Central venous catheters misplaced in paraspinal veins: A systematic literature review based on case reports

Abstract

Background: Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports.Aim: To determine the clinical characteristics of paraspinal vein misplacement.Design: This was a systematic review.Methods: A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted.Results: Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced complications, of whom seven died. The most common complications included cerebrospinal fluid abnormalities, neurological symptoms, and deteriorated respiration. Among the entire case cohort, the onset of complications was the primary sign that alerted medical staff to misplacement (n = 23). The typical radiographic characteristics were posterior deviation of the catheter course overlapping with the spine on lateral X-rays and a bend, kink, or hump in the catheter course on anteroposterior X-rays at the L4 to L5 levels.Conclusions: Nurses should be aware of this particular complication if a patient who has undergone catheterization via a lower extremity presents deterioration of neurological function and respiration.Relevance to clinical practice: Lateral X-ray radiography is an effective method to verify misplacement and is recommended as routine practice during catheterization via lower extremities.Xiaoxia Zhang and Hongxiu Chen contributed equally to this work.

Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: Wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure

“…In a 1997 study, Durbec et al 19 reported a primary tip’s malposition rate of 37%. In particular, tip’s positioning in the paraspinal veins represents one of the situations which, although little investigated in the literature, 20 appears to be burdened by several consequences, 21 including clinical complications (76.2%) and death (26.9%). According to the need to reach an efficient control of the tip’s position in a bedside setting, in which no standard real time tip’s location procedure is reported in literature, we chose to rely only on ultrasonography.…”

Intravascular Catheter Accidentally Placed into the Right Lumbar Vein from the Right Femoral Vein: A Case Report

“…Although the position of the catheter tip inserted through the femoral vein is often confirmed on a frontal abdominal radio-graph, complications can arise if the catheter is misplaced into branching veins that are not identified by radiographs. Catheters inserted from the left femoral vein have been reported to stray into the left lumbar vein, whereas catheters inserted from the right femoral vein are less frequently misplaced into the right lumbar vein [ 6 ]. In this report, we present a case in which a catheter tip accidentally strayed into the right ascending lumbar vein during catheter insertion from the right femoral vein, and this misplacement was not detected on a frontal abdominal radiograph.…”

What is in the journal?

“…10 This survey was undertaken to examine the reasons for the comparatively high incidence of restraint use in Turkey 11 The next paper in this issue presents a systematic review of case reports and case series of the uncommon but potentially fatal misplacement of central venous catheters in paraspinal veins. 12 The aim of this review was to describe the clinical characteristics of this complication. This knowledge is essential for nurses caring for patients who have central venous catheters placed in lower extremities, especially in paediatrics where this occurs most commonly.…”