Cardiac tamponade during central venous vascular access port insertion

Smart, Philip; Kirton, Michael; Mann, Bruce

doi:10.1111/j.1445-2197.2005.03446.x

Cited by 2 publications

(1 citation statement)

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“…Factors that may play a role in the development of cardiac tamponade include penetration of the pericardial sac by the dilator and guidewire, catheter stiffness, angle of the catheter tip to the vessel wall, especially for left-sided catheters, and infusion of hyperosmolar solutions [24,25]. Over the last two decades, with the use of newer catheters, only nine cases of localized cardiac tamponade have been reported, and all of these were associated with the insertion of Swan-Ganz catheters, dialysis lines, and Port-A-Caths [26][27][28][29][30][31][32]. Of note, the tip position was not reported in these case reports.…”

Section: Discussionmentioning

confidence: 99%

A Novel Objective Approach Towards Physicians' Knowledge and Practice Patterns to Optimize Central Venous Catheter Placement: A Cross-sectional Study

2020

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Study objective: Central venous catheterization is an essential component of intensive care of critically ill patients, and proper positioning of the catheter is essential to prevent position-related complications. This study was conducted by using digital tape measurement to objectively assess clinician preferences for central venous catheter positioning based on specific position levels and landmarks on post-procedural chest radiographs. Design: A cross-sectional study using electronic questionnaire survey. Setting: Single academic teaching hospital participated in this study. Participants: The study enrolled 276 physicians from multiple clinical disciplines. Interventions: None. Measurements: A seven-level reference system labeled on a sample chest radiograph was used to identify the acceptable lower and upper limits and landmarks used to determine the optimal central venous catheter tip position as well as the pattern of clinical practices based on the specialty and level of experience of participants. Main results: Among the 276 respondents, the ratio of cumulative acceptance for the lower and upper catheter tip limit was 62% and 66.3% within a 4-cm range below or above the carina, respectively. Intensive care unit (ICU) physicians showed a greater tendency to choose a catheter tip 4 cm below and 6 cm above the carina (p = 0.004 and 0.002, respectively) as did experienced physicians (p = 0.007 and < 0.001, respectively). The commonest reason for catheter tip withdrawal was arrhythmia (50% of cases). Physicians in the ICU and experienced physicians were more concerned about the risk of cardiac perforation than other respondents (p < 0.001 and < 0.001, respectively). The carina was the most commonly used landmark in 71.7% of all physicians, although 50% of radiologists also used other landmarks. Conclusions: The acceptable limit of the catheter tip is 4 cm above and below the carina (-4 to +4), as determined on chest radiography, without a need for tip adjustment.

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