Imaging Approach to Misplaced Central Venous Catheters

Raptis, Demetrios A.; Neal, Kevin; Bhalla, Sanjeev

doi:10.1016/j.rcl.2019.08.011

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…It is crucial for the nursing team to thoroughly evaluate the vessel before surgery to prevent potential intravascular complications[ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein: A case report

Zhu,

Zhao,

Peng

et al. 2024

World J Clin Cases

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BACKGROUND Peripherally inserted central catheters (PICCs) are an essential infusion route for oncology patients receiving intravenous treatments, but lower extremity venipuncture is the preferred technique for patients with superior vena cava syndrome (SVCS). We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein, to indicate and verify PICC catheterisation in the lower extremity is safe and feasible. And hope to provide different perspectives for clinical PICC venipuncture to get the attention of peers. CASE SUMMARY On 24 August 2022, a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month, which worsened 10 d prior. Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS. Chemotherapy was not an absolute contraindication in this patient. Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head, neck, and upper extremities. The patient and his family were informed about the procedure, and informed consent was obtained. After successful puncture and prompt treatment, the patient was discharged, experiencing some relief from symptoms. CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS, particularly in complex situations involving ectopic placement.

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“…It is crucial for the nursing team to thoroughly evaluate the vessel before surgery to prevent potential intravascular complications[ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein: A case report

Zhu,

Zhao,

Peng

et al. 2024

World J Clin Cases

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“…Often, this malposition is recognized through a distinctive curve or notching of the catheter as it enters in the internal mammary vein. 6 For this reason, A-P projection alone is not sufficient to avoid image summation artifacts and a latero-lateral (L-L) projection could be recommended, but it is often unfeasible at the bedside.…”

Section: Discussionmentioning

confidence: 99%

“…Filippo Pelagatti 1 and Fulvio Pinelli 2 The Journal of Vascular Access 24 (6) For this reason, a new CICC in the left internal jugular vein was eventually correctly positioned.…”

Section: Time To Abandon Chest X-rays In Favor Of Intracavitary Ecg O...mentioning

confidence: 99%

Time to abandon chest X-rays in favor of intracavitary ECG or echocardiography for central venous access tip location: A case of a malpositioned CICC into the internal mammary vein

Pelagatti¹,

Pinelli

2022

J Vasc Access

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Central vascular access devices (CVADs) correct tip location is of paramount importance to avoid malposition related complications. Despite recent guidelines recommend avoiding postprocedure radiograph in favor of alternative tip location technology, chest X-rays are still widely used in clinical practice as a CVADs tip location method. We present a clinical case of a central inserted central catheter (CICC) malposition in the right internal mammary vein, erroneously interpreted by chest X-rays as correctly placed, in a critically ill patient.

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“…10,23 The other veri cation methods -transthoracic echocardiography with its known limitations, and bedside chest X-ray -are post-hoc techniques the results of which are available normally only after nishing the placement procedure. 24,25 One of the tasks of postprocedural chest X-rays is to assess mechanical complications and malpositions; 9,25 another is to verify the course of catheters and their tips when other methods are not available or have failed. 9,25 Simple calculation formulas do not have a place in the category veri cation technique.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 One of the tasks of postprocedural chest X-rays is to assess mechanical complications and malpositions; 9,25 another is to verify the course of catheters and their tips when other methods are not available or have failed. 9,25 Simple calculation formulas do not have a place in the category veri cation technique. They provide us only with a long guess ahead of catheter placement.…”

Section: Discussionmentioning

confidence: 99%

Siting central venous catheters precisely by means of the ECG method - A Reliability Study

Schummer¹

2022

Preprint

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Introduction: For central venous catheters (CVC) to function properly, optimal tip location is of utmost importance. One technique to verify CVC position is the ECG method. Nowadays, the ECG method is applied using the maximum P-wave amplitude (P-max). The hypothesis is that a method believed to be precise in assessing CVC position can provide the same results for CVC tip positions regardless of their respective insertion sites. Methods: Only critically ill patients with multiple organ dysfunction were eligible for the study. Another condition was a prerequisite for reliable illustration of the results, i.e. at least two central venous lines had to be in place. All catheters were placed using the ECG method with the CVC tip at P-max. In all patients, a chest X-ray was performed within 24 hours of line insertion to assess the CVC positions. Results: Between January 2018 and December 2020, 51 critically ill patients with more than one CVC concurrently in place were deemed eligible and were included in the study. The distance between the inserted CVC tips was measured using the picture archiving and communication system (PACS). Across 51 patients, the mean difference between the two central lines inserted was 0.31 cm. The median was 0.00 cm, indicating that more than half of the sample exhibited no difference in positioning. Conclusion: The ECG method of placing the CVC tip at P-max is a stable and reliable bedside method for positioning CVCs as the results for double CVCs impressively underline and it already works during the access procedure. However, the results demand confirmation in further studies.

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Imaging Approach to Misplaced Central Venous Catheters

Cited by 5 publications

References 18 publications

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein: A case report

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein: A case report

Time to abandon chest X-rays in favor of intracavitary ECG or echocardiography for central venous access tip location: A case of a malpositioned CICC into the internal mammary vein

Siting central venous catheters precisely by means of the ECG method - A Reliability Study

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