Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report

Kim, Jeongeun; Jeon, Joonpyo; Kim, Yong-Suk; Jeong, Su Ah; Moon, Young Eun

doi:10.4097/kjae.2014.66.4.306

Cited by 3 publications

(2 citation statements)

References 12 publications

(12 reference statements)

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“…Hematoma, pseudoaneurysm Pleura/lung 11,12 Pneumothorax, hemothorax Thoracic duct 13,14 Cutaneous chyle leak Stellate ganglion 15,16 Horner syndrome…”

Section: Injured Structure Complicationsmentioning

confidence: 99%

“…Although ultrasound guidance during cannulation of the internal jugular vein (IJV) has greatly reduced the risk of inadvertent needle tip injury to the carotid artery, double-wall puncture (DWP) of this vein still occasionally results in injury to other, less-ultrasound-visible subjacent anatomic structures (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Superficial anatomic landmark-guided IJV cannulation was associated with a DWP rate of approximately 50%. 17 Adoption of ultrasound guidance reduced this rate to 17% to 20%.…”

Section: Introductionmentioning

confidence: 99%

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Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients

Riopelle,

Kozmenko,

Wyche

et al. 2023

TOJ

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Background: During internal jugular vein (IJV) cannulation, needle tip injury to vulnerable subjacent cervical anatomic structures can be prevented if the cannulating needle tip is not permitted, even momentarily, to penetrate the deep portion of the IJV wall, an event known as double-wall puncture (DWP), also called posterior wall puncture. Methods: We conducted a 6-year ultrasound-guided IJV cannulation quality improvement project, seeking to minimize the occurrence of DWP in 228 adult patients using needles of different gauge and tip sharpness. Most needles were length-optimized to the distance between the skin puncture site and the IJV mid-lumen for a selected angle of needle insertion by (1) using a nylon screw-on needle stop or (2) using a cannulating needle that already had the desired shaft length. Results: Standard central venous cannulation kit needles were long enough to reach or traverse the deepest portion of the IJV wall in nearly all patients. Use of extra-sharp, smaller-diameter needles in place of standard needles was associated with a 26.3% relative reduction in DWP rate. Use of needles length-optimized to reach only the IJV mid-lumen was associated with a 78.4% relative reduction in DWP rate. A 0% DWP rate was attained using length-optimized 21-gauge extra-sharp needles and lengthoptimized 20-gauge needles of intermediate sharpness. Conclusion:The 9.2% DWP rate achieved during this project was approximately half the rate reported at the time of project inception. Use of length-optimized, sharper, narrower-gauge cannulating needles may help avoid DWP during ultrasound-guided IJV cannulation.

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“…Hematoma, pseudoaneurysm Pleura/lung 11,12 Pneumothorax, hemothorax Thoracic duct 13,14 Cutaneous chyle leak Stellate ganglion 15,16 Horner syndrome…”

Section: Injured Structure Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients

Riopelle,

Kozmenko,

Wyche

et al. 2023

TOJ

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Management of venous perforation during central venous catheterization in hemodialysis patients

De-jun²,

Wang³

et al. 2019

Medicine

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Rationale: In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage. Patients concerns: Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis. Diagnoses: Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed. Interventions: In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed. Outcome: In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained. Lessons: When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.

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Thoracoscopic purse-string suture technique for managing superior vena caval impalement from central venous catheterization

Liu

Lee²,

Hsieh³

et al. 2017

J Trauma Acute Care Surg

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Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report

Cited by 3 publications

References 12 publications

Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients

Lower Double-Wall Puncture Rate During Ultrasound-Guided Internal Jugular Vein Cannulation Using Sharper, Narrower-Gauge, and/or Length-Optimized Needles: A 6-Year Quality Improvement Clinical Series in Adult Patients

Management of venous perforation during central venous catheterization in hemodialysis patients

Thoracoscopic purse-string suture technique for managing superior vena caval impalement from central venous catheterization

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