Cardiovascular Monitoring

Bedside Procedure: Retained Central Venous Catheter

“…The modified Seldinger technique is utilized for catheter placement. If an IJ or subclavian (SC) catheter is inserted, chest X-ray is performed to confirm placement location and ensure no pneumothorax has developed [2,6,[12][13][14][15][16].…”

“…If an institution utilizes heparin saline for flushes, care should be exercised to identify patients with contraindications to heparin such as history of hypersensitivity reaction, and heparin-induced thrombocytopenia (HIT) [17][18][19]. There are many devices available for central venous access but they are generally composed of silicone or polyurethane which allows for relative stiffness at room temperature and a softened state at body temperature [6,11]. CVC can be broadly categorized into non-tunneled, tunneled, and implantable with ports.…”

“…These include bleeding events, arterial puncture, infective sequela, cardiac conduction abnormalities, catheter malposition, thrombotic events, and mechanical device failure [1,6,25]. Identified risk factors for complications during CVC insertion are number of unsuccessful needle passes, inexperience of provider, body mass index >30 or <20, hypovolemia, large catheter size (specifically related to vascular complications), and previously failed catheterization attempts [1,5,25,26].…”

“…Venous hematomas can arise from multiple punctures, venous laceration, and attempted access at an inappropriate site. The utilization of ultrasound or fluoroscopy is advocated for prevention of these complications [1,6,25].…”

“…The most common immediate complications of central venous catheterization (CVC) include pneumothorax (incidence of 0.5-1.5%), arterial puncture (0.5-3.7%), and cardiac ectopy (0.9%) [1,5,6]. Retained guide wire is a recognized but rare complication during insertion of CVC.…”