scholarly journals Chances of Pneumothorax and Malpositioning of Central Venous Catheters in Internal Jugular Vein Versus Subclavian Vein Routes

2020 ◽  
Vol 34 (3) ◽  
pp. 13-17
Author(s):  
Riffat Saeed
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Sampling Technique ◽  
Central Venous Catheters ◽  
P Value ◽  
Central Venous ◽  
Local Data ◽  
Chi Square ◽  
Study Results

Introduction: Central venous catheterization (CVC) is being done all over the world. It has specific indications and should be reserved for the patient who has the potential to benefit from it. Catheter related infections are an important cause of morbidity and mortality worldwide. All complications and side effects are dependent on vascular access route. International data shows malpositioning and pneumothorax related to malpositioning to be the most common complications of central venous cannulation. However there is paucity of local data regarding which of the two, IJV or SCV routes are more prone to develop these complications. Aims & Objectives: To compare the incidence of pneumothorax and malpositioning with internal jugular vein (IJV) and subclavian vein (SCV) routes of central venous catheters. Place and duration of study: This randomized control trial was conducted at Department of Anesthesia, Shaikh Zayed Hospital, Lahore, from 8-12-2014 to 7-6-2015. Material & Methods: The non-probability purposive sampling technique was used in this study. After the approval of Hospital Ethical Committee, 290 patients were included in this study and informed consent was obtained. Demographic profile was also obtained. Patients were randomly divided in two groups by using lottery method. In Group A, CVC was inserted through internal jugular vein while in Group B, CVC was inserted through subclavian vein. During the procedure, malpositioning and pneumothorax were monitored immediately and after 36 hours and were labeled. Patients were shifted to the ward after procedure and were followed-up there. During first 36 hours, chest x-ray for placement of tip of catheter and development of pneumothorax was carried out. Chi-square was used to compare complications in both groups taking p value <0.05 as significant. Results: Malposition was found in 18 cases, (6 from IJV group and 12 from SCV group) (p-value 0.144). Pneumothorax was seen in 12 cases (3 from IJV and 9 from SCV group) (p-value 0.077). Conclusion: Our study results concluded that IJV showed fewer incidences of pneumothorax and malpositioning than SCV technique. However, the difference was not statistically significant.

scholarly journals A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

2018 ◽  
Vol 2 (3) ◽  
pp. 277-281
Author(s):  
Lalit Kumar Rajbanshi ◽  
Sambhu Bahadur Karki ◽  
Batsalya Arjyal
Keyword(s):  
Real Time ◽  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Anatomical Landmark ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Landmark Technique

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

scholarly journals Arterial Placement of Central Venous Catheters

2020 ◽  
Vol 15 (3) ◽  
pp. 45-48
Author(s):  
Benjamin Wierstra ◽  
Selena Au ◽  
Paul Cantle ◽  
Kenton Rommens
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Posterior Wall ◽  
Arterial Injury ◽  
Central Venous Catheters ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Carotid Injury ◽  
Radiologie Interventionnelle ◽  
The Common

Arterial misplacement of central venous catheters can often be avoided with the use of real-time ultrasound-guided procedural competency.  However, misplacement can still occur and is more likely to occur when the internal jugular vein is located directly above the common carotid injury.  The resultant injury to the common carotid artery occurs through the posterior wall of the internal jugular vein.  Arterial injury may also occur when the subclavian vein is attempted in a non-ultrasound-guided fashion.  Optimal management requires a coordinated evaluation of the catheter misplacement by Interventional Radiology and Vascular Surgery to ensure maximum patient safety during catheter removal.  This article reviews the literature around this topic and provides a summary of the best approach to safely remove the misplaced catheter. Resume Le mauvais positionnement artériel des cathéters veineux centraux peut souvent être évité grâce à l'utilisation de compétences procédurales guidées par ultrasons en temps réel.  Cependant, un mauvais positionnement peut toujours se produire et est plus susceptible de se produire lorsque la veine jugulaire interne est située directement au-dessus de la lésion carotidienne commune.  La lésion de l'artère carotide commune qui en résulte se produit à travers la paroi postérieure de la veine jugulaire interne.  Une lésion artérielle peut également se produire lorsque la veine sous-clavière n'est pas guidée par un ultrason.  Une gestion optimale nécessite une évaluation coordonnée du mauvais positionnement du cathéter par la radiologie interventionnelle et la chirurgie vasculaire afin de garantir une sécurité maximale au patient lors du retrait du cathéter.  Cet article passe en revue la littérature sur ce sujet et fournit un résumé de la meilleure approche pour retirer en toute sécurité le cathéter mal placé.  

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

Internal Jugular Vein Occlusion Test for Rapid Diagnosis of Misplaced Subclavian Vein Catheter into the Internal Jugular Vein

2001 ◽  
Vol 95 (6) ◽  
pp. 1377-1379 ◽  
Author(s):  
Sushil P. Ambesh ◽  
Jyotish C. Pandey ◽  
Prakash K. Dubey
Keyword(s):  
Internal Jugular Vein ◽  
Chest Radiography ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Venous Pressure ◽  
Test Results ◽  
Central Venous ◽  
Occlusion Test ◽  
Vein Catheter ◽  
Catheter Tip

Background During subclavian vein catheterization, the most common misplacement of the catheter is cephalad, into the ipsilateral internal jugular vein (IJV). This can be detected by chest radiography. However, after any repositioning of the catheter, subsequent chest radiography is required. In an effort to simplify the detection of a misplaced subclavian vein catheter, the authors assessed a previously published detection method. Methods One hundred adult patients scheduled for subclavian vein cannulation were included in this study. After placement of subclavian vein catheter, chest radiography was performed. While the x-ray film was being processed, the authors performed an IJV occlusion test by applying external pressure on the IJV for approximately 10 s in the supraclavicular area and observed the change in central venous pressure and its waveform pattern. The observations thus obtained were compared with the position of catheter in chest radiographs, and the sensitivity and specificity of this method were evaluated using a 2 x 2 table. Results In 96 patients, subclavian vein cannulation was successfully performed. In four patients, cannulation was unsuccessful; therefore, these patients were excluded from the study. There were six misplacements of venous catheters as detected by radiography. In five (5.2%) patients, the catheter tip was located in the ipsilateral IJV, and in one (1.02%), the catheter tip was located in the contralateral subclavian vein. In the patients who had a misplaced catheter into the IJV, IJV occlusion test results were positive, with an increase of 3-5 mmHg in central venous pressure, whereas the test results were negative in patients who had normally placed catheters or misplacement of a catheter other than in the IJV. There were no false-positive or false-negative test results. Conclusion The IJV occlusion test successfully detects the misplacement of subclavian vein catheter into the IJV. However, it does not detect any other misplacement. The test may allow avoidance of repeated exposure to x-rays after catheter insertion and repositioning.

Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates

2020 ◽  
Vol 55 (9) ◽  
pp. 1920-1924 ◽  
Author(s):  
Fernando Montes-Tapia ◽  
Karla Hernández-Trejo ◽  
Fernando García-Rodríguez ◽  
Julio Jaime-Reyes ◽  
Consuelo Treviño-Garza ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Central Venous Catheters ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Optimal Depth

Safe Placement of Central Venous Catheters

2011 ◽  
Vol 26 (6) ◽  
pp. 392-396 ◽  
Author(s):  
William T. McGee ◽  
Patrick T. Mailloux ◽  
Richard T. Martin
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Prospective Trial ◽  
Vena Cava ◽  
Pericardial Tamponade ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Insertion Depth ◽  
Simple Method

Introduction. To develop a simple method for safely placing central venous catheters (CVCs) outside the heart from the subclavian or internal jugular vein in compliance with Food and Drug Administration (FDA) and manufacturer guidelines. Methods. Patients requiring CVCs were enrolled into this prospective trial. Central venous catheters were inserted into the subclavian or internal jugular vein from either the right or left side to a depth of 15 cm. Chest radiographs were obtained immediately after insertion of the catheter to check tip placement and to evaluate for mechanical complications. Results. Operators successfully placed 201 of 210 (96%) CVCs outside the heart. Six of these required repositioning. Nine catheter tips were located in an intracardiac position. No cases of pneumothorax, hemothorax, or pericardial tamponade occurred. One case of delayed hydrothorax due to superior vena cava injury occurred. Conclusions. Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines.

Percutaneous Ultrasound-guided Central Venous Catheters: The Lateral In-plane Technique for Internal Jugular Vein Access

2013 ◽  
Vol 15 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Umberto G. Rossi ◽  
Paolo Rigamonti ◽  
Vladimira Tichà ◽  
Elena Zoffoli ◽  
Antonino Giordano ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Central Venous Catheters ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Vein Access ◽  
Plane Technique
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