Point-of-care ultrasonography: a boon for early localization and retrieval of broken fragment of external jugular venous catheter

Mohanty, Chitta Ranjan; Ahmad, Suma Rabab; Elyat, Anirudh; Bellapukonda, Snigdha; Panigrahi, Sourav

doi:10.4097/kja.19285

Cited by 4 publications

(6 citation statements)

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“…Однако крайне важно, чтобы при любых затруднениях процесс был остановлен и начат поиск причин, не позволяющих извлечь катетер, поскольку форсированные тракции способны привести к его фрагментации, которая чревата миграцией обломка в сосудистое русло, что может приводить к таким жизнеугрожающим состояниям, как желудочковая тахикардия, эмболизация инородным телом, перфорация камер сердца [14,15]. Важную роль в диагностическом алгоритме в подобных ситуациях занимает ультразвуковое исследование в формате POCUS -point of care ultrasound [12]. Быстрая визуализация с помощью линейного датчика v. basilica, подмышечной и подключичной вен позволяет оценить сам катетер, положение его дистального конца, наличие узлов, фибринового чулка или тромботических масс вокруг него, вовремя распознать миграцию фрагмента и локализовать его [12].…”

Section: Discussionunclassified

“…Важную роль в диагностическом алгоритме в подобных ситуациях занимает ультразвуковое исследование в формате POCUS -point of care ultrasound [12]. Быстрая визуализация с помощью линейного датчика v. basilica, подмышечной и подключичной вен позволяет оценить сам катетер, положение его дистального конца, наличие узлов, фибринового чулка или тромботических масс вокруг него, вовремя распознать миграцию фрагмента и локализовать его [12]. Как правило, при фрагментации катетера его обломки удаляют открытым хирургическим путем или эндоваскулярно [12,13,16].…”

Section: Discussionunclassified

“…Выделяют несколько причин трудностей при удалении катетера: образование узлов, формирование фибринового чулка, спазм вен, тромбофлебит с плотной фиксацией катетера к тромботическим массам и стенке сосуда [4,[7][8][9][10]. Попытка форсированного удаления в подобных случаях может привести к довольно опасной ситуации -фрагментации (отрыву) катетера и даже его миграции в легочные артерии, что может вызывать клиническую картину легочной эмболии и требует неотложного эндоваскулярного или открытого вмешательства [11][12][13]. Именно поэтому крайне важным представляется своевременное распознавание этого типа осложнений и использование методик, обеспечивающих предотвращение фрагментации PICC при его извлечении и профилактику его миграции в камеры сердца и малый круг кровообращения при фрагментации [4,6].…”

Section: Introductionunclassified

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Non-surgical remove of hard-to-remove peripherally inserted central venous catheter: case report

Cherkashin¹,

Valieva²,

Alexandrov³

et al. 2022

Ross. ž. det. gematol. onkol.

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A peripherally inserted central catheter (PICC) line allows permanent vascular access and is widely used in pediatric oncology. In patients, who fully completed antitumor treatment, the PICC line should be removed. In some cases, however, the procedure may be complicated and such a catheter is then called a ‘hard-to-remove’ or a ‘non-removable’. This article describes a clinical case of successful non-surgical removal of a PICC line with a developed fibrin sheath.

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Section: Discussionunclassified

Section: Introductionunclassified

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Non-surgical remove of hard-to-remove peripherally inserted central venous catheter: case report

Cherkashin¹,

Valieva²,

Alexandrov³

et al. 2022

Ross. ž. det. gematol. onkol.

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“…The popliteal artery can be a very useful option in this situation. Point-of-care ultrasonography (POCUS) has made vascular structures easily accessible for diagnostic and therapeutic purposes, which were previously impossible with blind techniques [1,2]. POCUS can be an invaluable tool for popliteal artery cannulation due to its deeper location and presence of the popliteal vein above it [3].Written informed consent obtained from the patient.…”

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confidence: 99%

Point-of-care ultrasonography as rescue for popliteal artery cannulation in prone position

Mohanty

Bellapukonda

Topono

et al. 2021

Korean J Anesthesiol

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The prone position is among the many positions used during various neurosurgical and orthopedic surgeries (posterior fossa tumors and spine). Complications associated with prone positioning include stroke, upper airway obstruction, endotracheal tube dislodgement and brachial plexus injury, among others. Arterial cannula displacement during positioning or in the middle of an ongoing major surgery is a nightmare to anesthesiologists, due to difficulties of accessing commonly used arteries for arterial cannulation. It becomes even more challenging when the extremities are not available for cannulation in patients with polytrauma. The popliteal artery can be a very useful option in this situation. Point-of-care ultrasonography (POCUS) has made vascular structures easily accessible for diagnostic and therapeutic purposes, which were previously impossible with blind techniques [1,2]. POCUS can be an invaluable tool for popliteal artery cannulation due to its deeper location and presence of the popliteal vein above it [3].Written informed consent obtained from the patient. A 60-year-old woman with history of fall from a 6-m height was scheduled for pedicle screw fixation of L1 vertebral fracture. She also had bilateral upper limb fractures along with right metatarsal fracture. She was known to be diabetic and hypertensive with irregular medications. Due to intraoperative hemodynamic instability and difficulty of measuring noninvasive blood pressure, arterial cannulation (over the needle technique) was performed in the left dorsalis pedis artery. During the intraoperative period, the arterial cannula was displaced, as indicated by damping in the arterial wave tracing. After repeated failed attempts to cannulate the left posterior tibial artery, we decided to cannulate the left popliteal artery. The left popliteal fossa was cleaned and draped. An ultrasound image of the popliteal artery with the vein lying above and the nerve bundle below was obtained (Fig. 1A). Colored Doppler was used to improve identification of the artery. The artery was found just below the vein from the roof of the popliteal fossa. Hence, it could not be punctured perpendicularly. The vein was to be bypassed by puncturing the artery from the medial or lateral side using the Seldinger technique (Fig. 1B).The popliteal artery is accessed in the popliteal fossa, which is bound by the biceps femoris, plantaris, and lateral head of the gastrocnemius laterally and by the semitendinosus, semimembranosus, and medial head of the gastrocnemius medially. The floor is formed by the knee joint, and the roof is formed by the skin, subcutaneous, and fascia lata [2]. The popliteal artery has an average diameter of 7.4-9.5 mm [3]. The popliteal artery and vein are present in the common sheath, and the vein crosses the artery from the lateral to medial as we move from above to below. Easy accessibility in the prone position, reliable anatomy, and large diameter were advantages of popliteal artery cannulation. However, because of its deep location and adjacent placeme...

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“…Furthermore, a few nuances are to use a good quality catheter, and USG during the removal of this cannula and this may help to avoid catheter breakage, migration and easy detection. [ 7 ] It is a potential source for infection and should be cared as CVC care bundles. Attaching a three-way extension [ Figure 1 ] would avoid contamination of cannula and air embolism.…”

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confidence: 99%

External jugular vein cannulation – A double-edged sword

Ahmad

Bellapukonda

Mohanty

et al. 2021

Indian Journal of Anaesthesia

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Point-of-care ultrasonography: a boon for early localization and retrieval of broken fragment of external jugular venous catheter

Cited by 4 publications

References 4 publications

Non-surgical remove of hard-to-remove peripherally inserted central venous catheter: case report

Non-surgical remove of hard-to-remove peripherally inserted central venous catheter: case report

Point-of-care ultrasonography as rescue for popliteal artery cannulation in prone position

External jugular vein cannulation – A double-edged sword

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