Complication Of Central Venous Cannulation Research Articles

Hemiplegia Following Fluid Administration Through an Implanted Venous Access Device: A Case Report.

IntroductionMany patients seen in the emergency department (ED) have central venous access placed or previously established placement. Catheters inadvertently placed in the arterial circulation may lead to complications or adverse events.Case ReportWe present a case of hemiplegia in a 63-year-old man following intravenous fluid administration through a malpositioned catheter that was initially unrecognized. The patient initially presented to the ED for stroke-like symptoms and was discharged following workup. On a subsequent visit for similar symptoms, intra-arterial placement of the catheter was diagnosed.ConclusionIt is important for emergency physicians to be aware of this potential complication of central venous cannulation and that arterial malposition of a previously placed central line may go unrecognized with the potential to cause cerebral ischemia when cerebral blood flow is reduced by the infusion of intravenous fluids or medications.

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

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.

Effect of head pillow and shoulder roll on diameter of the right internal jugular vein

Background: Right internal jugular vein (RIJV) is the most commonly used site for central venous cannulation. Ultrasound guidance has increased success rate and reduced complications of central venous cannulation. The main aim before cannulation is to increase the size of the vein by optimal positioning. We used ultrasound to assess changes in right internal jugular diameter with use of a head pillow and shoulder roll and their effect on the degree of overlap between RIJV and carotid. Methodology: 106 patients were recruited in the study. After intubation the patients were placed in the following 3 positions (i) P1 -without head pillow or shoulder roll, (ii) P2 - with head pillow and (iii) P3- with shoulder roll. All measurements were made in 15 degree Trendelenberg tilt and head turned to the left by 30 degree. The following measurements were recorded in all 3 positions. (a) Transverse and Antero-Posterior diameter of the RIJV. (b) Transverse diameter of the right carotid. (c) Overlap between RIJV and carotid. Results: In our study the mean transverse diameter of RIJV was 1.87cm in P1 and P2 and 1.72 cm in P3respectively. The mean antero-posterior diameter was 1.39cm, 1.37cm and 1.13 cm in P1, P2 and P3 respectively. The increase in diameter in P1 was statistically significant (P Conclusion: We conclude that placing the patient supine in 15 degree Trendelenberg tilt and a30 degree head rotation to the opposite side with or without use of a head pillow would lead to greater chance of first pass success during R IJV cannulation as the diameter was found to be maximum in this position. We do not recommend use of a shoulder roll as there was significant reduction in diameter though the overlap between RIJV and carotid was found to be minimal. Use of ultrasound and proper positioning of the patient will reduce the possible catastrophic complications associated with RIJV cannulation.

1176: IMMEDIATE COMPLICATIONS OF CVC INSERTIONS: FEASIBILITY PILOT OF A UK NATIONAL AUDIT (ICNAP)

Wong, Adrian; Arora, Nitin; Olusanya, Olusegun; Sharif, Ben; Lundin, Robert; Clark, Sam; Dhadda, Amrit; Szakmany, Tamas

Accidentally Missed Guidewire during Insertion of a Dialysis Catheter

Missed guidewire is a rare and potentially avoidable complication of central venous cannulation. Unsupervised insertion by trainees, distraction during insertion, and high workload may increase the risk. Simple measures such as holding onto the wire at all times until removal from the vessel, routine use of central venous catheter insertion checklist, and vigilant supervision of the trainees may help prevent missing of the guidewire.

Vascular Complications of Central Venous Catheter Placement: Evidence-Based Methods for Prevention and Treatment

PRACTITIONERS, MANUFACTURERS, AND REGULATORY AGENCIES have long regarded central venous catheters (CVCs) as relatively dangerous, problem-prone devices. Recent attention has been focused primarily on reduction of infectious complications of CVCs. Application of strict aseptic precautions (the so-called “central-line bundle”) when placing CVCs effectively has reduced the incidence of catheter-related infection, 1 Hewlett A.L. Rupp M.E. New developments in the prevention of intravascular catheter associated infections. Infect Dis Clin North Am. 2012; 26: 1-11 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar and Medicare no longer reimburses for costs related to these infections. 2 Hoff T.J. Soerensen C. No payment for preventable complications: Reviewing the early literature for content, guidance, and impressions. Qual Manag Health Care. 2011; 20: 62-75 Crossref PubMed Scopus (11) Google Scholar However, mechanical complications of central venous cannulation remain a significant cause of morbidity and mortality. Data from the American Society of Anesthesiologists Closed Claims Project database have suggested that since 1990, the majority of mechanical complications associated with CVCs are vascular injuries, 3 Domino K.B. Bowdle T.A. Posner K.L. et al. Injuries and liability related to central vascular catheters: A closed claims analysis. Anesthesiology. 2004; 100: 1411-1418 Crossref PubMed Scopus (204) Google Scholar and “accidental puncture or laceration” is a reportable National Quality Measures Patient Safety Indicator. 4 Agency for Healthcare Research and Quality (AHRQ): National Quality Measures C. Accidental puncture or laceration (provider-level): Rate per 1,000 discharges. Available at: http://www.qualitymeasures.ahrq.gov/content.aspx?id=38525. Accessed March 21, 2013 Google Scholar Fortunately, most vascular injuries from CVCs should be preventable

Indigenous Device for Intra-atrial ECG-Guided Central Venous Catheter Placement

Central venous catheters (CVCs) are frequently inserted in the operating room or the intensive care unit (ICU) for fluid management and haemodynamic monitoring. There are two main concerns during central venous catheterization. One is to locate and cannulate the vein rapidly and safely, avoiding accidental arterial puncture and acute pleuropulmonary complications (such as pneumothorax). Another is correct positioning of the catheter tip. Accurate placement of the catheter tip is not easy, and malpositions are a frequent complication of central venous cannulation. The ultrasoundguided CVC insertion provide visualization of vein and its anatomical variations, improves the success rate1 and decrease the number of venipuncture attempts and complications associated with it but does not guide the subsequent correct positioning of catheter tip. Different methods have been advocated for guidance of correct positioning of the catheter tip because incorrect CVC position can be associated with serious adverse effects2 like cardiac tamponade, malignant arrhythmias, placement in coronary sinus and tricuspid valve. The accurate length of the catheter to be inserted, can be estimated by anatomical landmarks3 or by ready-to-use algorhythms, radiological methods4 (intraoperative fluoroscopy or postoperative chest radiography), electrocardiographic (ECG) methods, echocardiographic5,6 methods (standard or transesophageal echocardiography). Intra-atrial ECG (IAECG) guidance is a simple, inexpensive, and safe method which can be used for this purpose. Although ECG guidance for CVC positioning was suggested in 1949 with several7-9 studies indicating the usefulness of the technique, this is not widely used. It could be due to the non availability of the device used for IAECG monitoring. This is an electrical switching device for alternating between the skin lead and intra-atrial lead. Here, we are reporting an indigenous device for the IAECG which can be used in place of the devices supplied by the various manufacturers, like Certodyn Universal Adaptor (B Braun Melsungen, Germany) or Tyco/Arbo VIDM-P73 complete cable.

Unusual right internal jugular vein catheter malposition into the right axillary vein: A rare case report

One of disastrous complications of central venous cannulation (CVC) is malposition of central venous catheter. In this case report, we present an adult patient with history of multiple trauma and intracranial hemorrhage in whom the right axillary vein was accidentally cannulated during CVC insertion.

Posterior Glenohumeral Joint Dislocation: A Rare Complication of Central Venous Cannulation in a Patient Undergoing Coronary Artery Surgery

CENTRAL VENOUS CATHETERS are placed routinely for fluid administration and hemodynamic monitoring in patients undergoing cardiac surgery. Many well-known complications of central venous catheters have been described. The authors describe a patient who suffered a rare orthopedic complication during the placement of a central venous catheter immediately before scheduled coronary artery bypass graft (CABG) surgery.

A giant subclavian pseudoaneurysm following central venous catheterization

Inadvertent iatrogenic injury to an adjacent major artery is a rare but life-threatening complication of central venous cannulation. The present article reports the development of a large right subclavian artery pseudoaneurysm, presented as a rapidly growing mass at the site of injury, following attempted central venous catheterization.

A reply

We would like to thank Drs Jefferson and Ball for their interest in our survey and welcome their comments. Our survey [1] was conducted in the latter half of 2006 over a 5-month period, 4 years after publication of NICE and 6 years after the authors’ survey [2]. We accept that the results from both surveys demonstrate there has been a marked increase in the availability of ultrasound in critical care areas and a subsequent increase in use for placement of central venous catheters. The authors state our survey can be used to compare the use of ultrasound in critical care before and after the NICE recommendations. This is indeed an interesting comparison; however, the authors’ survey was of lead consultants in critical care units and as such responses may have over- or under-estimated the use of ultrasound if lead clinicians were responding to the questionnaire in the context of unit policy and not individual practice. In fact, this criticism was made of our first survey [3] where we sought the opinion of departmental college tutors and this survey was the catalyst for the larger, recently published work which directly questioned individual senior anaesthetists, 23% of whom worked in critical care areas. We would reinforce our view that it is good practice to document the technique used for placement of central venous catheters, as supported by the Royal College of Anaesthetists [4]. This will facilitate audit of complications of central venous cannulation and potentially explore the lack of adoption of NICE guidance where this is present.

Mechanical and Infectious Complications of Central Venous Cannulation in Children: Lessons Learned From a 10-Year Experience Placing More Than 1000 Catheters

We sought to better describe the expected incidence of mechanical and infectious complications associated with central venous cannulation of critically ill children. We undertook a retrospective analysis of a prospective data collection of 1056 consecutive percutaneous central venous catheters inserted under the supervision of an experienced surgeon. There were 245 (23%) subclavian (SC), 118 (11%) internal jugular (IJ), and 693 (66%) femoral (F) catheters placed in 289 children with an average age of 6.4 +/- 5.1 years (range, 4 weeks to 18 years) admitted to a burn intensive care unit. Catheter sepsis occurred in 7.4% of SC, 7.6% of IJ, and 4.9% of F catheters (NS, P = .25), for an overall sepsis rate of 5.8%. The number of catheter lumens did not impact infection rate. Infection rates increased in catheters left in situ more than 10 days, increasing to 37.5% at 14 days. Acute mechanical complications occurred in three insertions (0.3%), including two (0.8%) SC, zero (0%) IJ, and one (0.1%) F catheters (NS, P = .20). All three were arterial cannulations that were recognized and treated successfully without surgery. There were no pneumothoraces, vascular lacerations, acute thromboses, or catheter emboli. There were six (0.6%) cases of deep venous thrombosis that occurred in cannulated sites: one (0.4%) SC, two (1.6.%) IJ, and three (0.4%) F sites (NS, P = .23). Patient age did not influence complication rates. A total of 239 (23%) of the CVCs were placed in infants less than 24 months; 273 (26%) 2 to 5 years, 259 (25%) 6 to 10 years, and 285 (27%) >10 to 18 years. Catheter sepsis occurred in 6.7%, 5.9%, 6.2%, and 4.6%, respectively (NS, P = .75). There was no difference in rates of infection or mechanical complication between younger and older children. When closely supervised by an experienced surgeon, a low rate of infection (5.8%), acute mechanical complication (0.3%), and deep venous thrombosis (0.6%) accompanies central venous cannulation of critically ill children.

Unusual positioning of a central venous catheter

Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.

Diaphragmatic Paralysis after Endovascular Stent Grafting of a Thoracoabdominal Aortic Aneurysm

Diaphragmatic Paralysis after Endovascular Stent Grafting of a Thoracoabdominal Aortic Aneurysm

Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging.

Multi-detector row computed tomographic (CT) angiography is an effective modality for vascular imaging in the thorax. It allows acquisition of high-resolution data sets during a single breath hold, making it the preferred method for evaluation of patients with acute vascular disease. In contrast to conventional angiography, multirow CT angiography not only depicts the vessels but also allows assessment of adjacent structures. Multirow CT angiography with two- and three-dimensional reformation can be used to diagnose vascular emergencies of the thorax after blunt and iatrogenic trauma. These include incomplete and complete aortic rupture; traumatic aortic dissection; arterial dissection and rupture after minor trauma in patients with Ehlers-Danlos syndrome; traumatic intramural hematoma; pseudoaneurysm after endovascular repair; injuries due to Swan-Ganz catheters; complications of central venous cannulation, pacemaker implantation, and percutaneous pericardial drainage; and foreign-body embolism. The diagnoses can be established with multirow CT angiography in the emergency department. Thus, the time to diagnosis can be considerably decreased by obviating conventional angiography. Knowledge of the CT findings in various vascular conditions is essential to make use of multirow CT angiography in combination with two- and three-dimensional reformation as an efficient and accurate diagnostic tool in emergency radiology.

Another neurological complication of central venous cannulation

Another neurological complication of central venous cannulation

Immediate complications of central venous cannulation in ICU

Immediate complications of central venous cannulation in ICU

Central venous cannulation in patients with liver disease and coagulopathy--a prospective audit.

To determine the incidence of vascular complications associated with central venous cannulation in patients with liver disease and coagulopathy. A prospective audit of all cannulation episodes in patients with liver disease and a prothrombin (INR) more than 1.5 and/or platelet count of 150 x 10(9)/l or less. A specialist liver unit between January 1996 and September 1997. Patients with acute or chronic liver diseases and patients undergoing liver transplantation or other hepatobiliary surgery. Vascular complications of central venous cannulation were classified as major (any haemodynamically significant haemorrhage) or minor (superficial oozing or haematoma). We recorded 658 cannulations (subclavian, 352, and internal jugular, 306). The median INR was 2.4 (range 1-16) in the subclavian group and 2.7 (1-17) in the internal jugular group (p < 0.05); median platelet counts were 81 x 10(9)/l (range 9-1088) and 83 x 10(9)/l (10-425), respectively (difference not significant). One patient developed a haemothorax after accidental subclavian artery puncture (INR was 1.5, platelets 68 and regional prostacyclin therapy was being given for haemofiltration). There were no other major vascular complications. Risk factors for minor vascular complications included internal jugular cannulation, more than one needle pass into the vein, failure to pass any guidewire, a high INR and low platelets for haematoma formation, and low platelets and heparin therapy for superficial oozing. The incidence of major vascular complications following central venous cannulation in patients with liver disease and coagulopathy was low in this audit. In liver disease the presence of a raised INR alone should not be considered a contra-indication to central venous cannulation.

Iatrogenic haematoma causing airway obstruction in a burned patient

Haematoma is a rare complication of central venous cannulation. This report describes such a haematoma causing significant airway obstruction in a burned patient, and illustrates the need to be aware of unusual complications of attempted therapy.

Infected right atrial thrombi: a complication of central venous cannulation

We report three cases of infected right thrombi associated with central venous cannulae that required surgical removal to eradicate infection.