Inadvertent Catheterization Research Articles

Successful endovascular management of inadvertent catheterization of subclavian artery

Successful endovascular management of inadvertent catheterization of subclavian artery

Misplacement of a central venous catheter into azygos vein via the right internal jugular vein

For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described.

In vivo demonstration of magnetic guidewire steerability in a MRI system with additional gradient coils.

To assess the ability to control the steering of a modified guidewire actuated by the magnetic force of a magnetic resonance imaging system with additional gradient coils for selective arterial catheterization in rabbits. Selective catheterizations of the right renal artery, left renal artery, superior mesenteric artery, and iliac artery were performed on two rabbits. A 3D magnetic force was applied onto a magnetic bead placed at the tip of a guidewire. The ability of the guidewire to advance in the aorta without entering the side branches when the magnetic force was not applied was also evaluated. Steering of the guidewire was combined with a dedicated tracking system and its position was registered on the 3D model of a magnetic resonance angiography (MRA). The magnetic catheterization of the renal arteries was successful and showed reproducibility. Superior mesenteric artery and iliac artery showed that the catheterization was feasible. These two arteries were difficult to visualize on MRA, making catheterization and setting the direction of the force more difficult. There was no inadvertent catheterization of side vessels when the guidewire was advanced with magnetic steering despite the hook shape at the tip of the guidewire caused by the alignment of the bead anisotropy with the permanent magnetic field. This first evaluation of selective catheterization of aortic branches with a magnetic guidewire provided a successful steering in the less angled side branches and this modified guidewire was advanced in the aorta without inadvertent selective catheterization when manipulated without magnetic actuation.

Endovascular management of inadvertent brachiocephalic arterial catheterization

Inadvertent catheterization of brachiocephalic arteries (carotid artery, subclavian artery, or vertebral artery) during attempted placement of a central venous catheter can have potentially disastrous complications. While removal of the catheter in the operating room is almost always an option, there are circumstances in which a less invasive approach may be more appropriate. The authors present their experience using endovascular techniques for removal of inadvertently placed central venous catheters to elucidate potential options for successful nonsurgical management. The authors reviewed their database of interventional procedures that occurred between January 1, 2000, and February 1, 2009. All cases referred for management of suspected brachiocephalic arterial catheterization or arterial injury after attempted placement of a central venous catheter were included. Medical records and radiological imaging were reviewed to determine patient demographics, clinical situation, methods for removal, as well as clinical and imaging follow-up. A total of 13 patients, ranging in age from 31 to 88 years old, were referred to interventional radiology for management of suspected inadvertent arterial catheterization of the brachiocephalic arteries. Angiography confirmed arterial catheterization in 9 patients. Three patients were referred after developing uncontrolled hemorrhage or expanding hematomas following attempted catheterization. One patient who had an arterial waveform after placement of an internal jugular catheter was found to have early venous filling from a dialysis fistula requiring no intervention. Ten patients were treated in the interventional suite using angiographically monitored manual pressure (1 patient), balloon tamponade (3 patients), use of a percutaneous closure device (1 patient), stent grafting (4 patients), or embolization of the injured vessel alone (1 patient). One patient was taken to the operating room for removal of the inadvertently placed catheter due to vessel thrombosis. No procedural complications were encountered, and no patient required sacrifice of a major brachiocephalic vessel. Angiographic evaluation of patients who underwent inadvertent catheterization of brachiocephalic arteries or their branches allowed successful endovascular treatment or excluded the need for intervention in 12 (92%) of 13 patients. The choice and use of specific endovascular techniques should be dictated by patient factors and the vessel inadvertently catheterized.

Inadvertent Catheterization of the Ascending Lumbar Vein

A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.

All Roads Do Not Lead to Rome

All Roads Do Not Lead to Rome

Percutaneous Closure of a Subclavian Artery Injury after Inadvertent Catheterization

Life-threatening complications of subclavian central venous access are rare. Herein a case of inadvertent subclavian artery catheterization and subsequent percutaneous arterial repair with use of the Prostar XL suture-mediated closure device and temporary balloon tamponade is reported. This approach obviated a complex surgical intervention that would have required medial clavicle resection.

Balloon Tamponade for the Treatment of Inadvertent Subclavian Arterial Catheter Placement

THE routine placement of central venous access devices using bony landmarks is cost-effective and safe. Complications from “blind” subclavian vein access are uncommon, but they can occur and include pneumothorax, accidental puncture of the subclavian artery (SCA) with or without subsequent catheter placement, arteriovenous fistula formation, pseudoaneurysm formation, and “pinch-off syndrome” ( 1 Todd MR Barone JE Recognition of accidental arterial cannulation after attempted central venipuncture. Crit Care Med. 1991; 19: 1081-1083 Crossref PubMed Scopus (25) Google Scholar , 2 Andris DA Krzywda EA Schulte W Ausman R Quebbeman EJ Pinchoff syndrome: a rare etiology for central venous catheter occlusion. J Parenter Enteral Nutr. 1994; 18: 531-533 Crossref PubMed Scopus (78) Google Scholar ). Inadvertent catheterization of the SCA has been classically treated in one of two ways: (i) surgical catheter removal with repair of the arterial injury and (ii) uncontrolled catheter removal with simultaneous external compression. We relate our experience with a simple technique previously described for the controlled removal of inadvertently placed SCA catheters by endovascular balloon tamponade.

Inadvertent catheterization of the hepatic artery during placement of transjugular intrahepatic portosystemic shunts.

Inadvertent catheterization of the hepatic artery may occur during placement of transjugular intrahepatic portosystemic shunts (TIPS). The authors treated this complication in three patients (one man, aged 60 years; two women, aged 50 and 52 years) by embolizing the transparenchymal tract leading to the hepatic artery and performing hepatic angiography after completion of TIPS placement. No sequelae were noted at follow-up of any of these patients.