Evaluation of Formulas for Optimal Positioning of Central Venous Catheters

Czepizak, Christine A.; O’Callaghan, James M.; Venus, Bahman

doi:10.1378/chest.107.6.1662

Cited by 102 publications

(83 citation statements)

References 23 publications

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“…Perhaps unsurprisingly, because of this anatomical difference, right-SCV catheterization has been reported to be associated with a higher rate of malpositioning than left-SCV catheterization [7,8,9]. On the other hand, the right BCV joins the superior vena cava at a more obtuse angle than the left BCV, whereas the route from the right SCV to the cavoatrial junction is shorter and less tortuous than the route from the left SCV [10,11,12]. This may explain the belief that catheter-related venous thrombosis is less likely to occur with right- compared with left-SCV catheterization in central venous access [13].…”

Section: Introductionmentioning

confidence: 99%

Right- and Left-Subclavian Vein Port-A-Cath Systems: Comparison of Complications

Tsai

Ku²,

Chen³

et al. 2012

Eur Surg Res

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Background: Central venous access systems are frequently used for delivery of medications; however, few studies have compared surgical and postoperative complications of right versus left access via the subclavian vein (SCV). The aim of this study was to compare the surgical and postoperative complications associated with Port-A-Cath system insertion via the right and left SCV. Methods: The medical records of patients who received Port-A-Cath insertion via the SCV for parenteral chemotherapy between August 2004 and July 2008 were reviewed. The incidence of surgical and postoperative complications was compared between patients who received right- versus left-SCV Port-A-Cath insertion. Results: A total of 1,848 patients were included in the study. Right-SCV catheterization was attempted in 1,029 (55.7%) patients and was successful in 866 (84.2%). Left-SCV catheterization was attempted in 819 (44.3%) patients and was successful in 651 (79.5%). The mean length of postoperative follow-up was 417.3 ± 401.3 and 396.7 ± 379.9 days for the right- and left-SCV groups, respectively. The incidence of SCV puncture failure was significantly lower in the right-SCV group (12.3%) compared with the left-SCV group (16.8%, p = 0.006). The incidence of catheter knotting at the ipsilateral brachiocephalic vein was also significantly lower in the right-SCV group (0.0%) compared with the left-SCV group (0.5%, p = 0.038), as was the incidence of catheter occlusion (1.0% for right SCV vs. 3.5% for left SCV, p = 0.001). Conclusion: These findings suggest that the right-SCV approach is superior to the left-SCV approach for Port-A-Cath insertion.

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Section: Introductionmentioning

confidence: 99%

Right- and Left-Subclavian Vein Port-A-Cath Systems: Comparison of Complications

Tsai

Ku²,

Chen³

et al. 2012

Eur Surg Res

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“…-La punta del catéter localizado en la aurícula daña el endocardio en forma progresiva con cada contracción auricular, posteriormente la punta es fijada a través de un trombo (1,15,17); raramente la punta es atrapada por los pilares del corazón. Posteriormente, el catéter lentamente necrosa la pared auricular; esto es más frecuente en cavidades distendidas o con infiltración grasa (15).…”

Section: Discusionunclassified

“…-El catéter localizado (y previamente fijado) en vena cava, migra varios centímetros con los movimientos del cuello: 2-6cm (16), cabeza 2-6cm (1,15) y brazos: 2-3cm (6); pudiendo punzar la vena cava o cualquier otra pared al desplazarse a través de la aurícula derecha, del ventrículo derecho o de la arteria pulmonar (13,17,18).…”

Section: Discusionunclassified

“…Una presión de infusión entre 15 y 20 cm de H 2 0 2 una inyección rápida de contraste (15), la irritación repetida de soluciones hiperosmolares (19), la guía metálica, el dilatador o la sobreinserción de un catéter de cola rígida puede dañar o perforar la pared del vaso o del corazón (17).…”

Section: Discusionunclassified

“…En otras series el intervalo de tiempo entre la inserción del catéter y el inicio de los síntomas de taponamiento es de minutos a días con un promedio de 60 horas (15,17). El cuadro clínico descrito es cianosis súbita, engrosamiento de las venas de la cara y del cuello, náuseas, disnea, dolor retroesternal o epigástrico, ansiedad, confusión y coma (15).…”

Section: Discusionunclassified

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Cateterismo venoso central y perforación de miocardio. Presentación de un caso.

Villavicencio¹,

Hurtado²

2013

Rev Med Hered

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SUMMARYThe use of central venous catheters has a wide use in our hospitals, but it is not exempt from complications. We report a 18 years old woman who had one of this life involved complication. The patient died and necropsy she was diagnosed as follow: perforation of miocardium and pericardial tamponade. The possible mechanism of perforation it was a gradual form which has several causes. It is very important to understand the different forms of perforation and also to evaluate frequently every central venous catheter to prevent all these fatal ocurrences. ( Rev Med Hered 1998; 9:119-122 ). INTRODUCCIONEl uso del catéter endovenoso tanto para la administración de fluídos como para el monitoreo de la Presión Venosa Central, tiene gran aceptación en nuestro medio. Sin embargo no está exento de complicaciones, siendo las más severas: la laceración y penetración de la pared del miocardio (1), y el taponamiento pericárdico por perforación del miocardio (2).Cuando una vena central es caracterizada, al desplazar la punta del catéter, ésta puede perforar la vena a cualquier nivel e independientemente del lugar desde donde se localice el otro extremo.De ocurrir este evento podría producirse un hidromediastino, un hidrotórax o más grave aún un taponamiento pericárdico (3). En la cateterización cardiaca la punta del catéter cruza las cámaras cardíacas, existiendo también riesgo de perforación de perforación con posterior taponamiento pericárdico, o de inducción de arritmias (4). Aún después que el catéter haya sido colocado y fijado adecuadamente, la punta del catéter puede ser movilizada y/o desplazada durante: el movimiento de la extremidad contigua, durante la rotación del cuerpo respecto a dicha extremidad, durante el movimiento de cuello (5), o durante el masaje cardiaco (6); durante estos movimientos la punta del catéter entra en forma repetida en contacto con la pared del vaso y/o del miocardio pudiendo producir la perforación de cualquiera de éstas.A continuación reportamos un paciente que presentó una de estas complicaciones.COMUNICACION CORTA

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Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children

Yang

Kong

Liu

et al. 2020

Clinical Cardiology

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A totally implantable venous access port (TIVAP) is important in children who need intravenous infusion for a long time. A number of studies have shown methods for locating the tip of the TIVAP catheter. To explore whether transesophageal echocardiography (TEE) can be used to accurately locate the TIVAP catheter tip through a subclavian approach and to improve the rate of correct TIVAP catheter placement and reduce complications of TIVAP placement. In 36 children who needed TIVAP implantation surgery, we used real‐time TEE guidance to place the catheter tip around the crista terminalis. In all children, chest X‐rays were used to figure out whether the catheter tip as localized by TEE was within the T5‐T7 segment. Then, we compared the length of the catheter calculated by the height formula and the actual catheter length applied under TEE guidance. The medical records, surgical details, nursing records, and recorded complications were collected during the follow‐up. The success rate of TIVAP implantation was 100% in all enrolled patients and no hemopneumothorax or pinch‐off syndrome occurred. Compared with TEE, chest X‐ray showed a coincidence rate of 80.56% in correctly detecting the TIVAP catheter tip locate. The height‐derived catheter length (11.0 [9.6, 11.8]) cm and the TEE‐derived catheter length (10.0 [9.3, 10.8]) cm were significantly different (p < .001). TEE can be used to guide TIVAP catheter positioning through a left subclavian approach in children accurately and successfully and more accurate than chest X‐ray and height calculation formula.

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Evaluation of Formulas for Optimal Positioning of Central Venous Catheters

Cited by 102 publications

References 23 publications

Right- and Left-Subclavian Vein Port-A-Cath Systems: Comparison of Complications

Right- and Left-Subclavian Vein Port-A-Cath Systems: Comparison of Complications

Cateterismo venoso central y perforación de miocardio. Presentación de un caso.

Application of transesophageal echocardiography for localization in totally implantable venous access port implantation through subclavian approach in children

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