Faculty Opinions recommendation of Eliminating arterial injury during central venous catheterization using manometry.

2009 ◽  
Author(s):  
Nikolaus Gravenstein ◽  
Felipe Urdaneta
Keyword(s):  
Central Venous Catheterization ◽  
Arterial Injury ◽  
Central Venous ◽  
Venous Catheterization

Emergency Central Venous Catheterization during Trauma Resuscitation: A Safety Analysis by Site

2015 ◽  
Vol 81 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Rachel L. Choron ◽  
Andrew Wang ◽  
Kathryn Van Orden ◽  
Lisa Capano-Wehrle ◽  
Mark J. Seamon
Keyword(s):  
Central Venous Catheterization ◽  
Blood Stream Infection ◽  
Arterial Injury ◽  
Blood Stream ◽  
Primary Objective ◽  
Central Venous ◽  
Exact Test ◽  
Arterial Injuries ◽  
Venous Catheterization ◽  
Subclavian Catheter

Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may cause complications including catheter-related blood stream infection (CRBSI), deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. Our primary objective compared subclavian versus femoral CVC complications during initial trauma resuscitations. A retrospective review (2010–2011) at an urban, Level-I Trauma Center reviewed CVCs during initial trauma resuscitations. Demographics, clinical characteristics, and complications including: CRBSIs, DVTs, arterial injuries, pneumothoraces, and PEs were analyzed. Fisher's exact test and Student's t test were used; P ≤ 0.05 was considered statistically significant. Overall, 504 CVCs were placed (subclavian, n = 259; femoral, n = 245). No difference in age (47 ± 22 vs 45 ± 23 years) or body mass index (28 ± 6 vs 29 ± 16 kg/m2) was detected ( P > 0.05) in subclavian vs femoral CVC, but subclavian CVCs had more blunt injuries (81% vs 69%), greater systolic blood pressure (95 ± 55 vs 83 ± 43 mmHg), greater Glasgow Coma Scale (10 ± 5 vs 9 ± 5), and less introducers (49% vs 73%) than femoral CVCs (all P < 0.05). Catheter related arterial injuries, PEs, and CRBSIs were similar in subclavian and femoral groups (3% vs 2%, 0% vs 1%, and 3% vs 3%; all P > 0.05). Catheter-related DVTs occurred in 2 per cent of subclavian and 9 per cent of femoral CVCs ( P < 0.001). There was a 3 per cent occurrence of pneumothorax in the subclavian CVC population. In conclusion, both subclavian and femoral CVCs caused significant complications. Subclavian catheter-related pneumothoraces occurred more commonly and femoral CRBSIs less commonly than expected compared with prior literature in nonemergent scenarios. This suggests that femoral CVC may be safer than subclavian CVC during initial trauma resuscitations.

Eliminating Arterial Injury During Central Venous Catheterization Using Manometry

2009 ◽  
Vol 109 (1) ◽  
pp. 130-134 ◽  
Author(s):  
Catalin S. Ezaru ◽  
Michael P. Mangione ◽  
Todd M. Oravitz ◽  
James W. Ibinson ◽  
Richard J. Bjerke
Keyword(s):  
Central Venous Catheterization ◽  
Arterial Injury ◽  
Central Venous ◽  
Venous Catheterization

scholarly journals Central Venous Catheterization (CVC) Site Choice Based on Anatomical Landmark Technique: A Systematic Review and Meta-analysis Short title:CVC Site Choice Strategy

2020 ◽  
Author(s):  
Yang Gu ◽  
Wenting Xu ◽  
Qingqing Zhang ◽  
Zhigang Chen ◽  
Di Feng ◽  
...  
Keyword(s):  
Success Rate ◽  
Central Venous Catheterization ◽  
Meta Analysis ◽  
Individual Preference ◽  
Arterial Injury ◽  
Adult Patients ◽  
Central Venous ◽  
Mechanical Complications ◽  
Venous Catheterization ◽  
High Level

Abstract BACKGROUND: Internal jugular vein (IJV) and subclavian vein (SCV) have been the most preferred central venous catheterization (CVC) sites clinically. Based on individual preference and institutional routine, however, the choice of IJV catheterization (IJVC) or SCV catheterization (SCVC) is lack of high-level evidence. We sought to provide useful clinical strategy by comparing the catheterization time, success rate and the mechanical complications involved of the two CVCs.METHODS: We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. RESULTS: A total of 3378 patients from 7 studies were included in the analysis. Neither difference was found on the catheterization time (SMD 95% CI: -0.095-0.124, p=0.792), nor any difference on the overall success rate (RR=1.017, 95% CI: 0.927-1.117, p=0.721, I2=89.6%) between the 2 procedures. However, subgroup analysis showed overall success rate of IJVC was significantly lower than that of SCVC (RR=0.906, 95%CI:0.850-0.965, p=0.002) in adult patients. The first-attempt success rate of IJVC group was higher than SCVC group in the adult patients (RR=1.472, 95%CI:1.004-2.156, p=0.047). No significance was detected in arterial injury (RR=1.137, 95% CI: 0.541-2.387, p=0.735) and pneumothorax (RR=0.600, 95% CI: 0.32-1.126, p=0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR=2.824, 95% CI: 1.181-6.751, p=0.02). CONCLUSIONS: Compared with IJVC, SCVC has a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma. However, more high-quality studies are essential to provide better evidence especially in pediatric patients. TRIAL REGISTRATION: This meta-analysis was pre-registered in PROSPERO (CRD42020165444).

scholarly journals Objective Assessment Metrics for Central Line Simulators: An Exploration of Causal Factors

2020 ◽  
Vol 64 (1) ◽  
pp. 2008-2012
Author(s):  
Jessica M. Gonzalez-Vargas ◽  
Dailen C. Brown ◽  
Jason Z. Moore ◽  
David C. Han ◽  
Elizabeth H. Sinz ◽  
...  
Keyword(s):  
Central Venous Catheterization ◽  
Objective Assessment ◽  
Central Line ◽  
Expert Interviews ◽  
Central Venous ◽  
Patient Case ◽  
Causal Factors ◽  
Venous Catheterization ◽  
Assessment Metrics ◽  
Automated Feedback

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees’ performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

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