Analysis of 13800 Subclavian Vein Catheterizations

Eerola, R; Kaukinen, L.; Kaukinen, S.

doi:10.1111/j.1399-6576.1985.tb02184.x

Cited by 77 publications

(35 citation statements)

References 19 publications

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“…2,3 Central venous cannulation in general is a safe procedure, and complications of the technique are rarely life threatening. 4 However, deaths occur as a direct result of this procedure. 5,6 In this series of 312 patients undergoing percutaneous cannulation, we experienced life-threatening complications in 1.28% of the patients and mortality in 0.32% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

et al. 2001

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The aim of this study is to establish the incidence of serious morbidity and mortality associated with the placement of large-bore (18 to 20 F) percutaneous bypass cannulae for venovenous bypass (VVBP) during orthotopic liver transplantation (OLT). This technique has been reported to be rapid, simple, and safe. We reviewed the case notes of 312 patients who underwent OLT in our center using this technique. We describe 4 cases of serious morbidity (incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to percutaneous placement of the bypass cannula. We conclude that percutaneous cannula placement for VVBP during OLT has the potential for lifethreatening complications, and this must be considered when electing to use this technique. When percutaneous cannulae are to be used, we recommend the use of the right internal jugular vein for return cannulation and the use of ultrasound guidance, particularly in those patients in whom cannulation is predictably difficult. S urgical approaches to adult orthotopic liver transplantation (OLT) vary among institutes and individual surgeons around the world. Approaches to maintain venous return if the inferior vena cava is clamped and divided during the conventional surgical technique vary among institutes. Some centers perform venovenous bypass (VVBP) only in high-risk patients, whereas others use VVBP whenever the conventional surgical technique is used. Methods of cannulae placement for VVBP vary among institutes, but percutaneous placement is common and has been reported to be rapid, simple, and safe. [1][2][3] We report the serious morbidity and mortality associated with a series of 312 OLTs performed using VVBP with percutaneous placement of large-bore (18 to 20 F) bypass cannulae over 8 years. MethodsIn this institute, percutaneous catheters for VVBP have been used with increasing frequency since the early 1990s. It is now our practice in those patients undergoing OLT with the use of VVBP to insert two 18 F, polyurethane, 15-cm long, wirereinforced, thin-walled cannulae (Fem-Flex II femoral arterial cannula with internal dilator; Research Medical Inc, Midvale, UT) percutaneously after induction of anesthesia. One cannula is inserted into either the internal jugular (IJV) or subclavian vein (SCV) and the other into a femoral vein using the Seldinger technique and serial dilation. The cannulae are flushed with heparin, 1 IU/mL (maximum, 50 mL), and clamped pending connection to the bypass circuit. In the operating room after mobilization of the portal vein, all cannulae are connected in circuit to the centrifugal pump (Medtronics Inc, Minneapolis, MN).We reviewed the case notes of 312 patients for whom this method of cannulation was used to establish the safety of this technique.

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Section: Discussionmentioning

confidence: 99%

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

et al. 2001

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“…In a study dealing with 1,500 subclavian venous catheterizations, FELICIANO et al [11] did not describe any cases of AVF. Among the 13,800 cases of subclavian venous catheterizations reported by EEROLA et al [12], there were 113 (0.9%) accidental arterial punctures, but there was no case of an AVF. However, in these two studies, the search for AVF was not systematic, which may explain why no cases were reported.…”

Section: Discussionmentioning

confidence: 99%

An opacity in the chest following a subclavian catheterization

Portel

Hilbert²,

Gruson³

et al. 1998

Eur Respir J

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A 70 yr old male was admitted to a nephrology department with an acute anuric renal failure. In his past history, one could note a hypertensive cardiomyopathy with an atrial fibrillation, treated with amiodarone, digoxine, flecainide, trinitrine and fluindione, and a noninsulin dependent diabetes treated with metformine. One month before admission, the patient had been treated for an ischaemic cerebrovascular stroke, which was complicated by a rhabdomyolysis responsible for renal failure with a creatinine clearance measured at 26 mL·min -1 .On admission, clinical examination revealed an overall cardiac failure and fine crackles were heard over the pulmonary bases. Oedema of the lower limbs was also found. Biological analysis revealed a worsening of the pre-existing renal failure with a creatinine clearance of 9 mL·min -1 without any associated ionic disorder. Diuretic treatment was initiated, enabling a transitory improvement before a rapid deterioration of the renal function occurred. The patient developed anuria, so that dialysis became necessary. The anticoagulant treatment was interrupted and treatment with heparin injections (250 IU·kg -1 ·day -1 in three injections) was initiated, 4 days before a dialysis catheter was set up. Injections immediately before and immediately after the venous catheterization were omitted. The prothrombin time was then measured at 96% and the activated

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“…Trotzdem ist diese Methode nach wie vor mit vielen Komplikationen behaftet. Stellvertretend für die Vielzahl der Berichte über die Häufigkeit der möglichen Komplikationen sei auf die repräsentativen Untersuchungen von Burri [1978] und Eerola et al [ 1985] hingewiesen.…”

Section: Introductionunclassified

Eine sichere Methode zur infraklavikulären Punktion der Vena subclavia

Anderhuber

Lechner²,

Tesch³

1988

Cells Tissues Organs

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Investigations of 25 human cadavers, using various anatomical techniques, led to the development of a safe and simple method of subclavian venipuncture. This method was tested with special regard to possible complications. The authors describe the guidelines for the choice of the point where the skin has to be penetrated as well as of the point towards which the needle has to be directed. While the latter is situated a little beyond the spinous process of the seventh cervical vertebra, the other is determined as follows: the distance between the acromion and the sternoclavicular joint is divided into three parts, and the junction between the medial and central third of this distance is marked on the skin. Starting from this point a vertical is dropped towards the line between the acromion and the sternal angle. The point of intersection between this line and the vertical is where the cannula penetrates the skin. After a distance of between 2.5 and 4.5 cm the top of the needle reaches the subclavian vein. Even if the vessel is pierced through and through, no complication such as pneumothorax, laceration of arteries, lesions of the adjacent nerves, etc., can occur. Using this method the authors performed catheterization of the subclavian vein in 200 patients, and there were no complications at all.

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Analysis of 13800 Subclavian Vein Catheterizations

Cited by 77 publications

References 19 publications

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

An opacity in the chest following a subclavian catheterization

Eine sichere Methode zur infraklavikulären Punktion der Vena subclavia

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