Misplacement of a femoral venous catheter into the ascending lumbar vein: repositioning using ultrasonographic guidance

Carrion, Enrique; Hertzog, James H.; Gunter, Andrew; Lu, Tie; Ruff, Cullen; Hauser, Gabriel J.

doi:10.1007/s001340000670

Cited by 20 publications

(13 citation statements)

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“…Malposition of femoral venous catheter into ascending lumbar vein was detected by Carrion et al [5] which was then repositioned using ultrasonographic guidance. Paravertebral and intraspinal malposition resulting in quardiplegia has been also reported in neonates [6].…”

Section: Discussionmentioning

confidence: 99%

“…Accident arterial puncture can be easily managed by applying pressure. So in our case, we selected femoral route for central venous cannulation, but it also has inherent complications.Malposition of femoral venous catheter into ascending lumbar vein was detected by Carrion et al [5] which was then repositioned using ultrasonographic guidance. Paravertebral and intraspinal malposition resulting in quardiplegia has been also reported in neonates [6].…”

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confidence: 99%

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Kinking of Transfemoral Central Venous Catheter in an Infant: A Case Report

Bansal¹

2016

JACCOA

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Submit Manuscript | http://medcraveonline.com procedure for extrahepatic biliary atresia. Because of major nature of the procedure and difficult peripheral cannulation CVC through femoral route was planned. A 4.5 F, 6 cm triple lumen central venous catheter was inserted through the right femoral vein using the Seldinger´s technique in the first attempt without difficulty. A good back flow was confirmed and the catheter was secured and taped. During the surgery there was difficulty in aspiration of blood although fluid and blood infusions were smooth. Postoperatively chest X-ray was done which revealed kinking of the catheter in the right femoral vein. The fluid infusion was terminated and catheter was removed (Figure 1). DiscussionThe main purpose of CVC in infants are major surgical procedure, difficult peripheral cannulation, administration of drugs, fluids, total parentral nutrition, blood and central venous pressure monitoring. The common sites of catheter insertion in infants are subclavian vein, internal jugular vein, femoral vein, umbilical vein or external jugular vein. The subclavian venous cannulation has complication rate of approximately 4% [1] which includes malpositioned catheter into the ipsilateral IJV or contralateral SCV, pneumothorax, haemothorax and air embolism. Cardiac temponade leading to death has also been reported as a major complication with SCV, IJV or umbilical vein cannulation. Weil et al. [2] found that the catheter tip in right atrium is associated with increased risk of cardiac tamponade. Kayashima K et al. [3] evaluated the mechanical complications during paediatric CVC from 1994 to 2013 and found that most of these complications are associated with SCV, IJV, umbilical vein cannulation. In an another study done by Jha M et al. [4] showed more complication rate with SCV cannulation as compared to FV cannulation in terms of more arterial puncture, hematoma and pneumothorax. Advantages of femoral cannulation includes large diameter of the vein, convenient access and distant to the cardiac and pulmonary structures. Accident arterial puncture can be easily managed by applying pressure. So in our case, we selected femoral route for central venous cannulation, but it also has inherent complications.Malposition of femoral venous catheter into ascending lumbar vein was detected by Carrion et al. [5] which was then repositioned using ultrasonographic guidance. Paravertebral and intraspinal malposition resulting in quardiplegia has been also reported in neonates [6]. Therefore catheters in the ascending vein or vertebral plexus should be removed immediately. First warning signs of catheter malposition is absent blood on aspiration. Others are catheter present over vertebral column on x-ray and resistance to guide wire insertion. In our case we could not aspirate blood and were also unable to reinsert the guidewire. These malpositioned catheters can be identified by ultrasound, X-ray, linogram (contrast enhanced study) and fluroscopic screening. In our case X-ray abdomen revealed kinking o...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Kinking of Transfemoral Central Venous Catheter in an Infant: A Case Report

Bansal¹

2016

JACCOA

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“…6 Furthermore, the catheter may be safely repositioned into the IVC with the use of a J-guide wire catheter 8 or by bedside ultrasound guidance. 9 If a catheter is misplaced, it takes 14.8 days on average to be diagnosed. 5 However, the elderly and mental disorder patients usually find it difficult to personally complain of symptoms.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Iliopsoas Abscess and Cerebellum Abscess Caused by Misplacement of Central Venous Catheter

et al. 2015

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A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently.We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.Keywords: catheter misplacement, iliopsoas abscess, cerebellum abscess, ascending lumbar vein Case Report A 64-year-old female had been undergoing nasal feeding due to anorexia nervosa and depression for about a year at another hospital. One day, she developed fever approximately three weeks prior to admission at our hospital. She was diagnosed with urinary tract infection and treated with an antibiotic. CVC was inserted from the right femoral vein. Her fever reduced temporarily, although her inflammatory reaction worsened progressively. She developed fever again two days prior to admission at our hospital. She had progressive disturbance of consciousness. She was brought to the emergency department of this hospital.She had a past medical history of atrial fibrillation. Initial vital signs were as follows: blood pressure of 116/83 mmHg, heart rate of 115 beats/min, respiratory rate of 15 breaths/min, SpO 2 of 97% on room air, body temperature of 36.7°C, and the Glasgow Coma Scale was E2V1M1 (total 4/15). Physical examination revealed edema in her entire body, while other system examinations revealed nothing in particular. Laboratory studies were as follows: white blood cell (WBC) count 43,410/µl, hemoglobin (Hb) 10.8 g/dl, and C-reactive protein (CRP) 19.13 mg/dl. Cerebrospinal fluid (CSF)

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“…Especially in young children, it has been recommended that radiography be used to confirm correct catheter position. 1 We recently experienced a case of unintended placement of a left femoral venous catheter into the ascending lumbar vein.…”

Section: Radiographic Confirmation Following Pediatric Femoral Venousmentioning

confidence: 99%

“…[1][2][3] The greatest reported experience with the GVL is in adult patients. 1,3 We recently used the neonatal model GVL in five neonates presenting for elective nasotracheal intubation (NTI). Demographics are reported in the Table. Nasotracheal intubation was performed by two pediatric residents supervised by an expert neonatologist.…”

Section: The Glidescope® Video Laryngoscope: Initial Experience In Fimentioning

confidence: 99%