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

Gao²,

et al. 2010

Echocardiography

“…These results are similar to other studies. 30 The ability to guide their proper placement by TEE during insertion could help to eliminate the potential complications.…”

Section: Discussionmentioning

confidence: 99%

The Role of Intraoperative Transesophageal Echocardiography in Robotic Mitral Valve Repair

Gao²,

et al. 2010

Echocardiography

“…Ultrasound-guided technique offers both safety and convenience in inserting catheters into the internal jugular vein (IJV). Correct CVC positioning can be assisted by means of chest radiography (CXR), intravascular electrocardiogram (ECG), and transesophageal echocardiography (TEE) (3)(4)(5). Radiography is also helpful in diagnosing complications such as pneumothorax or hematothorax.…”

mentioning

confidence: 99%

The Anterior Jugular Venous System: Variability and Clinical Impact

Schummer¹,

Schummer²,

Bredle³

et al. 2004

Anesthesia & Analgesia

The anterior jugular venous system, with its interconnections to the subclavian and deep jugular veins, provides a collateral venous network across the midline of the neck area, which is especially important in unilateral occlusion of an innominate vein. We illustrate the variability of this system and its clinical impact on catheterization by three cases of landmark-guided central venous cannulation. Case 1: Cannulation of the left internal jugular vein with a central venous catheter and of the left innominate vein (LIV) with a pulmonary artery catheter resulted in correctly positioned catheter tips. However, these catheters were actually not placed in the innominate vein but coursed through the jugular venous arch. Case 2: Cannulation of the left subclavian vein was complicated by resistance of guidewire advancement at 13 cm. Occlusion of the LIV and enlargement of the jugular venous arch were present. Case 3: Insertion of a pulmonary artery catheter and a central venous catheter through the LIV. The pulmonary artery catheter was correctly placed. The tip of the central venous catheter was mistakenly positioned in the left anterior jugular vein. We describe the normal anatomy of the anterior jugular venous system and its role as a major collateral. Correct placement of central venous catheters may be possible via the anterior jugular venous system. Conversely, central venous catheters malpositioned in the anterior jugular vein can increase the risk for complications and should be removed.

“…12 We found, however, that it is not always easy to confi rm fl exion or inversion of the catheter tip using ultrasonography. Although heparinized saline fl ushing has been reported to help determine the exact position of a CVC tip, 13 the technique was less effective in this study, probably because of the relatively poor image quality obtained with a hand-held ultrasonograph, as has been previously reported. 14 Although the optimal position for the tip of a CVC inserted from the femoral vein has not been established, the tip of the catheter should not be inserted into the heart, because it can cause cardiac tamponade, malignant arrhythmia, and other lethal complications.…”

Section: Discussionmentioning

confidence: 68%

Use of hand-held ultrasonography to confirm the correct placement of a central venous catheter tip

et al. 2007

To avoid severe complications resulting from malpositioning of a central venous catheter, removal and recannulation of the catheter may be necessary, thus wasting medical equipment and increasing stress on the patient. Therefore, central venous catheters should be inserted correctly the first time. We tested whether real-time hand-held ultrasound-guided confirmation of the location of the tip of a central venous catheter inserted from the femoral vein could reduce the rate of malpositioning. Catheters were inserted using conventional methods for 65 patients, and using ultrasound guidance for 29 patients. For the latter group, when a central venous catheter was inserted, the ultrasound examiner first identified its tip located dorsal to the liver in the inferior vena cava and then fixed the catheter in position. We considered a central venous catheter to be malpositioned when its tip appeared in neither the inferior vena cava nor the right atrium-inferior vena cava junction in X-rays. Flexed or inverted catheters were also considered to be malpositioned. We compared the malpositioning rates for the ultrasound and conventional groups. Malpositioning was identified for two (6.9%) patients in the ultrasound group and 19 (29.2%) patients in the conventional group. The relative risk of ultrasound-guided versus conventional catheter insertion was 0.23 (95% confidence interval, 0.09-0.62). Our data suggest that real-time ultrasound monitoring is useful for avoiding malpositioning of central venous catheters inserted from the femoral vein.