Migration of Tips of Central Venous Catheters in Seated Patients

Lee, Don S.; Kuhn, Jeannette; Shaffer, Michael J.; Weintraub, Herbert D.

doi:10.1213/00000539-198410000-00013

Cited by 14 publications

(5 citation statements)

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“…Extravasation secondary to malpositioned proximal lumen of a double‐lumen hemodialysis catheter at the subclavian vein suggests that multiple‐lumen catheters can be partially dislodged by head movement and changes in position even if they were firmly fixed. In adults, subclavian catheters have been shown to move up to 3 cm towards the heart with movement of the head or neck 42,43 . Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary to central venous catheter dislodgment.…”

Section: Discussionmentioning

confidence: 99%

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Complications of central venous catheterization in critically ill children

Karapınar

Cura

2007

Pediatrics International

126

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Section: Discussionmentioning

confidence: 99%

“…In adults, subclavian catheters have been shown to move up to 3 cm towards the heart with movement of the head or neck. 42,43 Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary to central venous catheter dislodgment.…”

Section: Discussionmentioning

confidence: 99%

Complications of central venous catheterization in critically ill children

Karapınar

Cura

2007

Pediatrics International

126

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“…The best way to do this is by ECG, where the catheter is used as one of the leads 32 . An X-ray picture to confirm placement may be inadequate as the tip position changes with changes of patient position 33 , and changes in cardiac output and ventilation may cause movement of the catheter. b.…”

Section: Air Aspirationmentioning

confidence: 99%

Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

2005

Anaesth Intensive Care

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Neurosurgery in the sitting position offers advantages for certain operations. However, the approach is associated with potential complications, in particular venous air embolism. As the venous pressure at wound level is usually negative, air can be entrained. This air may follow any of four pathways. Most commonly it passes through the right heart into the pulmonary circulation, diffuses through the alveolar-capillary membrane and appears in expelled gas. It may pass through a pulmonary-systemic shunt such as a probe patent foramen ovale (paradoxical air embolism); it may collect at the superior vena cava-right atrial junction. Rarely it may traverse through lung capillaries into the systemic circulation. Many monitors, such as the precordial Doppler, capnography, pulmonary artery catheter, transoesophageal echocardiography are useful for venous air embolism detection, with transoesophageal echocardiography being today's gold standard. Various manoeuvres, including neck compression and volume loading, are also useful in reducing the incidence of venous air embolism. Volume loading, in particular, is very helpful as it reduces the risk of hypotension. Other particular concerns to the anaesthetist are airway management, avoidance of pressure injuries, and the risk of pneumocephalus, oral trauma, and quadriplegia. Newer anaesthetic agents have made the choice of anaesthetic technique easier. An appreciation of the implications of neurosurgery in the sitting position can make the procedure safer.

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“…Because of difficulty to appreciate the junction of SVC and right atrium in the standard anterior-posterior chest radiograph, we decided to use the carina as the radiographic landmark of measurement. Considering the recommendation of Food and Drug Administration guidelines for central venous catheter placements that catheter tips never enter the atrium and a report about catheter migration with movement of the patient's arms or head 1-3 cm caudally, we tried to locate the tip of PICC in the lower SVC fast the carina near cavoatrial junction (19-21). In addition, when the catheter tip ends near the carina, the catheter tip tends to abut the right SVC wall with obtuse angle because of the natural anatomy of the junction of left innominate vein and SVC and stiffness of the catheter in left-side approach of PICC, so, we tried to insert the carina more deeply and fast as possible to lower SVC near the cavoatrial junction.…”

Section: Discussionmentioning

confidence: 99%