An unending supply of ‘unusual’ complications from central venous catheters

Extravasation Injuries in Adults

“…Sites most often implicated in extravasation injuries include the dorsum of the hand and foot [5], ankle, antecubital fossa [6], and near joints or joint spaces [7] where there is little soft tissue protection for underlying structures [8]. Limbs with local vascular problems such as lymphoedema may have reduced venous flow causing pooling and potential leakage of infusates around the site of cannulation [5, 9].…”

“…Limbs with local vascular problems such as lymphoedema may have reduced venous flow causing pooling and potential leakage of infusates around the site of cannulation [5, 9]. Peripheral rather than central venous administration of antineoplastic agents is more likely to be associated with frequent cannulation which is a risk factor for extravasation, and this should be avoided [5, 7]. …”

“…Many antineoplastic (Cellular Toxic) agents asdoxorubicin,daunorubicin,vincristine,vinblastine,mitomycin,paclitaxel,azathioprine,acyclovirare vesicant (i.e., produce blisters) [7, 9], and as well as causing immediate injury may also bind to tissue DNA [30] so that the drug is continually released from dying to healthy cells, resulting in a slow increase in ulcer size over time. Doxorubicin, for example, has been shown to remain in tissue for 5 months after extravasation [31] which means that the injury can present late with extensive tissue destruction [32].…”

A National Survey of Neonatal Peripherally Inserted Central Catheter (PICC) Practices

“…9 Understanding processes surrounding PICC insertion and evaluating maintenance practices can provide a glimpse into strategies to potentially improve care and outcomes. However, the profile of complications can differ among the populations with the fragile neonate regarded as facing a higher risk of complications, particularly infection, catheter occlusion, and migration or dislodgement.…”

Left internal jugular catheter tip wedged in the left superior intercostal vein, an inferior tributary of the brachiocephalic

“…The many inherent risks of central line insertion in babies and small children (3) may be minimized by various considerations: these include specific insertion techniques, U/S guidance, appropriate catheter designs and sizes, length of catheter insertion (using child height and weight) (4). In addition a high index of suspicion should be maintained, with repeated clinical and radiological checks with time.…”