) and was strictly and positively correlated with ΔScvO2 (r = 0.954, P < 0.0001). Conclusions Therefore we suggest that in patients with CVC and a newly created AVF, it is possible to monitor AVF Qa without DU by simply measuring blood gas and ΔScvO2. This technique is simple, cheap, repeatable, non-invasive and operator independent and represents a new useful screening test to detect delayed AVF access maturation deserving prompt DU measurement and surgical revision. It helps to quickly identify patients in urgent need of DU verification and possible surgical revision. Regrettably, it is applicable only in patients with CVC.

Off-label use of Proglide percutaneous closure device in iatrogenic arterial catheterizations: Our experience

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 756-759
Author(s):  
Javier Fernández Lorenzo ◽  
Jorge Vidal Rey ◽  
Irene López Arquillo ◽  
Jose Manuel Encisa de Sá
Keyword(s):  
Carotid Artery ◽  
Central Venous Catheter ◽  
Open Surgery ◽  
Venous Catheter ◽  
Percutaneous Closure ◽  
Closure Device ◽  
Off Label Use ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Off Label

Introduction Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. Objectives Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation. Methods Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA). Results All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described. Conclusions Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.

THE EFFICACY OF MEDICAL SIMULATION COURSE ON IMPROVING ULTRASOUND—GUIDED CENTRAL VENOUS CATHETER INSERTION

2015 ◽  
Vol 1 (1) ◽  
pp. 41.2-41 ◽  
Author(s):  
Sawsan M Alyousef ◽  
Mohammed Almaani ◽  
Jihad Zahraa ◽  
Ali Hassan ◽  
Hani Lababidi
Keyword(s):  
Central Venous Catheter ◽  
Training Programs ◽  
Venous Catheter ◽  
Central Line ◽  
Skill Assessment ◽  
Medical Simulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Knowledge And Skills ◽  
Hands On

BackgroundWhile insertion of CVC (central venous catheter) is common, it is an intricate procedure and not risk-free. Traditionally, inexperienced residents learn to insert CVC on real patients and thus can put patients' life at risk. One way to reduce medical errors is to use high-fidelity simulation for training tomorrow's practitioners on ultrasound-guided CVC insertion.ObjectiveTo evaluate the efficacy of medical simulation based learning course on knowledge and skills improvement on ultrasound-guided CVC insertion.MethodsA pre-assessment was performed through a pre-test and hands-on skill assessment for central line insertion under U/S guidance (Internal Jugular, Subclavian or Femoral lines) utilizing a standardized checklist. All candidates then attended one day course that included theoretical and hands-on simulation training using phantoms. A post-test and hands-on assessment was performed at the end of the day.ResultsTwenty residents from Internal Medicine and Paediatrics were enrolled in the study at King Fahad Medical City Simulation Center. There was significant improvement in the knowledge based training: 90% showed significant increase in their MCQ scores (p<0.001), 10% had equal scores and none showed decline in their scores. For the hands-on skills: All 20 candidates showed significant improvement in their skills (p<0.001).ConclusionA one day simulation course on CVC insertion under ultrasound guidance significantly improves the knowledge and skills for residents in training programs.RecommendationsSuch courses and other similar should be compulsory for all Residents training programs as it is called safe training.

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.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

Ultrasound-Guided Central Venous Catheter Placement by Surgical Trainees: A Safe Procedure?

2010 ◽  
Vol 11 (4) ◽  
pp. 288-292 ◽  
Author(s):  
Marijn Hameeteman ◽  
Aron S. Bode ◽  
Arnoud G. Peppelenbosch ◽  
Frank M. Van der Sande ◽  
Jan H.M. Tordoir
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Catheter Placement ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Surgical Trainees
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