Misplacement and Loop Formation of Central Venous Catheters

Malatinský, J; Kadlic, T; Májek, M; Sámel, M

doi:10.1111/j.1399-6576.1976.tb05035.x

Cited by 88 publications

(38 citation statements)

References 24 publications

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“…Indeed, once the guide wire was in place, feeding of the catheter was possible without any problems in all supraclavicular punctures. Misplacement into adjacent vessels, reported to occur in up to 6% of infraclavicular cannulations, [7][8][9][10] was not observed in our study although fluoroscopy was not used in any procedure. This is obviously due to the straight path of the catheter to the right atrium, even if the puncture is performed from the left side (Figure 1).…”

Section: Discussionmentioning

confidence: 54%

“…The incidence of secondary migration may be as high as 7% for soft silicone rubber lines introduced by the infraclavicular approach. 6,10 We observed one secondary catheter migration (1.2%), the first case in our 4 years experience with the supraclavicular approach (more than 1000 catheters). We are convinced that both the coaxial lie of the line in the vessel and our policy to position the catheter tip into the upper third of the right atrium, are responsible for this extremely low incidence of secondary migration.…”

Section: Discussionmentioning

confidence: 72%

“…[6][7][8][9][10] For these reasons implantation is usually performed under fluoroscopic guidance in the operation theatre or angiogram suite, 5,6 which is expensive and causes exposure of the patient to radiation and potential nephrotoxic contrast media. Secondary migration, compression (the pinch off sign) and fragmentation of the catheter are other adverse events related to the infraclavicular approach.…”

mentioning

confidence: 99%

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Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Apsner

Schulenburg

Sunder‐Plassmann

et al. 1998

Bone Marrow Transplant

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Summary:The purpose of this study was to evaluate the efficacy and safety in placement of Hickman catheters via the supraclavicular route without fluoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded prospectively. Seventy-nine punctures were successful (97.5%). One pneumothorax (1.2%) and three accidental arterial punctures (3.7%) occurred. Difficulties in introducing the catheter through the peel away sheath or misplacement were not observed. The catheters remained in place for a total of 7657 days (mean 94.5, range 3-392 days). Sixteen blood cultures were positive (2.1/1000 catheter days). Five catheters (6.1%) were lost because of mechanical complications. Forty-two lines (52%) were removed electively, 23 (28.4%) because of suspected infection, and two (2.5%) because of tunnel infection. Nine patients died with a functioning catheter. We conclude that the supraclavicular approach to the subclavian vein is safe and efficient for introduction of Hickman catheters. Using this access, routine fluoroscopic or sonographic guidance is not required for proper placement. Implantation of the lines in an intensive care unit did not lead to higher infection rates than those reported in the literature. Keywords: Hickman; supraclavicular access; fluoroscopic guidance; infection; bone marrow transplantation Central venous access for antineoplastic treatment, supportive therapy and parenteral nutrition is required in most patients scheduled for bone marrow transplantation (BMT). In many centers a Hickman catheter is routinely inserted before BMT. [1][2][3] Usually the infraclavicular route to the subclavian vein is chosen for percutaneous implantation of the line. [4][5][6] Pneumothorax, arterial puncture and chylothorax are well known complications of this approach. 7 number of problems occur during placement of permanent catheters from the infraclavicular site: failure to pass the gap between the first rib and the clavicle, kinking of the guide wire and the introducer sheath and misplacement of the line into adjacent vessels such as the contralateral subclavian vein or both internal jugular veins. 6-10 For these reasons implantation is usually performed under fluoroscopic guidance in the operation theatre or angiogram suite, 5,6 which is expensive and causes exposure of the patient to radiation and potential nephrotoxic contrast media. Secondary migration, compression (the pinch off sign) and fragmentation of the catheter are other adverse events related to the infraclavicular approach. 6,11,12 The obvious disadvantages of the infraclavicular route prompted us to evaluate a 'new' approach for placement of Hickman catheters in patients scheduled for BMT. Supported by our previous experience, 9,13,14 our hypothesis was that routine fluoroscopic guidance could be avoided by using the supraclavicular ac...

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 72%

mentioning

confidence: 99%

See 1 more Smart Citation

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Apsner

Schulenburg

Sunder‐Plassmann

et al. 1998

Bone Marrow Transplant

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“…However, the catheter tip can be commonly misplaced at multiple sites, increasing the risk of cardiac arrhythmias, chemical or bacterial thrombophlebitis, vascular erosion, and impaired CVP measurement [1,2]. The incidence of misplaced CVC through the right infraclavicular subclavian vein approach is 5.5%-24% [1][2][3].…”

mentioning

confidence: 99%

Late migration of subclavian venous catheter after initial correct placement

Ahuja

Bhaga

2009

J Anesth

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“…Incidence of malposi on of central venous catheteriza on 7 (CVC) ranges from 1-60%. The catheter p can be directed to the ipsilateral internal jugular vein from subclavian vein and vice versa or towards the contralateral subclavian vein.…”

Section: Introductionmentioning

confidence: 99%

A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

Rajbanshi

Karki

Arjyal

2018

Birat J. Health Sci.

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Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

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Misplacement and Loop Formation of Central Venous Catheters

Cited by 88 publications

References 24 publications

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Late migration of subclavian venous catheter after initial correct placement

A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

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