A Controlled Study of Transesophageal Echocardiography to Guide Central Venous Catheter Placement in Congenital Heart Surgery Patients

Andropoulos, Dean B.; Stayer, Stephen A.; Bent, Sabrina T.; Campos, Carlos José Reis de; Bezold, Louis I.; Alvarez, Melquiades; Fraser, Charles D.

doi:10.1097/00000539-199907000-00012

Cited by 56 publications

(19 citation statements)

References 20 publications

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“…[1] Ultrasound has reduced some of the complications during its insertion, but cannot locate the catheter tip in relation to heart. Only transesophageal echocardiography can accurately detect a CVC tip in relation to superior vena cava (SVC) and right atrium (RA),[23] but its availability as a bedside tool is limited to major hospitals. In our centre, we routinely perform a post-procedure chest X-ray (CXR) to confirm the tip of the catheter and we could detect some of the catheter malpositions that are illustrated below.…”

Section: Introductionmentioning

confidence: 99%

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Venugopal

Koshy

2013

J Anaesthesiol Clin Pharmacol

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Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.

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Section: Introductionmentioning

confidence: 99%

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Venugopal

Koshy

2013

J Anaesthesiol Clin Pharmacol

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“…Various landmarks,[23] simple formulae[45] and sophisticated techniques like right atrial ECG[67] and transesophageal echocardiography[78] have been developed to ensure correct placement of the CVC tip. Peres' utilized the patient's height to predict the optimal length of the catheter to be inserted by different approaches and demonstrated that 24% terminated in right atrium.…”

Section: Introductionmentioning

confidence: 99%

Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula

Joshi

Bhosale

Parikh

et al. 2008

Indian Journal of Critical Care Medicine

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Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP) readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV) catheterization using Seldinger's technique. In group A, central venous catheterization was done under electrocardiography (ECG) guidance. In group B, the catheter was inserted blindly using Peres' formula of “height (in cm)/10”. The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.

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“…6,7 Transesophageal echocardiography can be used to guide central venous catheter placement in congenital heart surgery. 8 The presence of intracardiac shunting with a VSD cannot be demonstrated in all affected children by 2D-echocardiography. In a recent study, 77 patients, age one day to 15.5 yr were identified over a two year period as having VSDs by colour-flow Doppler (CFD) mapping; 97 defects were noted by colour-flow imaging that were not visualized by standard 2D-echocardiography.…”

Section: Discussionmentioning

confidence: 97%

Inadvertent placement of pulmonary artery catheter into right carotid artery

Kanbak

Öcal

2000

Can J Anesth/J Can Anesth

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Purpose: To report a case of misplacement of a pulmonary artery catheter (PAC) into the carotid artery after open heart surgery.Clinical features: A 20-mo-old boy underwent open heart surgery (VSD repair ). On the first day postoperatively, he had severe pulmonary hypertension and a PAC was inserted via the left internal jugular approach without complication. Two hours later, chest radiography showed the PAC in the right internal carotid artery which it had reached via the right and left ventricles and aorta. The PAC was withdrawn and a new PAC was inserted and its position was confirmed by chest radiography. Two years later echocardiography failed to demonstrate the second VSD or a residual leak through the patch although a PAC could be passed from the right ventricle to the left ventricle and subsequently into the aorta and right carotid artery. Conclusion:Correct placement of a PAC should be confirmed by chest radiography or other techniques to prevent complication.Objectif : Rapporter le cas d'un cathéter artériel pulmonaire (CAP) déplacé dans l'artère carotide après une intervention à coeur ouvert.Éléments cliniques : Un garçon de 20 mois a subi une opération à coeur ouvert (réparation d'une CIV). Le jour suivant l'opération, il a présenté une hypertension pulmonaire sévère et on a inséré un CAP, sans complication, en passant par la veine jugulaire interne gauche. Deux heures plus tard, une radiographie pulmonaire a révélé la présence du CAP dans l'artère carotide interne droite, position atteinte par les ventricules droit et gauche et l'aorte. On a retiré le CAP et inséré un nouveau cathéter. On a vérifié sa position par une radiographie pulmonaire. Deux ans plus tard, l'échocardiographie n'a pu démontrer une seconde CIV ou une fuite résiduelle provenant de la réparation, bien qu'un CAP puisse passer du ventricule droit au ventricule gauche et ensuite dans l'aorte et l'artère carotide droite.Conclusion : La mise en place correcte d'un CAP doit être confirmée par une radiographie pulmonaire ou d'autres techniques afin de prévenir toute complication.

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A Controlled Study of Transesophageal Echocardiography to Guide Central Venous Catheter Placement in Congenital Heart Surgery Patients

Cited by 56 publications

References 20 publications

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula

Inadvertent placement of pulmonary artery catheter into right carotid artery

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