Central Venous Catheter Placement in the Left Internal Jugular Vein Complicated by Perforation of the Left Brachiocephalic Vein and Massive Hemothorax

Wetzel, Lindsay R.; Patel, Priyesh R.; Pesa, Nicholas L.

doi:10.1213/xaa.0000000000000511

Cited by 14 publications

(21 citation statements)

References 10 publications

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“…CVC malposition, especially when the catheter tip rests against a central vein wall at an acute angle, rather than being in the middle of the right atrium or at the cava-atrial junction, favors vessel wall injury and vein perforation. This complication has been reported frequently for the LBV (García Pérez, Moreno Segovia, Méndez García, & Cruz, 2009;Igawa et al, 2007;Ko et al, 2007;Nakabayashi, 2015;Ou & Deng, 2013;Wetzel, Patel, & Pesa, 2017;Winkes, Loos, Scheltinga, & Teijink, 2016). Also, stenosis/thrombosis of the LBV can have other clinically relevant consequences, including neurological disease due to cerebral venous hypertension (Nishijima et al, 2011;Wasse, 2017), which can be reversed if central vein stenosis is recognized and treated in time (Herzig et al, 2013).…”

Section: Resultsmentioning

confidence: 94%

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

et al. 2020

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Introduction: Most hemodialysis patients start renal replacement therapy with a central venous catheter (CVC). The left internal jugular vein (LIJV) is the second-choice vein for CVC positioning, after the right IJV. However, to reach the right atrium, the CVC must pass through the left brachiocephalic vein (LBV), which also drains blood from the left arm through the subclavian vein. The purpose of this study is to describe how the anatomy of the central venous system and in particular that of the LBV affects vascular access in hemodialysis patients. Materials and methods: Three-dimensional (3D) virtual model reconstructions of the central thoracic veins of three hemodialysis patients were obtained from contrastenhanced computed tomography scans acquired in the venous phase. The images were exported as DICOM files and loaded on open-source software for visualizing and analyzing the medical imaging (3D Slicer, Windows version 4.8.1). Results: As expected, the 3D reconstructions showed that the LBV has a tortuous path with three main angulations that could be associated with external compression and stenosis. These could determine the difficulties and increased risks of venous injury during CVC placement, and an increased risk of medium to long-term catheterassociated vein thrombosis and stenosis. Conclusions: The anatomical features of the LBV indicate that the path of a CVC from the LIJV to the right atrium is tortuous and can easily be complicated by vein injury, negatively affecting the creation of future arterio-venous vascular accesses in the left arm.

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Section: Resultsmentioning

confidence: 94%

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

et al. 2020

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“…The real time control with fluoroscopy of dilators and peelable introducers makes drilling of the central venous trunks highly improbable, exceptional in the right accesses, but there have been cases reported of LIJV canalization. [28][29][30] Catheter misplacement was communicated in one patient, which we believe was related to obesity and high mammary volume. 19 Our study has some limitations: it is an operatordependent technique, there is no exact method for measurement of the angulation and direction of the needle in chest radiography, rather it is an approximate calculation; this is not a randomized study and is not comparable to a sample of similar patients where the puncture is performed in LAX or SAX.…”

Section: Discussionmentioning

confidence: 90%

Ultrasound‐guided left internal jugular vein cannulation: Advantages of a lateral oblique axis approach

Moreno‐Sanchez

Moreno‐Ramirez

2020

Hemodialysis International

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Introduction: Retrospective observational study to evaluate the technique of cannulation guided by ultrasound of the left internal jugular vein (LIJV) using a lateral oblique axis (LOAX) approach with variable angulation in the placement of tunneled central venous catheters (CVC) for hemodialysis. Methods: Seventy-one patients with 77 LIJV vascular accesses aged 16 or older who needed CVC for hemodialysis were evaluated. The catheters were inserted, guided by LOAX ultrasound with variable angulation, depending on the angulation of the left brachiocephalic trunk. The success rate, additional instrumentation needs, and number of immediate and late complications were analyzed. Findings: Central venous catheters placement was possible in all cases and none of the peelable introducers folded. A placement guide was needed in only eight patients, whose brachiocephalic trunk elongation and angulation was 90. We found no major complications, and only five cases of minor complications (6.5%): four periprocedural and one displacement of the catheter a week after placement. Discussion: Tunneled CVC percutaneous cannulation in LIJV guided by ultrasound with the LOAX approach with variable angulation provides very good results, allows visualization of the needle and the vascular structures at the same time, and reduces the number of manoeuvers required for placement and complications that might arise.

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“…According to our results, the number of attempts for dilator insertion was significantly higher in patients in the ipsilateral tilt than the supine position, presumably because the soft tissue of the patients would be shifted ipsilaterally to operator’s side by tilting the operating table in patients in the ipsilateral position. The use of excessive force to achieve dilator insertion and repeated attempts to insert the dilator can cause serious vessel injuries [ 30 – 32 ]. Moreover, although we did not observe any other significant difference in procedure-related variables between the groups, the ipsilateral position might negatively affect the number of needling or guidewire insertion as well.…”

Section: Discussionmentioning

confidence: 99%

Effects of ipsilateral tilt position on the cross-sectional area of the subclavian vein and the clinical performance of subclavian vein catheterization: a prospective randomized trial

et al. 2020

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Background: The cross-sectional area of the subclavian vein (csSCV) is a crucial factor in the successful catheterization of the subclavian vein. This randomized controlled study investigated the effects of the csSCV on landmark-based subclavian vein catheterization. Methods: This study was performed using a two-stage protocol. During stage I, the csSCV was measured in 17 patients placed in the supine, 20°ipsilateral tilt, and 20°contralateral tilt positions in a random order. During stage II, landmark-based subclavian vein catheterization was randomly performed in patients placed in either the supine (group S, n = 107) or the ipsilateral tilt (group I, n = 109) position. The primary outcome measure was the csSCV in stage I and the primary venipuncture success rate in stage II. Secondary outcome measures were the time to successful venipuncture, the total catheterization time, the first-pass success rate, and the incidence of mechanical complications during catheterization. Results: The csSCV was significantly larger in the ipsilateral tilt than in either the supine or contralateral tilt position (1.01 ± 0.35 vs. 0.84 ± 0.32 and 0.51 ± 0.26 cm 2 , P = .006 and < .001, respectively). The primary venipuncture success rate did not differ significantly between the group S and I (57.0 vs. 64.2%, P = .344). There were also no significant differences in the secondary outcome measures of the two groups. Conclusions: The csSCV was significantly larger in patients placed in the ipsilateral tilt than in the supine position, but the difference did not result in better clinical performance of landmark-based subclavian vein catheterization. Trial registration: NCT03296735 for stage I (ClinicalTrials.gov, September 28, 2017) and NCT03303274 for stage II (ClinicalTrials.gov, October 6, 2017).

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Central Venous Catheter Placement in the Left Internal Jugular Vein Complicated by Perforation of the Left Brachiocephalic Vein and Massive Hemothorax

Cited by 14 publications

References 10 publications

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

Ultrasound‐guided left internal jugular vein cannulation: Advantages of a lateral oblique axis approach

Effects of ipsilateral tilt position on the cross-sectional area of the subclavian vein and the clinical performance of subclavian vein catheterization: a prospective randomized trial

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