Ultrasound Guidance for Central Venous Catheterization: A Step Further to Prevent Malposition of Central Venous Catheter Before Radiographic Confirmation

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.

Download Full-text

Evaluation of a central venous catheter tip placement for superior vena cava–subclavian central venous catheterization using a premeasured length

Medicine ◽

10.1097/md.0000000000009600 ◽

2018 ◽

Vol 97 (2) ◽

pp. e9600

Author(s):

Hyun-Jung Kwon ◽

Young-Il Jeong ◽

In-Gu Jun ◽

Young-Jin Moon ◽

Yu-Mi Lee

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Central Venous Catheterization ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Central Venous ◽

Venous Catheterization ◽

Catheter Tip

Download Full-text

Ultrasound to Detect Central Venous Catheter Placement Associated Complications

Anesthesiology ◽

10.1097/aln.0000000000003126 ◽

2020 ◽

Vol 132 (4) ◽

pp. 781-794 ◽

Cited By ~ 1

Author(s):

Jasper M. Smit ◽

Mark E. Haaksma ◽

Endry H. T. Lim ◽

Thei S. Steenvoorden ◽

Michiel J. Blans ◽

...

Keyword(s):

Central Venous Catheter ◽

Diagnostic Accuracy ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Reference Standard ◽

Central Venous ◽

Central Venous Catheter Placement ◽

X Ray ◽

Venous Catheterization ◽

Chest X Ray

Abstract Background Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax. Methods This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen’s κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound. Results In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen’s κ-coefficient of 0.50 (95% CI, 0.19 to 0.80). Conclusions This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Identification and correction of guide wire malposition during internal jugular cannulation with ultrasound

CJEM ◽

10.1017/s1481803500014949 ◽

2007 ◽

Vol 9 (02) ◽

pp. 131-132 ◽

Cited By ~ 3

Author(s):

Michael B. Stone

Keyword(s):

Real Time ◽

Ultrasound Guidance ◽

Central Venous Catheterization ◽

Guide Wire ◽

Venous Catheter ◽

Central Venous ◽

Venous Catheterization ◽

Procedural Complications ◽

Introducer Needle ◽

Wire Resistance

ABSTRACT Real-time ultrasound guidance for central venous catheterization increases success and reduces procedural complications. I describe a case in which guide wire resistance was encountered and real-time ultrasound visualization of the guide wire facilitated correction of guide wire malposition. No additional passes of the introducer needle were necessary and the chances of inadvertent carotid artery puncture or pneumothorax were therefore reduced. The technique described here may prove valuable when guide wire resistance is encountered while placing a central venous catheter.

Download Full-text

Coiling of shaft of the central venous catheter inside left subclavian vein- a case report

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v4i2.21209 ◽

2018 ◽

Vol 4 (2) ◽

pp. 87-90

Author(s):

Lalit Kumar Rajbanshi ◽

Shambhu Bahadur Karki ◽

Batsalya Arjyal

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Guide Wire ◽

Venous Catheter ◽

Anatomical Landmarks ◽

Central Venous ◽

Venous Catheterization ◽

Left Subclavian Vein ◽

The Common ◽

Blood Aspiration

Central venous catheterization is one of the common procedures used for gaining vascular access for various indications. Sometimes, the catheter can take unusual course inside the vein that can lead to erroneous pressure measurement, increase the risk of thrombosis or trauma to the vessel. Any resistance during insertion of the guide wire or catheter and absence of blood aspiration are some alarming signs that help to detect malposition at the earliest moment. We report a case of coiling of the shaft of the central venous catheter inside left sublacvian vein in a patient with head injury. Technical expertise, sound knowledge of anatomical landmarks and use of real time ultrasound can minimize malposition of the catheter. We suggest at any moment if there is resistance during insertion of guide wire or catheter or if there is absence of blood aspiration from any of the lumen, the catheter should be removed immediately suspecting malposition.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 87-90

Download Full-text

Misplacement of a central venous catheter into azygos vein via the right internal jugular vein

The Journal of Vascular Access ◽

10.1177/1129729820950996 ◽

2020 ◽

pp. 112972982095099

Author(s):

Minjia Wang ◽

Liang Xu ◽

Yue Feng ◽

Shijin Gong

Keyword(s):

Central Venous Catheter ◽

Critically Ill Patients ◽

Central Venous Catheterization ◽

Jugular Vein ◽

Venous Catheter ◽

Azygos Vein ◽

Central Venous ◽

Venous Catheterization ◽

Tip Position ◽

The Right

For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described.

Download Full-text

Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v4i1.198 ◽

2019 ◽

Vol 4 (1) ◽

Author(s):

Mojtaba Mansouri ◽

Gholamreza Massoumi ◽

Ali Akbar Shateri

Keyword(s):

Central Venous Catheter ◽

Gold Standard ◽

Central Venous Catheterization ◽

Venous Catheter ◽

P Value ◽

Central Venous ◽

Gold Standard Method ◽

Venous Catheterization ◽

Catheter Tip ◽

Landmark Technique

Introduction: Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. Methods: This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery. In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.Results: In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94 and P-value<0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).Conclusion: Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique.

Download Full-text

Central venous access

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.8.c114 ◽

2019 ◽

Vol 80 (8) ◽

pp. C114-C119

Author(s):

Joel Lockwood ◽

Neel Desai

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Catheter ◽

Seldinger Technique ◽

Haemodynamic Monitoring ◽

Central Venous ◽

Venous Catheterization

Central venous catheterization is the placement of a catheter in such a manner that its tip is positioned within the proximal third of the superior vena cava, the right atrium or the inferior vena cava. It is indicated when access for administration of drugs or extracorporeal blood circuits and haemodynamic monitoring or interventions is needed. When inserting a central venous catheter, appropriate preparation and asepsis, positioning of the patient, and the use of ultrasound should be considered. Compared to the landmark method of localization, ultrasound can account for anatomical variations, facilitate visualization of venous puncture, and safeguard against inadvertent arterial puncture. In the Seldinger technique, which is the primary mode of central venous catheterization, a needle is passed towards the chosen vessel. Once the needle is in the vein, a guidewire is introduced through the needle into the vessel and the needle is removed. Following a small skin incision at the base of the guidewire, a dilator is advanced over the guidewire and then taken out. Subsequent to this, the central venous catheter is railroaded over the guidewire into the vein and the guidewire is withdrawn. Complications of central venous catheterization can be mechanical, infectious or thrombotic.

Download Full-text

Munchausen Syndrome by Proxy: A New Complication of Central Venous Catheterization

PEDIATRICS ◽

10.1542/peds.75.3.523 ◽

1985 ◽

Vol 75 (3) ◽

pp. 523-525

Author(s):

J. Jeffrey Malatack ◽

Eugene S. Wiener ◽

J. Carlton Gartner ◽

Basil J. Zitelli ◽

Elizabeth Brunetti

Keyword(s):

Central Venous Catheter ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Small Child ◽

Gi Bleeding ◽

Gi Tract ◽

Munchausen Syndrome ◽

Central Venous ◽

Munchausen Syndrome By Proxy ◽

Venous Catheterization

A recent case of supposed gastrointestinal (GI) bleeding in a small child underscored the difficulty inherent in making the diagnosis of Munchausen syndrome by proxy. In this case, an indwelling Broviac central venous catheter was used by the mother to withdraw blood which was then arranged to feign blood loss from her son's upper and lower GI tract. Despite the mother/perpetrator's displaying the classic personality traits of Munchausen syndrome by proxy, diagnosis was not made for many weeks.

Download Full-text

Comparative Analysis of Ultrasound Guided Central Venous Catheterization Compared to Blind Catheterization

PRILOZI ◽

10.1515/prilozi-2017-0028 ◽

2017 ◽

Vol 38 (2) ◽

pp. 107-114 ◽

Cited By ~ 2

Author(s):

Darko Sazdov ◽

Marija Jovanovski Srceva ◽

Zorka Nikolova Todorova

Keyword(s):

Real Time ◽

Complication Rate ◽

Ultrasound Guidance ◽

Central Venous Catheterization ◽

Femoral Vein ◽

Venous Catheter ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

A Prospective Study

Abstract Introduction: Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods. Material and Methods: This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures. Results: The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008). Conclusion: Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.

Download Full-text