Femoral Central Venous Catheter Research Articles

231

Introduction: Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may result in severe complications including infection, deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. We hypothesized that femoral trauma resuscitation CVCs are safer than subclavian trauma resuscitation CVCs. Our primary study objective was to compare life-threatening complications secondary to subclavian versus femoral CVC placement during initial trauma resuscitations. Methods: A retrospective review (2010–2011) at an urban, Level-I Trauma Center revealed 504 subclavian or femoral CVCs placed during initial trauma resuscitations. Demographics and clinical characteristics were analyzed. Measured complications included catheter related DVTs and arterial injuries, along with life-threatening complications including catheter related bloodstream infections, pneumothoraces and PEs. Fisher’s exact test and Student’s t-test compared categorical and continuous variables. A p≤ 0.05 was statistically significant. Results: Overall, 504 CVCs were placed (subclavian, n=259; femoral, n=245). No difference in age (47 ± 22 vs. 45 ± 23 years) or BMI (28 ± 6 vs. 29 ± 16 kg/m2) was detected (p>0.05) in patients who underwent subclavian vs. femoral CVC placement, but those who underwent subclavian CVC placement more often had blunt injuries (81% vs. 69%), had a greater SBP (95 ± 55 vs. 83 ± 43 mmHg) and GCS (10 ± 5 vs. 9 ± 5), and were less likely to have introducer catheters placed (49% vs. 73%) than those with femoral CVC insertion (all p<0.05). While no difference in total attributable complications was detected between subclavian and femoral CVC groups (p=0.184), complications were more often life-threatening in the subclavian (61%) rather than the femoral CVC group (24%, p=0.005). Conclusions: Both subclavian and femoral CVCs were associated with significant complication rates, but attributable life-threatening complications were more common after subclavian CVC placement. Our results suggest that femoral CVC insertion is safer than subclavian CVC insertion during initial trauma resuscitations. Thus, femoral CVC access should be the anatomic site of choice in this clinical scenario.

Simulation Training for Pediatric Residents on Central Venous Catheter Placement

To assess the effect of simulation training on pediatric residents' acquisition and retention of central venous catheter insertion skills. A secondary objective was to assess the effect of simulation training on self-confidence to perform the procedure. Prospective observational pilot study. Single university clinical simulation center. Pediatric residents, postgraduate years 1-3. Residents participated in a 60- to 90-minute ultrasound-guided central venous catheter simulation training session. Video recordings of residents performing simulated femoral central venous catheter insertions were made before (baseline), after, and at 3-month following training. Three blinded expert raters independently scored the performances using a 24-item checklist and 100-mm global rating scale. At each time point, residents rated their confidence to perform the procedure on a 100-mm scale. Twenty-six residents completed the study. Compared with baseline, immediately following training, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 83.3% [interquartile range, 70.0-91.7%]), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 79.5 mm [interquartile range, 16.3-91.7 mm]), success rate (38.5% vs 80.8%), and self-confidence (8.0 mm [interquartile range, 3.8-19.0 mm] vs 52.0 mm [interquartile range, 43.5-66.5 mm]) all improved (p < 0.05 for all variables). Compared with baseline, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 54.2% [interquartile range, 45.8-80.4%], p = 0.47), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 35.5 mm [interquartile range, 5.3-77.0], p = 0.62), and success rate (38.5% vs 65.4%, p = 0.35) were similar at 3-month follow-up. Self-confidence, however, remained above baseline at 3-month follow-up (8.0 mm [interquartile range, 3.8-19.0 mm] vs 61.0 mm [interquartile range, 31.5-71.8 mm], p < 0.01). Simulation training improved pediatric residents' central venous catheter insertion procedural skills. Decay in skills was found at 3-month follow-up. This suggests that simulation training for this procedure should occur in close temporal proximity to times when these skills would most likely be used clinically and that frequent refresher training might be beneficial to prevent skills decay.

4:02 PM Abstract No. 227 - Optimization of iterative reconstruction technique for CT pulmonary arteriography: systemic assessment in a porcine model

Purpose To evaluate the quantitative and qualitative image quality of pulmonary CT arteriography images reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR) scanned at differential radiation doses. Materials and Methods A healthy 56.1 kg Yorkshire pig underwent fluoroscopic placement of a femoral central venous catheter. The catheter was subsequently injected with macerated, previously clotted autologous blood. After pulmonary emboli were visualized in the left lower lobe segmental pulmonary arteries, successive pulmonary arterial CT angiography on a Discovery 750HD MDCT scanner (GE Healthcare) was performed at 700, 400, 200, 100, and 50 mA at 120, 100, and 80 kVp, for a total of 15 scans. Each scan was reconstructed FBP, ASIR (50% blend) and MBIR. Noise (SD) and contrast-to-noise ratios were calculated from ROIs over the left lower lobe segmental pulmonary artery and paraspinous muscle. Selected axial images were scored subjectively for PE visibility and overall image quality. Results Averaged across all doses, MBIR reduced noise and improved contrast to noise ratio (CNR) compared to FBP by 73% and 232%, and reduced noise and improved CNR compared to ASIR by 69% and 110%, respectively. The effect was more pronounced in higher noise settings. Averaged across all doses, MBIR improved subjective image quality and diagnostic sensitivity for pulmonary embolism (PE) compared to FBP by 50% and compared to ASIR by 25%. Subjective improvements in image quality were most pronounced in higher noise settings. At 120 kVp/400 mA, readers scored FBP, ASIR, and MBIR images equally. At 100 mA/120 kVp, readers scored FBP and ASIR images as nondiagnostic for detection of PE, while MBIR images were considered of moderate quality but remained diagnostic for detection of PE. Conclusion MBIR reduced image noise and improved CNR for the pulmonary arteries compared to ASIR and FBP across all dose levels. Furthermore, MBIR resulted in higher subjective image quality and improved diagnostic sensitivity for pulmonary embolism, particularly in higher noise settings.

Resident accuracy in locating the common femoral vein in normal weight vs. obese patients

Objectives: Ultrasound guidance increases the success of internal jugular central venous catheter (CVC) placement. The common femoral vein (CFV) is considered an easier site and physicians frequently place CFV CVCs using anatomical landmark guidance. No research has demonstrated the effect of patient weight on placement of a femoral CVC. The authors hypothesized that resident physicians could determine by anatomical landmarks the insertion site of a femoral CVC in normal and overweight adults. Methods: Investigators consented adult patients in the Emergency Department to serve as study models. Patients were grouped by BMI: Normal (BMI (BMI > 25). PGYI-III Emergency Medicine residents who volunteered to participate were included. Residents inspected and palpated the inguinal regions on a patient and marked the patient’s skin directly over the CFV. A faculty member assessed success using a 10 MHz linear probe (Sonosite Micro Maxx) centered over the mark. The attempt was successful if the mark was directly over the CFV and unsuccessful if distal, lateral, or medial to the CFV. Results: Nineteen residents (6 PGYI, 7 PGY II, and 6 PGYIII) assessed 17 patients. There were 43 attempts on Normal patients and 57 attempts on Overweight patients. The success rate on Normal patients was 74% and on Overweight patients was 42% (p = 0.0021). Conclusion: Residents were more successful in correctly identifying the CFV by anatomical landmarks in Normal patients. Training year had no effect on success. Ultrasound guidance may increase the success rate of placing a femoral CVC in patients with BMI > 25.

1068

Case Reports: Cumulative fluid overload predicts poor outcomes in critically ill children with acute renal failure. It is often difficult to remove fluid in critically ill infants with renal failure and fluid overload. Slow continuous ultrafiltration (SCUF) is a procedure to remove fluid without removing solutes. This is used to treat fluid overload in adults with congestive heart failure, but has not been widely used in pediatrics. We present two infants in renal failure in whom fluid was successfully removed using SCUF via small central venous catheters. To our knowledge, these are the first two infants for which this has been reported. The first patient was a 3-month-old male with D-transposition of the great arteries who underwent arterial switch procedure complicated by acute renal failure secondary to acute tubular necrosis. A peritoneal dialysis catheter was placed but fluid removal was unsuccessful secondary to significant leakage around the catheter. He had worsening pulmonary edema and was not receiving adequate nutrition. A 5 French 8 centimeter double lumen femoral central venous catheter was placed and SCUF initiated. Over 17 days, 8.1 liters of fluid was removed, ventilator settings were weaned, and enteral feeding was initiated. This patient developed hyponatremia (Na 120mmol/L), a known complication of ultrafiltration. Ultrafiltration was discontinued but was restarted two days later with improved sodium levels. The second patient was a 4-month-old male with autosomal recessive polycystic kidney disease who had inadequate fluid removal via peritoneal dialysis secondary to increased intraabdominal pressure due to hepatomegaly. He had a hemodialysis catheter, but it had to be removed because of infection. He was in respiratory distress, though not requiring ventilatory support, and was more than 20% fluid overloaded. A 5 French 13 centimeter double lumen central venous catheter was placed in the femoral vein for SCUF. Over 23 days, 10.4 liters of fluid was removed from this patient. He remained extubated and feeds were advanced. The major benefits of SCUF in infants are small catheter size and feasibility.

Venous thromboembolism after trauma

Rates of venous thromboembolism as high as 58% have been reported after trauma, but there is no widely accepted screening protocol. If Medicare adds venous thromboembolism to the list of "preventable complications," they will no longer reimburse for treatment, which could have devastating effects on many urban centers. We hypothesized that prescreening with a risk assessment profile followed by routine surveillance with venous duplex ultrasound that could identify asymptomatic venous thromboembolism in trauma patients. Prospective, observational trial with waiver of consent. Level I trauma center intensive care unit. At admission, 534 patients were prescreened with a risk assessment profile. Patients (n = 106) with risk assessment profile scores >10 were considered high risk and received routine screening venous duplex ultrasound within 24 hrs and weekly thereafter. In prescreened high-risk patients, 20 asymptomatic deep vein thrombosis were detected with venous duplex ultrasound (19%). An additional ten venous thromboembolisms occurred, including six symptomatic deep vein thrombosis and four pulmonary emboli, resulting in an overall venous thromboembolism rate of 28%. The most common risk factors discriminating venous thromboembolism vs. no venous thromboembolism were femoral central venous catheter (23% vs. 8%), operative intervention >2 hrs (77% vs. 46%), complex lower extremity fracture (53% vs. 32%), and pelvic fracture (70% vs. 47%), respectively (all p < .05). Risk assessment profile scores were higher in patients with venous thromboembolism (19 ± 6 vs. 14 ± 4, p = .001). Risk assessment profile score (odds ratio 1.14) and the combination of pelvic fracture requiring operative intervention >2 hrs (odds ratio 5.75) were independent predictors for development of venous thromboembolism. The rates of venous thromboembolism for no chemical prophylaxis (33%), unfractionated heparin (29%), dalteparin (40%), or inferior vena cava filters (20%) were not statistically different (p = .764). Medicare's inclusion of venous thromboembolism after trauma as a "never event" should be questioned. In trauma patients, high-risk assessment profile score and pelvic fracture with prolonged operative intervention are independent predictors for venous thromboembolism development, despite thromboprophylaxis. Although routine venous duplex ultrasound screening may not be cost-effective for all trauma patients, prescreening using risk assessment profile yielded a cohort of patients with a high prevalence of venous thromboembolism. In such high-risk patients, routine venous duplex ultrasound and/or more aggressive prophylactic regimens may be beneficial.

Central venous catheter–associated complications in infants with single ventricle

Among infants with single-ventricle heart disease who require surgical palliation, central venous access is routinely obtained via the umbilical or femoral veins. Both routes are associated with potential complications, including thrombosis. We sought to analyze the clinical outcomes of patients with umbilical venous catheter vs. femoral central venous catheter placement at the time of initial central venous access in this high-risk patient population. This was a retrospective study, with data collected including demographics, catheter type, duration, complications, and clinical outcomes. Patients were designated as group 1 (initial umbilical venous catheter placed, n = 70) or group 2 (initial femoral central venous catheter placed, n = 19). The study was conducted at a single tertiary care referral institution. We included all 89 patients who underwent single-ventricle palliation at this institution in 2007 and 2008. The overall rates of survival to hospital discharge, thrombosis, and iliofemoral vein occlusion were 82%, 18%, and 21%, respectively. The proportion of thrombosis was 11% in group 1, compared with 42% in group 2 (p < .01). The proportion of iliofemoral vein occlusion was 16% in group 1, compared with 42% in group 2 (p = .02). The proportions of catheter-associated bloodstream infection, need for transhepatic access, and ultrasound-documented thrombus at the inferior vena caval-right atrial junction did not differ significantly between the groups. Patients with non-tunneled femoral central venous catheters for ≥14 days had a higher prevalence of thrombosis (52%) than those with femoral central venous catheters for <14 days (13%) but no difference in the prevalence of iliofemoral vein occlusion. In this population, initial placement of an umbilical venous catheter rather than a femoral venous catheter resulted in significantly lower risks of catheter thrombosis and iliofemoral vein occlusion. For femoral venous catheters, the prevalence of thrombosis, but not of iliofemoral vein occlusion, is proportional to the duration of catheterization.

Characterization of central venous catheter–associated deep venous thrombosis in infants

Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants. Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence. Of 333 patients, 47% (155/333) had femoral, 33% (111/333) had jugular, and 19% (64/333) had subclavian CVCs. Deep venous thromboses occurred in 18% (60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16% DVT rate in those with saphenofemoral Broviac CVCs vs 83% (20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54% vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 ± 17 days vs 30 ± 37 days, P = .02). Patients with +DVT had longer length of stay (86 ± 88 days vs 48 ± 48 days, P < .01) and higher percentage of intensive care unit admission (82% vs 70%, P = .02). Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal.

A Prerotational, Simulation-Based Workshop Improves the Safety of Central Venous Catheter Insertion: Results of a Successful Internal Medicine House Staff Training Program

The purpose of this study was to evaluate the effectiveness of a simulation-based workshop with ultrasonography instruction in reducing mechanical complications associated with central venous catheter (CVC) insertion.A single-center prospective cohort study was conducted in the medical ICU and respiratory step-down unit of an urban teaching hospital. Fifty-six medical house staff members were trained prior to their rotations over a 6-month period. The data on mechanical complication rates after the implementation of the workshop were compared with previous experience when no structured educational program existed.There were 334 procedures in the preeducation period compared to 402 procedures in the posteducation period. The overall complication rate, including placement failure, in the preeducation and posteducation period was 32.9% and 22.9%, respectively (P < .01). Placement failure rate decreased from 22.8% to 16.2% (P = .02), and arterial punctures decreased from 4.2% to 1.5% (P = .03). Ultrasonography usage increased from 3.0% to 61.4% (P < .01). Multivariate analysis demonstrated that interns were more likely to cause overall mechanical complications compared with fellows and attending physicians in the preeducation period (P = .02); however, this trend was not observed in the posteducation period. Catheter site and ultrasonography usage significantly affected the overall complication rate in both periods, and ultrasound-guided femoral CVC was the safest procedure in the posteducation period.Implementation of a prerotational workshop significantly improved the safety of CVC insertion, especially for CVCs placed by inexperienced operators. We suggest that simulation-based training with ultrasonography instruction should be conducted if house staff members are responsible for CVC placement.

Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population

Adult data show a difference in central venous catheter (CVC) infection rates between 3 major sites: subclavian (SC), internal jugular (IJ), and femoral veins. We hypothesized that in patients in pediatric intensive care units (PICUs), there is no difference in rates of CVC infection among these three sites, but specifically the femoral compared to all other sites. In this retrospective cohort study, data from January 1999 to January 2008 were collected prospectively for internal review and quality assurance. All PICU patients with a CVC were enrolled. The rate of CVC infection was determined using Cox regression survival analysis to account for various durations of CVC placement at the various sites, then adjusted for severity of illness, number of lumens, and patient age. Mortality was compared in patients with a CVC infection versus those without. A total of 4,512 patients with a CVC were enrolled. No site was associated with an increased risk of infection compared with the other sites, with hazard ratios of 0.951 (95% confidence interval [CI], 0.612-1.478) for the SC site, 0.956 (95% CI, 0.593-1.541) for the IJ site, and 1.120 (95% CI, 0.753-1.665) for the femoral site. No significant association between mortality and presence of CVC infection was found when adjusted for age, severity of illness, and duration of CVC placement. An association was found between the presence of a CVC infection and prolonged PICU length of stay (3.98 days longer; P < .001). Femoral CVCs are not associated with higher rates of infection in the PICU. In addition, the presence of CVC infection does not affect mortality, but is associated with longer PICU admission.

Manejo clínico-microbiológico de los hemocultivos positivos por Staphylococcus coagulasa negativos

A 53-year old male admitted for episodes of sustained ventricular tachycardia subjected to electrical cardioversion, carrier of a right femoral central venous catheter, began with febrile peaks, and Staphylococcus epidermidis was isolated in the blood cultures. What is the value of isolation in the blood cultures of S. epidermidis, a microorganism that forms a part of the usual flora of the skin and mucous of the patient? How should this situation be managed? Should an antimicrobial agent be administered? Which one? For how long?

Comparison of cardiac output and blood volumes in intrathoracic compartments measured by ultrasound dilution and transpulmonary thermodilution methods

To compare cardiac output (CO) and blood volumes measured by COstatus(®) (Transonic Systems Inc., NY, USA) versus PiCCO (Philips IntelliVue MP40 with PiCCO-technology module M3012A#10, Netherlands) in adult ICU patients. This was a prospective single-center study. Each of the 30 patients studied received a 5-Fr Pulsiocath femoral arterial and a standard central venous catheter. Twenty ml of iced 5% dextrose solution was injected for PiCCO measurements. For COstatus measurements, an extracorporeal arteriovenous loop, with two sensors placed on it, was connected between the Pulsiocath femoral arterial and central venous catheters. Blood was circulated through this loop at 12 ml/min for 5-8 min using a pump. Twenty ml of warm saline was injected into the venous side for measurements. For each method, three injections were averaged for comparison. A good agreement for measured CO (range 3.65-16.3 l/min) with a percentage error of 20% was observed, with r = 0.95, bias = -0.037 l/min. PiCCO's global end-diastolic volume (GEDV) was 2.5 times larger than the analogous COstatus's total end-diastolic volume (TEDV) [TEDV = 0.28 × GEDV + 176 ml]. PiCCO's intrathoracic blood volume (ITBV) was larger than the analogous COstatus's central blood volume (CBV) [CBV = 0.73 × (ITBV) +78 ml]. CO measured by COstatus was found to be equivalent and hence interchangeable with PiCCO in this study population. COstatus blood volumes were found to be within the expected physiological range whilst PiCCO blood volumes were significantly higher, which was also observed in other studies. Future studies using 3D echo/MRI are required to validate these blood volumes.

Femoral-Based Central Venous Oxygen Saturation Is Not a Reliable Substitute for Subclavian/Internal Jugular-Based Central Venous Oxygen Saturation in Patients Who Are Critically Ill

Central venous oxygen saturation (Scv(O(2))) has been used as a surrogate marker for mixed venous oxygen saturation (Sv(O(2))). Femoral venous oxygen saturation (Sfv(O(2))) is sometimes used as a substitute for Scv(O(2)). The purpose of this study is to test the hypothesis that these values can be used interchangeably in a population of patients who are critically ill. We conducted a survey to assess the frequency of femoral line insertion during the initial treatment of patients who are critically ill. Scv(O(2)) vs Sfv(O(2)) STUDY: Patients with femoral and nonfemoral central venous catheters (CVCs) were included in this prospective study. Two sets of paired blood samples were drawn simultaneously from the femoral and nonfemoral CVCs. Blood samples were analyzed for oxygen saturation and lactate. One hundred and fifty physicians responded to the survey. More than one-third of the physicians insert a femoral line at least 10% of the time during the initial treatment of patients who were critically ill. Scv(O(2)) vs Sfv(O(2)) STUDY: Thirty-nine patients were enrolled. The mean Scv(O(2)) and Sfv(O(2)) were 73.1% +/- 11.6% and 69.1% +/- 12.9%, respectively (P = .002), with a mean bias of 4.0% +/- 11.2% (95% limits of agreement: -18.4% to 26.4%). The mean serum lactate from the nonfemoral and femoral CVCs was 2.84 +/- 4.0 and 2.72 +/- 3.2, respectively (P = .15). This study revealed a significant difference between paired samples of Scv(O(2)) and Sfv(O(2)). More than 50% of Scv(O(2)) and Sfv(O(2)) values diverged by > 5%. Sfv(O(2)) is not always a reliable substitute for Scv(O(2)) and should not routinely be used in protocols to help guide resuscitation.

A Critical Incident Due to Migration of a Femoral Central Venous Catheter: An Easily Preventable Complication

A Critical Incident Due to Migration of a Femoral Central Venous Catheter: An Easily Preventable Complication

350: Resident Accuracy in Locating the Common Femoral Vein in Normal Weight versus Obese Patients

Previous research has shown that use of ultrasound can significantly increase the success rate for placing a central venous catheter (CVC) in the internal jugular veins. The common femoral vein (CFV) is considered a much easier location and physicians frequently place femoral CVCs without ultrasound guidance. No research has shown if a patient's weight affects the accuracy with which the physician can locate the proper placement for a femoral CVC. The authors hypothesized that resident physicians could accurately determine the correct site for insertion of a femoral CVC in both lean and obese adults by traditional anatomical assessment.

Emergency Femoral Central Venous Catheterization in an Elderly Patient Complicated by Distal Guidewire Migration

Central line placement is a common technique in emergency and critical care. Although it is not a very difficult procedure, severe complications sometimes occur. We present a very rare complication of distal guidewire migration to the superior vena cava while performing femoral venous catheterization in an elderly patient. The problems of human errors are discussed and precautions are proposed.

Radiological Evaluation of Femoral Central Venous Catheter Misplacement into the Ascending Lumbar Veins

Radiological Evaluation of Femoral Central Venous Catheter Misplacement into the Ascending Lumbar Veins

Femoral Vein Central Lines in Children: Another Case for Ultrasound Guidance

External landmarks typically are used to guide placement of femoral central venous catheters in adults and children. In this study, researchers used ultrasound to determine the depth, location, and diameter of the femoral vein and its relation to the femoral artery in children. A …

La contamination des hémocultures prélevées sur cathéters veineux centraux et sur veine périphérique. Étude prospective de 75 couples d'hémocultures

Objective. – To determine the frequency of contamination, the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous catheter or peripheral venipuncture. Design. – Prospective cohort study of critical ill medical surgical intensive care patients in whom samples for paired culture were drawn through a central venous catheter or peripheral venipuncture during a period of 8 months (from August 1st 2001 to Mars 31st 2002). Results. – During the study period, 75-paired cultures were studied. Fifteen peripheral blood cultures (20%) and 27 central blood cultures (36%) were positive and 6 peripheral blood cultures (8%) and 15 central blood cultures (20%) were contaminated ( P =0.034). The organism most commonly responsible for contamination was Coagulase Negative Staphylococcus (16% of central blood cultures and 6.7% of peripheral blood cultures). The frequency of contamination was of 42.9% for blood cultures drawn through a femoral central venous catheter, of 10% for jugular, and of 19% for subclavian central venous catheter ( P =0.22). For catheter draws compared with peripheral venipuncture, sensitivity was 100 and 75%, specificity was 76.2 and 90.5%, positive predictive value was 44.4 and 60% and negative predictive value was 100 and 95%. Conclusion. – Cultures of blood drawn through a catheter are more sensible and less specific than those obtained from a peripheral venipuncture and the organism most commonly responsible for contamination of blood cultures is Coagulase Negative Staphylococcus.

Arterial Misplacement of a Femoral Central Venous Catheter Complicated with Acute Arterial Occlusion

Femoral vein catheterization is often carried out during resuscitation and in critical care units. It is usually achieved via a blind, external landmark-guided technique, through manual localization of the femoral artery. However, this approach can be challenging in patients with severe shock because of absence or ambiguity of the arterial pulse. We report a case of inadvertent cannulation, with a large-bore catheter, of the right femoral artery, which was mistaken as a venous route for medication and massive transfusion. The large cannula caused direct mechanical obstruction, while intra-arterial medications induced vascular injury and vasospasm. Both factors led to thrombosis and occlusion of the right external iliac artery, thus jeopardizing the distal blood supply, and ultimately resulting in muscle necrosis of the involved limb, and the need for thrombectomy and extensive fasciotomy to salvage the extremity. This case highlights that correct placement of a central venous catheter should be clearly ascertained before the catheter is used for medical treatment, especially when catheterization is performed in shock status.