Complications Associated with Central Venous Catheters

Scott, Walter L.

doi:10.1378/chest.94.6.1221

Cited by 138 publications

(46 citation statements)

References 29 publications

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“…T he subclavian and jugular vein routeshavebecomeincreasingly popular for establishing central vein access, with a 1988 estimate approximating 3 million catheterizations per year [1]. Use of these routes has become commonplace not only for the delivery ofantibiotics, total parenteral mu trition, blood products, and chemotherapy agents but also for temporary dialysis, transjugular in trahepaticportosystemicshunt, pulmonary an giography, transjugular biopsy, and placement of inferiorvenacavafilters.…”

Section: Conclusion Sonographic Guidance Forcentral Veinaccess Viathmentioning

confidence: 99%

Sonographic guidance when using the right internal jugular vein for central vein access.

Caridi¹,

Hawkins²,

Wiechmann³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. The intentof thisstudywasto substantiate theadvantages of theuseof sonographic guidancefor centralvenousaccessvia the right internaljugular vein. SUBJECTSAND METHODS. Eightysequential patients requiring central veinaccesswere examined with a hand-held sonography transducer to determine the size, patency, and locationof the right internaljugular vein beforepuncture. Accessto the right internaljugular vein was subsequently performed, under sterile conditions, using sonographic guidance. Periprocedural complications were prospectively recorded. Subsequently, we compared our findingswith publishedreportsof complicationswhen visible and palpableanatomicland marks were used for guidance during cannulation of the internal jugular vein. RESULTS.Amongthese 80patients, theanatomy of therightinternal jugularveinwastypical in only 57 (71%). In another 13 patients (16%), sonography showed a medial position of the right internal jugular vein, anterior to the common carotid artery. In three other patients (4%), the right internaljugular vein was positioned laterally by more than 1 cm. In the remain ing seven patients (9%), the vein was thrombosed. Its diameter, measured without use of the Valsalva maneuver, also varied, measuring 0.5-2.0 cm. Cannulation was achieved in all 73 pa tients with a patent right internaljugular vein. One puncture was required in 68 patients (93%);two puncturesin threeotherpatients(4%); andthreepuncturesin the remainingtwo patients (3%). In no case was the common carotid artery inadvertently punctured. Only one periproce duralcomplicationoccurred, andit wasunrelatedto the useof sonographic guidance. CONCLUSION. Sonographic guidance forcentral veinaccess viatherightinternal jugular vein is safer and more efficient than the traditional landmark approach. 2â€"5]. The traditional method of using ana tomic landmarksto guide cannulation of the right internal jugular vein has yielded various rates for successful access and complications [6][7][8][9]. These rates depend not only on the experi ence of the operator but also on the underlying patency and anatomy ofthe right internal jugular vein. We believe that the use of a hand-held transducer for real-time sonography before the procedure and for guidance during the procedure canimproveaccess to therightinternal jugular vein and limit complications. Subjects and MethodsDuring a 3-month interval, 80 consecutive patients in whom a right internaljugular vein approachwas beingused for centralveinaccesswereexaminedbe fore the procedure with hand-held real-time sono graphic transducers. Either a Sonolayer SSH-140A(ToshibaAmericaMedicalSystems,Carroilton,TX) ora Site-Rite II (Dymax, Pittsburgh, PA)wasused to determinethe size, patency,and locationof the right internal jugular vein before puncture. To simulate the landmark approach, the patient's head was rotated 30'to the leftand scanningwas performedat the apexof bothheadsofthe sternocleidomastoid muscle.Thirty seven males and 43 females 15â€"76 years old were examined. For those patients who proceeded t...

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Section: Conclusion Sonographic Guidance Forcentral Veinaccess Viathmentioning

confidence: 99%

Sonographic guidance when using the right internal jugular vein for central vein access.

Caridi¹,

Hawkins²,

Wiechmann³

et al. 1998

American Journal of Roentgenology

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“…Bu subklaviyen venöz kateterizasyon uygulamasında, kateterin ucunun damar dışına çıkarak intraplevral aralığa yerleşmesi ender görülen bir komplikasyondur (4,5) . Özellikle subklaviyen kateter girişimi uygulanan hastada hemotoraks gelişirse ve kateter intraplevral aralığa yönlenmişse plevra yaprakları arasında biriken kan aspire edilebilir.…”

Section: Discussionunclassified

Intrapleural Placement Of Catheter And Hemothorax During Insertion Of Hickmann Catheter

Şahin¹,

Alper²,

Akan³

et al. 2015

Behcet Uz Cocuk Hast Derg

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ÖZET Hickmann® kateter ile santral venöz kateterizasyon işleminde genellikle juguler veya subklaviyen venler kullanılmaktadır. Kateterizasyon sırasında ultrasonografi kullanılması, kateterizasyon komplikasyonlarını azaltmaktadır. Kateterizasyon sonrasın-da, olguların fizik muayene ve posterior-anterior akciğer grafisi ile kontrol edilmesi, kateter lokalizasyonu ve olası komplikasyonların görülmesini sağlamaktadır. Santral venöz kateteri kullanmadan önce kateter lümeninden ajite serum fizyolojik uygulanması ile kateter ucundan çıkan baloncukların ekokardiyografi altında sağ atriumda görülmesi de, kateter ucunun yerinin değerlendirilmesini sağlamaktadır. Bu olgu sunumunda, akut lenfoblastik lösemi tanısı ile izlenen çocukta sol subklaviyen venden Hickmann ® kateter takılması sırasında kateterin intraplevral yerleşimi ve plevral efüzyon ile masif hemotoraksın tanı ve tedavisi sunulmuştur.Anahtar kelimeler: Hemotoraks, tünelli santral venöz kateter, kateter komplikasyonu ABSTRACT Central venous catheterization with the Hickmann® catheter is generally done via jugular or subclavian veins. During catheterization, use of ultrasonography reduces complications of catheterization.After cardiac catheterization, cases should be checked through both a posteroanterior chest radiography and a physical examination to observe the location of the catheter and possible complications. Before using central venous catheter, the agitated physiologic serum is firstly delivered through catheter's lumen and then emanating micro bubbles are observed at the catheter tip on right atrium under echocardiography which confirms the location of the catheter tip. In this case report, diagnosis and treatment of a pleural effusion and a massive hemothorax and an intrapleural placement of the catheter during implantation of a Hickmann ® catheter in a child with acute lymphoblastic leukemia are presented.

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“…Perforation of the superior vena cava and laceration of the right ventricle have a high-mortality risk but are quite rare as is air embolus. Chylothorax or chylous leak may also occur (Scott, 1988). The overall mechanical complication rate in placing 821 central catheters in patients on chemotherapy at MD Anderson Cancer Center was reported to be 10.5% (Mansfield et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Anatomical basis of central venous catheter fracture

Jensen

2008

Clinical Anatomy

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Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.

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Complications Associated with Central Venous Catheters

Cited by 138 publications

References 29 publications

Sonographic guidance when using the right internal jugular vein for central vein access.

Sonographic guidance when using the right internal jugular vein for central vein access.

Intrapleural Placement Of Catheter And Hemothorax During Insertion Of Hickmann Catheter

Anatomical basis of central venous catheter fracture

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