Choice of Route for Central Venous Cannulation: Subclavian or Internal Jugular Vein? A Prospective Randomized Study

Kaiser, C; Koornick, Alan R.; Smith, Noelle B.; Soroff, Harry S.

doi:10.1016/s0022-5347(17)53811-2

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…Catheter misplacement occurs in 19% of internal jugular vein and 16% of subclavian vein cannulations [17]. Following internal jugular cannulation, the most common complication is inadvertent puncture of the internal carotid artery [18] occurring in 10% of procedures (Fig 3).…”

Section: Pulmonary Artery Cathetermentioning

confidence: 99%

Radiology in the Intensive Care Unit (Part I)

Trotman‐Dickenson

2003

J Intensive Care Med

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The increasing complexity of the intensive care patient combined with the recent advances in imaging technology has generated a new perspective on intensive care radiology. The purpose of this 2-part review article is to describe the contribution of radiology to the management of these critically ill patients. The first article will discuss the impact of picture archiving and communication system (PACS) on critical care management and utility of the portable chest radiograph in the detection and evaluation of pulmonary disease with correlation to computed tomography (CT). The second article describes in more detail the increasing role of CT in diagnosis and therapeutic procedures. In particular, the implementation of CT pulmonary angiography in the evaluation of pulmonary emboli and the introduction of the new multislice detector CT scanners that allow even the most dyspneic patient to be evaluated. Pleural complications in the intensive care unit and image-guided intervention will also be discussed.

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Section: Pulmonary Artery Cathetermentioning

confidence: 99%

Radiology in the Intensive Care Unit (Part I)

Trotman‐Dickenson

2003

J Intensive Care Med

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“…They have stated that jugular access was reported to have lesser catheter malposition. 9,12,13,14,15 Peres et al, disagreed with the results of Luyt and Reusch studies and found that malposition was 18.97% with IJV but 33.6% with SCV which was significant (P0.01) however, pneumothorax was nil in both groups. 9 McGee, et al, investigated if the use of 16cm central venous catheters minimized intracardiac placements.…”

Section: Resultsmentioning

confidence: 86%

Chances of Pneumothorax and Malpositioning of Central Venous Catheters in Internal Jugular Vein Versus Subclavian Vein Routes

Saeed

2020

Proceedings

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Introduction: Central venous catheterization (CVC) is being done all over the world. It has specific indications and should be reserved for the patient who has the potential to benefit from it. Catheter related infections are an important cause of morbidity and mortality worldwide. All complications and side effects are dependent on vascular access route. International data shows malpositioning and pneumothorax related to malpositioning to be the most common complications of central venous cannulation. However there is paucity of local data regarding which of the two, IJV or SCV routes are more prone to develop these complications. Aims & Objectives: To compare the incidence of pneumothorax and malpositioning with internal jugular vein (IJV) and subclavian vein (SCV) routes of central venous catheters. Place and duration of study: This randomized control trial was conducted at Department of Anesthesia, Shaikh Zayed Hospital, Lahore, from 8-12-2014 to 7-6-2015. Material & Methods: The non-probability purposive sampling technique was used in this study. After the approval of Hospital Ethical Committee, 290 patients were included in this study and informed consent was obtained. Demographic profile was also obtained. Patients were randomly divided in two groups by using lottery method. In Group A, CVC was inserted through internal jugular vein while in Group B, CVC was inserted through subclavian vein. During the procedure, malpositioning and pneumothorax were monitored immediately and after 36 hours and were labeled. Patients were shifted to the ward after procedure and were followed-up there. During first 36 hours, chest x-ray for placement of tip of catheter and development of pneumothorax was carried out. Chi-square was used to compare complications in both groups taking p value <0.05 as significant. Results: Malposition was found in 18 cases, (6 from IJV group and 12 from SCV group) (p-value 0.144). Pneumothorax was seen in 12 cases (3 from IJV and 9 from SCV group) (p-value 0.077). Conclusion: Our study results concluded that IJV showed fewer incidences of pneumothorax and malpositioning than SCV technique. However, the difference was not statistically significant.

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“…Pneumothorax has been reported as a complication of central venous line insertion with an incidence of 0% to 6.6%, especially in emergency insertions, using large catheters and multiple needle passes. 2 Most studies have found a predominance with subclavian vein cannulation, while other studies have found internal jugular vein access to be associated with developing pneumothorax. 2 , 5 , 6 , 7 A Canadian study from 2002 to 2015 found a 1.7% incidence of pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…However, we and others have independently observed hospitalizations associated with pneumothoraces and pneumomediastinum that appeared incompletely or inadequately explained by the more typical barotrauma or iatrogenic causes including central venous line insertions. 1 , 2 …”

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confidence: 99%

Pneumothorax and Pneumomediastinum in COVID-19 Suggest a Pneumocystic Pathology

Jamil

Alam

Youssef

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To determine whether the apparent excess incidence of pneumothorax and pneumomediastinum in patients with coronavirus disease 2019 (COVID-19) is explained adequately by iatrogenic causes vs reflecting sequelae of severe acute respiratory syndrome coronavirus 2 infection. Patients and Methods We retrospectively reviewed patients within our health care system from March 15, 2020, through May 31, 2020, who had a diagnosis of pneumothorax or pneumomediastinum during hospitalization for confirmed COVID-19 infection with attention to timing of pneumothorax and pneumomediastinum; presence, laterality, and placement, or attempts at central lines; and presence of mechanical ventilation before the event. Results We report clinical data and outcomes from 9 hospitalized patients with COVID-19 who developed pneumothorax and/or pneumomediastinum among more than 1200 hospitalized patients admitted within our hospital system early in the pandemic. Many events were inexplicable by iatrogenic needle injury, including 1 spontaneous case without central line access or mechanical ventilation. One occurred before central line placement, 2 in patients with only a peripherally inserted central line, and 1 contralateral to a classic central line. Three of these 9 patients died of complications of COVID-19 during their hospital stay. Conclusion With COVID-19 affecting the peripheral lung pneumocytes, patients are vulnerable to develop pneumothorax or pneumomediastinum irrespective of their central line access site. We hypothesize that COVID-19 hyperinflammation, coupled with the viral tropism that includes avid involvement of peripheral lung pneumocytes, induces a predisposition to peripheral bronchoalveolar communication and consequent viral hyperinflammatory-triggered pneumothorax and pneumomediastinum.

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Choice of Route for Central Venous Cannulation: Subclavian or Internal Jugular Vein? A Prospective Randomized Study

Cited by 4 publications

References 15 publications

Radiology in the Intensive Care Unit (Part I)

Radiology in the Intensive Care Unit (Part I)

Chances of Pneumothorax and Malpositioning of Central Venous Catheters in Internal Jugular Vein Versus Subclavian Vein Routes

Pneumothorax and Pneumomediastinum in COVID-19 Suggest a Pneumocystic Pathology

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