Ultrasound-guided Supraclavicular Central Venous Catheter Tip Positioning via the Right Subclavian Vein using a Microconvex Probe

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

Birat Journal of Health Sciences ◽

10.3126/bjhs.v2i3.18943 ◽

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

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The right supraclavicular ultrasound view for real-time ultrasound-guided definite placement of a central venous catheter with a microconvex transducer

European Journal of Anaesthesiology ◽

10.1097/eja.0b013e3283642ae7 ◽

2014 ◽

Vol 31 (3) ◽

pp. 173-174 ◽

Cited By ~ 4

Author(s):

Stefan U. Weber ◽

Se-Chan Kim

Keyword(s):

Central Venous Catheter ◽

Real Time ◽

Venous Catheter ◽

Ultrasound Guided ◽

Central Venous ◽

The Right

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Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis

Emergency Radiology ◽

10.1007/s10140-016-1393-2 ◽

2016 ◽

Vol 23 (3) ◽

pp. 269-273 ◽

Cited By ~ 8

Author(s):

David H. Ballard ◽

Navdeep S. Samra ◽

Karen Mathiesen Gifford ◽

Robert Roller ◽

Bruce M. Wolfe ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Right Atrium ◽

Venous Catheter ◽

Central Venous ◽

Central Venous Thrombosis ◽

Catheter Tip ◽

The Right

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Abstract No. 24: Animal Study Based Alogarytm for Detection of Central Venous Catheter Tip and Its Distance from the Right Atrium

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.12.027 ◽

2008 ◽

Vol 19 (2) ◽

pp. S11

Author(s):

A. Belenky ◽

O. Barnea ◽

G. Bartal ◽

M. Lahav ◽

E. Atar

Keyword(s):

Central Venous Catheter ◽

Animal Study ◽

Right Atrium ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

The Right

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Difficult central venous catheter insertion via the right subclavian vein

Saudi Journal of Anaesthesia ◽

10.4103/sja.sja_962_20 ◽

2021 ◽

Vol 15 (2) ◽

pp. 245

Author(s):

Yasuhiro Morimoto ◽

Manabu Yoshimura

Keyword(s):

Central Venous Catheter ◽

Subclavian Vein ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

The Right

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Ultrasound-guided central venous tip confirmation via right external jugular vein using a right supraclavicular fossa view

The Journal of Vascular Access ◽

10.1177/1129729818771886 ◽

2018 ◽

Vol 20 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Mariko Kosaka ◽

Yoshimasa Oyama ◽

Tetsuya Uchino ◽

Yojiro Ogihara ◽

Hironori Koga ◽

...

Keyword(s):

Central Venous Catheter ◽

Jugular Vein ◽

Venous Catheter ◽

External Jugular Vein ◽

Central Venous Catheter Insertion ◽

Ultrasound Guided ◽

Central Venous ◽

X Ray ◽

Supraclavicular Fossa ◽

Catheter Tip

Introduction: Ultrasound-guided central venous catheter tip confirmation has a potential to precisely locate the central venous catheter, preventing its misplacement, using real-time guidance. This observational study sought to determine the accuracy of central venous catheter tip positioning via the external jugular vein via a supraclavicular fossa view under ultrasound guidance. Methods: In total, 77 patients scheduled for central venous catheter insertion via the right external jugular vein were enrolled. The depth of central venous catheter insertion was determined by advancing the tip of the guidewire to the junction of the superior vena cava and right pulmonary artery, using a right supraclavicular fossa view ultrasound method. We determined the reference insertion depth to the carina using a postoperative chest x-ray photograph method. We then compared insertion depths obtained by the ultrasound and x-ray photograph methods and body-height formula. Results: In total, 62 patients were able to advance the guidewire and underwent ultrasound-guided central venous catheter insertion. In four patients, we corrected for misplaced guidewires. According to Bland–Altman plots, the insertion depth was 0.88 cm shorter for the ultrasound method (95% limits of agreement, −1.66 to 3.41 cm) and 0.90 cm shorter for the formulaic method (95% limits of agreement, −2.77 to 4.56 cm), compared with the x-ray photograph method. The x-ray photograph method had significantly positive correlations with the ultrasound (r = 0.73) and formulaic methods (r = 0.27). Conclusion: A right supraclavicular fossa view improves the accuracy of central venous catheter tip positioning and prevents central venous catheter misplacement via the right external jugular vein.

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Lancisi’s sign and central venous catheter tip position: a case report

The Journal of Vascular Access ◽

10.5301/jva.5000760 ◽

2018 ◽

Vol 19 (1) ◽

pp. 92-93

Author(s):

Valentina Vigo ◽

Piero Lisi ◽

Giuseppe Galgano ◽

Carlo Lomonte

Keyword(s):

Case Report ◽

Central Venous Catheter ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position ◽

The Right ◽

Venous Pulse

Introduction: Valvular disease and pulmonary hypertension are common conditions in haemodialysis patients. In presence of tricuspid regurgitation, an increased retrograde blood flow into the right atrium during ventricle systole results in a typical modification of the normal venous waveform, creating a giant c-v wave. This condition clinically appears as a venous palpable pulsation within the internal jugular vein, also known as Lancisi’s sign. Case report: An 83-year-old woman underwent haemodialysis for 9 years. After arteriovenous fistula thrombosis, a right internal jugular vein non-tunnelled central venous catheter (CVC) was placed. About one month later, the patient was referred to our facility for the placement of a tunnelled CVC. Neck examination revealed an elevated jugular venous pulse, the Lancisi’s sign. Surprisingly, chest x-ray posteroanterior view showed the non-tunnelled catheter tip in correspondence with the right ventricle. She underwent surgery for temporary to tunnelled CVC conversion using the same venous insertion site (Bellcath®10Fr-length 25 cm to Mahurkar®13.5Fr-length 19 cm). In the postoperative period, we observed a significant reduction of the jugular venous pulse. Discussion: The inappropriate placement of a 25-cm temporary CVC in the right internal jugular vein worsened the tricuspid valve regurgitation, which became evident by the Lancisi’s sign. Removal of the temporary CVC from the right ventricle resulted in improved right cardiac function. Safe approaches recommended by guidelines for the CVC insertion technique and for checking the tip position should be applied in order to avoid complications.

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Central Venous Catheter Tip in the Right Atrium: A Risk Factor for Neonatal Cardiac Tamponade

Journal of Perinatology ◽

10.1038/sj.jp.7210541 ◽

2001 ◽

Vol 21 (7) ◽

pp. 461-464 ◽

Cited By ~ 54

Author(s):

Jonathan C Darling ◽

Simon J Newell ◽

Omar Mohamdee ◽

Orhan Uzun ◽

Catherine J Cullinane ◽

...

Keyword(s):

Risk Factor ◽

Central Venous Catheter ◽

Cardiac Tamponade ◽

Right Atrium ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

The Right

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Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study

BMJ Open ◽

10.1136/bmjopen-2020-041101 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041101

Author(s):

Minwoo Kang ◽

Jinkun Bae ◽

Sujin Moon ◽

Tae Nyoung Chung

Keyword(s):

Central Venous Catheter ◽

Superior Vena ◽

Vena Cava ◽

Venous Catheter ◽

Chest Ct ◽

Haemodynamic Monitoring ◽

Operating Characteristics ◽

Central Venous ◽

Catheter Tip ◽

The Right

ObjectivesThe tip-to-carina (TC) distance on a simple chest X-ray (CXR) has proven value in the determination of correct central venous catheter (CVC) positioning. However, previous studies have mostly focused on preventing the atrial insertion of the CVC tip, and not on appropriate positioning for accurate haemodynamic monitoring. We aimed to assess whether the TC distance could detect the passage of the CVC tip into the superior vena cava (SVC) and the right atrium (RA), and to accordingly suggest cut-off reference values for these two aspects.DesignRetrospective observational cohort study.SettingSingle urban tertiary level academic hospital.Participants479 patients who underwent CXR and chest CT scan after the insertion of a CVC with a 24-hour interval during the study period.InterventionThe TC distance was measured on CXR, and the position of the CVC tip was assessed on the chest CT images. The TC distance was described as a negative or positive number if the CVC tip was above or below the carina, respectively. Receiver-operating characteristics curve analyses were conducted to ascertain the TC distance to detect SVC entrance and RA insertion of CVC tip.ResultsThe TC distance could significantly detect both SVC entrance and RA insertion (p<0.001 for both; area under curve 0.987 and 0.965, respectively), with a reference range of −6.69 to 15.61 mm.ConclusionThe TC distance in CXR is a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate haemodynamic monitoring.

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