Internal Jugular Catheter Insertion Research Articles

Neck Horn Formation After Jugular Vein Catheterization For Haemodialysis: Case Report

Background: Haemodialysis is an essential life-saving procedure for persons suffering from kidney failure. Haemodialysis is usually aceived by central venous catheterization. Neck hornformation is one of the most serious and seldom complications of the procedure.
 Case Report: A haemodialysis catheter was placed in a 43-year-old man's right internal jugular vein after his arteriovenous fistula failed. After having the catheter removed, a neck horn developed at the puncture site. Horn resection and thrombus evacuation were the surgical treatment methods used.
 Conclusion: Neck horn following an internal jugular catheter insertion might be dangerous if left untreated. The horn and thrombus are best removed surgically and treated with antibiotics.

Accidental placement of hemodialysis catheter tip in the right internal mammary vein: a case report

Hemodialysis catheter placement, particularly Internal Jugular Catheter insertion, is a very common procedure for patients who require urgent access to renal replacement therapy. Most of these procedures are done under ultrasound guidance as recommended by KDIGO 2019 vascular access guidelines. However, catheter tip misplacement can still occur even in the experts’ hands and despite the use of ultrasound. In this case report, we will discuss a hemodialysis catheter tip placement in the right internal mammary vein and how we managed it.

Urgent Start Intermittent Peritoneal Dialysis Leads to Reduction of Catheter-Related Infection and Increased Peritoneal Dialysis Penetration

BackgroundNoncuffed catheters (NCC) are often used for incident hemodialysis (HD) patients without a functional vascular access. This, unfortunately results in frequent catheter-related complications such as infection, malfunction, vessel stenosis, and obstruction, leading to loss of permanent central venous access with superior vena cava obstruction. It is important to preserve central vein patency by reducing the number of internal jugular catheter insertions for incident HD patients with a functional vascular access. We sought to achieve this by introducing in-patient intermittent peritoneal dialysis (IPD) as bridging therapy while awaiting establishment of long-term vascular access for HD patients. MethodsIncident HD patients without permanent vascular access encountered from January to December 2014 were included in this study. Patients were divided into 2 groups: Group 1 were encountered within 6 months prior to introduction of in-patient IPD bridging therapy in substitution of noncuffed catheter (NCC) insertion while awaiting maturation of permanent vascular access. Group 2 were encountered within 6 months after the introduction of this policy. The number of NCC and peritoneal dialysiscatheter insertion, along with catheter-related infections were evaluated during this period. ResultsApproximately 450 patients were distributed in each group. We achieved 45% reduction in internal jugular catheter insertion from 322 to 180 catheters after policy change. This led to a significant drop in catheter-related blood stream infection (53%, P <0.001). On the other hand, 30% more peritoneal dialysiscatheter were inserted to accommodate our IPD bridging therapy. ConclusionsThe introduction of IPD as bridging therapy while awaiting maturation of permanent vascular access significantly reduced the utilization of NCC in incident HD patients and catherter-related blodstream infection. With this, it is our hope that it will contribute to the preservation of central vein patency.

Transient Pourfour du Petit Syndrome

To the Editor: Sulemanji et al. (1) recently reported a case of transient Horner’s syndrome after insertion of a subclavian venous catheter in a 3-yr-old. We recently observed a rare case of transient Pourfour du Petit syndrome, after internal jugular catheter insertion in a 17-mo-old male patient. Pourfour Du Petit, a 19th century French physician, first described the signs of cervical sympathetic hyperactivity in soldiers with stab wounds to the neck (2). The syndrome is classically described as mydriasis, exophthalmoses, and pale cool skin which are opposite to the symptoms described by Horner. Pourfour du Petit syndrome has been observed secondary to trauma and mass effect from tumors (3,4) but never after central venous catheterization. A 17-mo-old previously healthy male underwent exploratory laparotomy for bowel perforation secondary to intussusception. The surgery was uneventful and the surgeon requested a central venous catheter be inserted before tracheal extubation for administration of antibiotics. We used external landmarks to attempt the catheterization on the right internal jugular vein. On the first attempt, we were unsuccessful at aspirating blood. Our second attempt was at a spot just inferior and medial to the first and we successfully inserted a central venous catheter using Seldinger’s technique. We did not encounter any complications during catheter insertion. After an uneventful tracheal extubation, we observed that his right pupil was dilated in comparison to the left pupil (3 mm/2 mm); however, light reflex and accommodation remained intact. The patient’s right face and right upper extremity appeared mottled and cold compared with the left side. However, the right carotid and radial pulses remained intact and equal in strength compared to the left side. The combined symptoms led us to the diagnosis of Pourfour du Petit syndrome accompanied by hyperstimulation of the brachial plexus sympathetic chain. The patient’s symptoms regressed over the next 24 h and by discharge 5 d later, his symptoms had completely resolved. Jesse Aron, MD Debnath Chatterjee, MD Department of Anesthesiology Upstate University Hospital Syracuse, NY [email protected]

A Prospective Randomized Study to Compare Ultrasound-Guided with Nonultrasound-Guided Double Lumen Internal Jugular Catheter Insertion as a Temporary Hemodialysis Access

Internal jugular venous catheters (IJVC) for hemodialysis are a commonly employed temporary vascular access for hemodialysis. Most hospitals still follow the use of blind technique, which uses anatomical landmarks. Even in the most experienced hands this procedure has a variable success rate. Ultrasound guidance can decrease the incidence of periprocedural complications and improve the success rate. In this randomized study we compared the procedure success rate and periprocedural complications in patients undergoing ultrasound guided vs. nonultrasound guided IJVC insertion for a temporary hemodialysis access. Methods. All patients subjected to insertion of an IJVC between March 2004 and June 2004 were enrolled into the study, randomized to either the blind (group A) or ultrasound guided (group B) procedure, which uses a portable ordinary ultrasound machine without a needle guide. The aseptic Saldinger technique was used for catheterization in both the groups. Baseline characteristics of patient and periprocedural events were recorded. Results. A total of 60 patients were randomized, 30 patients each in two groups. First attempt venous cannulation success rate was 56.7% in group A compared to 86.7% in group B. Chance of occurrence of adverse outcome was significantly more in the blind procedure (P = 0.020). A post-procedure chest radiograph done in all patient showed no complications. Conclusion. Ultrasound guided procedure for internal jugular vein catheter insertion using an ordinary ultrasound machine was significantly safer and more successful as compared to the blind technique.

Real-Time Ultrasound and Endocavitary Electrocardiography for Venous Catheter Placement

The authors report on their experience with internal jugular vein catheterization with temporary and tunnelled cuffed hemodialysis catheters in 527 patients from 1991 to 2001, using ultrasound guidance and monitoring of catheter placement by endocavitary electrocardiography. The incidence of successful puncture and cannulation using ultrasound was 99.62%. The majority of patients had catheters inserted on the first pass (93%) and fewer attempts were required (range, 2 to 5). In the first year of the procedure in 1991, we observed two cases of accidental puncture of the carotid artery because of an error in ultrasound localization of the neck vessel. Arrhythmias were not observed during this procedure. Right atrial electrocardiography was successful on 504 occasions (96.83%), and correct catheter placement was confirmed by plain chest-X-ray in the first 100 patients. The results confirm that real-time ultrasound guidance for catheter insertion is superior to tradi-tional techniques relying on anatomic landmarks and should be adopted as the standard of care. Ultrasound guidance and EC-ECG improves both the success and the safety of internal jugular catheter insertion. The authors propose that EC-ECG be validated as a technique in compliance with recent Food and Drug Ad-ministration guidelines regarding the location of central venous catheter tips.

Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary?

To determine whether clinical features can be used in a decision rule to prospectively identify a subgroup of internal jugular catheter placements that are correctly positioned and free from mechanical complications, thus obviating the need for routine postprocedural chest radiographs in selected patients. Prospective cohort study. Tertiary care teaching hospital. A total of 107 consecutive patients who presented to our catheter service for internal jugular catheter insertion because of clinical indications between November 1995 and April 1996. Exclusion criteria were mechanical ventilation, an altered mental status, an age of <15 years, and a height of <152 cm. Right or left internal jugular vein catheter placement followed by a postprocedural chest radiograph. The operating physician completed a detailed questionnaire for each catheter insertion, designed to detect potential complications and to predict the necessity, or lack of necessity, for a postprocedural chest radiograph. The questionnaire documented patient characteristics, the number of needle passes, difficulty establishing access, operator experience, poor anatomical landmarks, number of previous catheter placements, resistance to wire or catheter advancement, resistance to aspiration of blood or flushing of the catheter ports, sensations in the ear, chest, or arm, and development of signs or symptoms suggestive of pneumothorax. After catheter insertion, chest radiographs were obtained to assess for mechanical complications and malpositioned catheters. In 46 cases, the decision rule predicted either a complication or a malposition and, thus, the need for a chest radiograph. In 61 cases, neither was predicted (no chest radiograph was needed). Radiographs confirmed one complication (pneumothorax) and 15 catheter tip malpositions (nine in the right atrium and six in the right axillary vein). Among the 46 cases predicted to have a potential complication or malposition, there were one actual complication (pneumothorax) and six actual malpositions (three axillary vein malpositions and three right atrial malpositions). The positive predictive value of this decision rule is 15%. Among the 61 cases predicted to be free from complications or malpositions and not to require a postprocedural chest radiograph, there were nine unexpected malpositions (three axillary vein malpositions and six right atrial malpositions). The negative predictive value is 85%. The overall sensitivity of the decision rule for detecting complications and malpositions is 44%, and the specificity is 55%. In experienced hands, internal jugular venous catheterization is a safe procedure. However, the incidence of axillary vein or right atrial catheter malposition is 14%, and clinical factors alone will not reliably identify malpositioned catheters. Chest radiographs are necessary to ensure correct internal jugular catheter position.