Central vein perforation during tunneled dialysis catheter insertion: Principles of acute management

Pua, Uei

doi:10.1111/hdi.12179

Cited by 6 publications

(13 citation statements)

References 7 publications

(9 reference statements)

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“…However, malposition was significantly less with the jugular access compared to the subclavian approach (5.3% vs. 9.3% RR 0.66 [044-099]) [9] . In terms of left vs. right insertions, however, the left produces more complications due to the angulations of vessels [3,4] .…”

Section: Discussionmentioning

confidence: 99%

“…When inserting the catheter, one vital step includes checking whether the catheter is inserted in the proper location and vessel. Aspiration of fluid is crucial in order to determine whether the catheter has been inserted in the vessel [3] . Bright blood suggests oxygenated blood, which signifies an arterial vessel in the systemic circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the orientation and knowledge of anatomy, it could signify iatrogenic trauma to surrounding structures, including the pleura, pericardium, or central vessels. Instead of withdrawing the catheter to re-attempt insertion, it is suggested to insert contrast dye into the location [3,4] . This will not only provide a tamponade effect, if a vessel was perforated, but it also reveals the location of the catheter tip when employing imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

“…This will not only provide a tamponade effect, if a vessel was perforated, but it also reveals the location of the catheter tip when employing imaging modalities. Computed tomography provides the most accurate location of the catheter; radiographs may prove inaccurate or lacking detail [3,4] .…”

Section: Discussionmentioning

confidence: 99%

“…One such complication is the iatrogenic perforation of the blood vessel during the course of cannulation [3,4] . Examination of the anatomy has determined that the left sided approach for hemodialysis cannulation presents a unique complication imposed by the angle between the subclavian and innominate vein [3] . We present a case of a tunneled hemodialysis catheter causing iatrogenic perforation of the innominate vein.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

Siordia

Ayers

Garlish

et al. 2015

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

Siordia

Ayers

Garlish

et al. 2015

International Journal of Surgery Case Reports

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An unusual case of iatrogenic central venous injury

Singh,

Dabas,

Singh

et al. 2023

Seminars in Dialysis

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Central venous catheter (CVC) provides ready vascular access and is widely used for the performance of hemodialysis. The use of CVC is associated with many complications and one life‐threatening complication is central venous injury. We describe an unusual case of central venous injury in a 69‐year‐old lady with a poorly functioning left internal jugular vein catheter, which was in situ at the time of attempting insertion of a replacement right internal jugular catheter. The management included initial stabilization, urgent hemodialysis, imaging, and an endovascular approach to mitigate the iatrogenic venous injury. The case highlights many learning points. The operator needs to be vigilant for anatomical abnormalities like stenosis in patients who have had previous CVC. In those with central venous perforation, the CVC should be left in situ till a definitive management plan is formulated. An endovascular approach, when feasible, is a minimally invasive effective management strategy.

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Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem

Xu,

Zeng,

2023

Front. Cardiovasc. Med.

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ObjectiveThe aim of this study was to evaluate the causes of the dysfunctional tunneled cuffed catheters (TCCs) using multi-spiral computed tomography venography (MSCTV), and to analyze the outcomes of endovascular salvage techniques.Material and methodsThis retrospective review data from 27 patients who experienced TCC dysfunction between July 1, 2016 and January 31, 2021 was conducted. Patients’ demographic data, clinical signs and symptoms, and imaging data were collected from interventional radiology database.ResultsMSCTV showed a range of abnormalities in the hemodialysis (HD) patients, including central venous occlusion (n = 4), fibrin sheath formation (n = 3), malposition of the catheter tips (n = 4), central venous perforation (n = 1), thrombus formation (n = 12), regular catheter exchange without determined lesions (n = 3). Interventional catheter salvage procedures were performed, such as catheter exchange, balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, and stent deployment. The technical success rate for catheter insertions was 100%, and no procedure-related severe complications were observed. The 30-day catheter patency for all assessable catheters was 85.2%.ConclusionThe use of MSCTV showed abnormal findings in almost 88.9% of cases concerning dysfunctional TCC. In this study, the examined appropriate endovascular techniques were found to be safe and technically successful, with a low incidence of procedure-related complications.

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Central vein perforation during tunneled dialysis catheter insertion: Principles of acute management

Abstract: Central venous perforation during dialysis catheter insertion is a potentially fatal complication. Prompt recognition and judicious initial steps are important in optimizing the outcome. The purpose of this manuscript is to illustrate the imaging features and steps in initial management.

Cited by 6 publications

References 7 publications

Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

An unusual case of iatrogenic central venous injury

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem

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