Late Cardiac Tamponade in Adults Secondary to Tip Position in the Right Atrium: An Urban Legend? A Systematic Review of the Literature

Pittiruti, Mauro; Lamperti, Massimo

doi:10.1053/j.jvca.2014.05.020

Cited by 41 publications

(48 citation statements)

References 39 publications

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“…Thus, the sensitivity of CVC malposition detection by ultrasound as reported by Meggiolaro et al is slightly higher than that used in this meta-analysis (64% compared to 53%). Given recent literature regarding the safety of the intra-atrial position (56–58), perhaps the definition of correct catheter positioning should be reevaluated. Most of the other included studies reported catheter malposition in aggregate and did not distinguish between intra-atrial catheter positioning and other types of malposition.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Ablordeppey

Drewry

Beyer

et al. 2017

Critical Care Medicine

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Objective We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared to chest radiography. Data Sources PubMed, EMBASE, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov Study Selection Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2×2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, inter-rater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Data Extraction Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Data Synthesis 15 studies with 1553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 [0.77, 0.86] and 0.98 [0.97, 0.99] respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 [14.72, 65.78] and 0.25 [0.13, 0.47]. The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Conclusions Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Ablordeppey

Drewry

Beyer

et al. 2017

Critical Care Medicine

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“…The risk is, however, extremely small, with a review by Pittiruti et al. identifying no cases of CVC‐associated late cardiac tamponade in adults between 1999 and 2014 . Because the incidence of complications from CVC tip malpositioning ‘too low’ is so rare, and because our overall net rate of malpositioning decreased, we suggest that the overall effect of our intervention is probably a net reduction in risk related to CVC tip malpositioning.…”

Section: Discussionmentioning

confidence: 79%

A checklist to improve the quality of central venous catheter tip positioning

2019

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Central venous catheter insertion is a routine procedure performed by anaesthetists in the peri-operative setting. Upper body central venous catheters are usually placed such that their tip lies within the superior vena cava or at the cavo-atrial junction. Positioning the tip 'too low' in the right atrium has long been argued against on the basis that it increases the risk of perforation, leading to cardiac tamponade. Positioning the tip 'too high' in the brachiocephalic vein or above can also be problematic in that proximal migration can result in extravascular placement of the proximal lumen. Such an incident occurred at our hospital in 2016, resulting in extravasation of a vesicant medication causing tissue necrosis. We undertook a quality improvement project involving a standardised bundle of care and a peri-operative central venous catheter insertion checklist with the aim of reducing the risk of such an incident re-occurring. We conducted a three-month pre-intervention audit (n = 84) in 2016 and a post-intervention audit (n = 84) in 2017. Compared with the pre-intervention audit, the post-intervention audit coincided with a lower rate of central venous catheter tip malpositioning (5.6% vs. 9.2%); and a higher rate of 'optimal' central venous catheter tip position in the distal superior vena cava or cavo-atrial junction (45.1% vs. 29.2%). The central venous catheter insertion checklist also substantially improved documentation of sterility measures, insertion depth and post-insertional documentation of tip position on chest radiograph.

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“…Internal migration deeper into the vessel can also occur with risks of atrial rupture, resulting in cardiac tamponade and death. 28 An effective securement device minimizes all such movements and all angles. Many devices available today are successful at securing the catheter hub from small repeated movements, but they are less capable of preventing dislodgment when the catheter is subjected to a sudden, high-impact force.…”

Section: Discussionmentioning

confidence: 99%

Catheter Securement Systems for Peripherally Inserted and Nontunneled Central Vascular Access Devices

Krenik

Smith

Bernatchez

2016

Journal of Infusion Nursing

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Sutureless catheter securement systems are intended to eliminate risks associated with sutures. The clinical acceptability of a novel system was investigated compared with the current method of securement for peripherally inserted central catheters (19 facilities using StatLock or sutures) or nontunneled central vascular access devices (3 facilities using StatLock or sutures or HubGuard + Sorbaview Shield). More than 94% of respondents rated the novel system as same, better, or much better than their current product. More than 82% of respondents were willing to replace their current system with the new one.

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Late Cardiac Tamponade in Adults Secondary to Tip Position in the Right Atrium: An Urban Legend? A Systematic Review of the Literature

Cited by 41 publications

References 39 publications

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis

A checklist to improve the quality of central venous catheter tip positioning

Catheter Securement Systems for Peripherally Inserted and Nontunneled Central Vascular Access Devices

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