Subclavian Venous Catheter Research Articles

Observation on application of PICC and subclavian venous catheter in patients with heart failure

Objective To observe the effects of application of peripherally inserted central catheter (PICC) and subclavian vein puncture (SVP) in heart failure patients. Methods 64 inpatients with heart failure from cardiology department of our hospital were selected, with 30 patients in the PICC group and 34 patients in the SVP group. The operating time of catheterization, achievement rate of initial catheterization, indwelling time and complications were observed in the two groups, respectively. Results The operating time of catheterization (16.3±3.4min) in the PICC group was shorter than that in the SVP group. The indwelling time (34.7±5.3d) was markedly longer in the PICC group than that in the SVP group. The differences were significant statistically (P<0.05). The number of phlebitis and occlusion of catheter in the PICC group were more than those in the SVP group (P<0.05). Conclusions The suitable method for venous puncture and catheterization should be selected according to the features of PICC and SVP as well as the actual situations of patients in clinical application. Key words: Peripherally inserted central catheter; Subclavian vein puncture; Heart failure

Hemothorax due to injuries of subclavian artery and first intercostal artery after subclavian venous catheterization in a pediatric patient : A case report.

Central venous catheterization is useful to evaluate intravascular volume status, while it has a chance of severe complications such as tension pneumothorax, cardiac tamponade, and so on. Now, we report a case of hemothorax after trying subclavian venous catheterization over again in a 2-year-old patient undergoing encephalo-duro-arterio-synangiosis, that required surgical intervention at the end. Though arterial puncture and massive hemothorax is a possible complication of subclavian venous catheterization, the injury of first intercostal artery might be due to inappropriate introducer needle accidentally. In conclusion, both routine chest image confirmation and close observation of expert might be important to prevent iatrogenic complication by anesthetic maneuvers.

Avoiding Common Technical Errors in Subclavian Central Venous Catheter Placement

Proficiency in placing infraclavicular subclavian venous catheters can be achieved through practice and repetition. But few data specifically document insertion technical errors, which mentors could teach novice operators to avoid. Surgical, medical, and anesthesia textbooks and procedural handbooks were reviewed. Subclavian catheter placement technical errors described were identified and consolidated. Video captures from 86 consecutive patients receiving subclavian central venous catheterizations at an urban trauma center were evaluated. In each video segment, the number of attempts at insertion, the number of failures at insertion, and the technical error observed during failed attempts were recorded and tabulated. Of the 86 subclavian line placements attempted, 77 were successful (89.5%), with a total of 357 subclavian venipuncture attempts and 279 failures (78% attempt failure rate). There was a mean of 3.2 failed attempts per line (left side, 2.1 attempts; right side, 5.5 attempts). Junior residents (PGY 1 to 2) had more failures per line than senior residents (PGY 3 to 5): 4.1 versus 3.6. The most common technical errors observed were improper site for needle insertion relative to the clavicle; insertion of the needle through the clavicular periosteum; too shallow of a trajectory for the needle; improper or inadequate anatomic landmark identification; aiming the needle too cephalad; and inadvertent movement of the needle out of the vein before or during wire placement. In subclavian central venous access attempts, there are six common technical errors. Mentors can improve novice operators' proficiency by teaching them to avoid these errors.

Endovascular repair of a brachio-cephalic trunk injury due to inadvertent central venous catheter insertion

Central venous access including catheter insertion is routinely practised in emergency and elective situations. We report a case of inadvertent brachio-cephalic trunk catheterisation in a 53-year-old woman during an attempt to insert a right subclavian vein catheter and describe the endovascular management with a covered stent. Although there have been previous reports of inadvertent arterial puncture during subclavian venous catheterisation, these have been of the subclavian artery. To our knowledge inadvertent brachio-cephalic arterial puncture and endovascular repair has not been previously reported.

Iatrogenic pseudoaneurysm of the brachiocephalic artery: a rare complication of Hickman line insertion

Central venous catheterization is widely used for hemodialysis for patients with renal failure. A number of short and long-term complications have been reported in literature. We describe a rare case of a lethal iatrogenic injury of the brachiocephalic artery (BA) in a 65-year-old woman following subclavian venous catheterization with a Hickman catheter. Contrast-enhanced CT-scan and reconstruction images demonstrated a pseudoaneurysm of the BA. Due to clinical deterioration, the patient underwent urgent sternotomy. Aspects concerning prevention and diagnosis of the above complication are analyzed.

Respiratory status that facilitates subclavian venous catheterization

Respiratory status that facilitates subclavian venous catheterization

Respiratory status that facilitates subclavian venous catheterization

Respiratory status that facilitates subclavian venous catheterization

Mechanical Occlusion of the Inferior Vena Cava: An Unusual Complication After Repair of Pectus Excavatum Using the Nuss Procedure

We describe the case of a 13-year-old girl with a pectus excavatum in whom acute occlusion of the inferior vena cava developed after a nuss repair. In this hemodynamically unstable patient, we evaluated the possibility of a penetrating injury to the thoracic and abdominal structures before confirming the diagnosis of inferior vena cava obstruction with a venogram. Removal of the nuss bar relieved the unexpected problem.

Comparison of Catheter-related Infection and Tip Colonization between Internal Jugular and Subclavian Central Venous Catheters in Surgical Neonates

The primary aim of this study was to compare catheter-associated infections and tip contaminations between percutaneously placed central venous catheters in the internal jugular and subclavian veins in surgical neonates undergoing major noncardiac surgery. The prospectively computerized protocols of 295 procedures were analyzed retrospectively. One hundred twenty-nine internal jugular venous (group I) and 107 subclavian venous catheters (group S) were included. The median postconceptual age was 37 weeks in group I and 38 in group S. The weight ranged from 580 g to 4.5 kg in group I and from 820 g to 4.5 kg in group S at the time of insertion. Significantly more catheter-associated infections were observed in group I (15.5 vs. 4.7%; chi-square analysis: P < 0.01). The internal jugular venous catheters were also associated with a significantly increased probability of an earlier onset of a catheter-associated infection compared with the subclavian venous catheters (log rank test: P < 0.01; Cox model: P < 0.01). This probability was only slightly increased by a lower weight (Cox model: P = 0.075), and it was not increased by a lower age (Cox model: P = 0.93). Significantly more catheter tips were contaminated by pathogens in group I (55.8 vs. 33.6%; chi-square analysis: P < 0.01). The internal jugular venous catheters were associated with a higher infection rate as well as earlier onset of catheter-associated infection compared with the subclavian venous catheters.

External Jugular Groshong Catheter Is Associated with Fewer Complications than a Subclavian Argyle Catheter

Background: To demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access. Methods: Central venous access was done by either insertion of a Groshong catheter via the EJV or an Argyle catheter via the subclavian vein with single puncture. Results: Eighty patients (group 1) were treated with 146 subclavian venous catheters for 2,770 catheter-days, and 98 patients (group 2) were treated with 147 external jugular venous catheters for 2,381 catheter-days. Fever appeared in 36.3% (53/146) and 16.3% (24/147) of the patients in groups 1 and 2, respectively (p < 0.01). The malposition and pneumothorax rates were 17.1% (25/146) and 2.0% (3/147; p < 0.01), and 2.7% (4/146) and 0% (0/147; p < 0.05) in the two groups, respectively. Conclusions: Insertion of a Groshong catheter via the EJV is more acceptable for central venous access than insertion of a conventional subclavian venous catheter.

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]

Firm‐based trial to improve central venous catheter insertion practices

Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein. Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control. Firm-based clinical trial between November 2004 and March 2005. General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital. Internal medicine residents (n = 150). Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training. Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications Residents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: -14% (95% CI, -52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar. Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.

Central venous catheter-related infections: Risk factors and effects of glycopeptide antibiotics

Central venous catheters (CVC) are used in the treatment of critically ill patients. Indications for placement of CVCs include hemodynamic monitoring, administration of intravenous fluids, medications and total parenteral nutrition. We investigated risk factors and effects of glycopeptide antibiotics on the development of central venous catheter-related injections in 300 patients treated in intensive care units. A semiquntitative culture technique was used. The investigation included: age, diagnosis on admission, catheter insertion site, catheter duration, the first or next catheter and using of glycopeptide drugs. 91 catheters (30.3%) were colonised, catheter-related infection was found in 50 catheters (16.7%). Infections were more frequent in catheters inserted through the internal jugular vein than in subclavian venous catheters, they were also more frequent if duration of catheterization was longer than seven days, but less frequent in patients who received glycopeptide antibiotics. The isolated microorganism was Staphylococcus aureus. Discussion According to the literature, a number of catheter-related risk factors for infections include: insertion site, type of catheter, the number of manipulations, inadequat asepsis, lumen number, type of antiseptic. The relative importance of one risk factor over another is difficult to assess, given that studies have no priority report. The duration of catheterization and the insertion site were the most frequent risk factors for infection. The use of glycopeptide antibiotics during catheterization has protective effects.

Two Cases of Fractured and Embolized Implanted Central Venous Chemoports in Lung Cancer

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.

Early transection of a central venous catheter in a sedated ICU patient

We report transection and embolization to the heart of a subclavian venous catheter in an immobilized and mechanical ventilated patient. The catheter tip was retrieved using a percutaneous method via the left femoral vein. Mechanical compression of the subclavian venous catheter at the costoclavicular area is termed pinch-off syndrome. It can be recognized by intermittent difficulties with drug injection, and chest wall swelling at the insertion site. The diagnosis can be confirmed by chest radiography with or without contrast administration. A more lateral approach of the subclavian vein is advocated to prevent compression.

Découverte tardive chez un patient de réanimation d'une perforation de la veine cave supérieure par un cathéter veineux sous-clavier

Perforation is a central venous catheterization complication mainly observed in children. Usually, patients develop sudden shock early after catheterization. We report an asymptomatic and delayed superior vena cava perforation after subclavian venous adult catheterization discovered by contrast injection tomography.

Horner Syndrome After Subclavian Venous Catheterization

Horner Syndrome After Subclavian Venous Catheterization

Broken guidewire during subclavian venous catheterization

AbstractThe use of cuffed tunneled hemodialysis catheters has become commonplace these days, but such use may be associated with certain known risks and complications. We report a catheterization of a right subclavian central vein that became complicated by a break in and entrapment of the guidewire used for the procedure. The proximal portion of the broken guidewire remained in the inferior vena cava and the distal portion in the right atrium. An angled wire loop retriever was used to remove the guidewire through the right femoral vein.

Central Venous Access in Obese Patients: A Potential Complication

To the Editor: Because peripheral IV access may be limited in obese patients (1), cannulation of a central vein (subclavian, internal jugular) is often recommended (2). We report a previously unrecognized complication of central line placement in an obese patient. A 54-yr-old, 160 kg, 183 cm tall (body mass index = 47.8 kg/m2) man with cerebral vasospasm was scheduled for cerebral angiography under general anesthesia. He had been admitted to the intensive care unit after an emergency craniotomy and clipping of an aneurysm after a subarachnoid hemorrhage 3 days earlier. At the time of the surgical procedure, a triple-lumen right subclavian venous catheter (Arrowgard® Blue Plus Multi-Lumen CVC, Arrow International, Inc., Reading, PA) had been percutaneously inserted without difficulty. On admission to the radiology suite propofol 100 μg · kg−1 · min−1 was infusing through the proximal lumen of the subclavian catheter and neosynephrine 200 μg · kg−1 · min−1 was infusing through the medial lumen. As is our routine, the patency of each lumen was checked before induction of general anesthesia. Blood could only be aspirated from the distal lumen. Under direct fluoroscopy using contrast medium it was noted that only the distal lumen was intravascular, and the propofol (proximal lumen) and neosynephrine (medial lumen) were extravasating into the subcutaneous tissue of the neck. A long guidewire was inserted under fluoroscopic guidance into the right atrium through the patent distal lumen. The triple-lumen catheter was removed and a double-lumen catheter (Blue FlexTip Catheter®, Arrow International) was passed over the guidewire. Fluoroscopy with dye injection confirmed that both catheter lumens were intravascular. The initial triple-lumen catheter was 16 cm long and had been inserted to the hub. The patient had an extremely large neck (>70 cm in circumference). Because of the distance between his skin and the vein, only the distal lumen was intraluminal. A chest radiograph after placement demonstrated that the catheter was intrathoracic, and because blood could be aspirated from the distal lumen its position was considered acceptable (Fig. 1). The replacement catheter was 20 cm long. The additional length was needed to allow both catheter lumens IV access (Fig. 2). A similar complication was recently reported with a much shorter 10.8 cm pulmonary artery catheter introducer in an obese patient (3).Figure 1.: A chest radiograph obtained after placement of the 16-cm triple-lumen subclavian catheter. Arrow points to the distal tip of the catheter.Figure 2.: A chest radiograph obtained after placement of the 20-cm double-lumen subclavian catheter. Arrow points to the distal tip of the catheter.Standard central venous access catheters placed in subclavian veins may not be long enough in some obese patients. Longer length catheters should be considered for these patients. When using any multilumen catheter, all lumens should be checked to confirm intravascular position after placement. In morbidly obese patients catheter position can change with movement (3), so position should be reconfirmed periodically. E. Ottestad, MD C. Schmiessing, MD John G. Brock-Utne, MD, PhD V. Kulkarni, MD D. Parris, MD J. B. Brodsky, MD Department of Anesthesia Stanford University Medical Center Stanford, CA [email protected]

Influence of orientations of guidewire tip on the placement of subclavian venous catheters

The role of a J-type guidewire tip has been known to prevent vascular or cardiac wall damage. We hypothesized that the course of the guidewire may be influenced by the initial orientations of the J-type guidewire tip during the subclavian approach. The purpose of this study was to investigate the influence of the direction of the needle bevel and J-wire tip on successful placement of subclavian catheters. A total of 140 adult patients of either sex were studied. Patients were randomly divided by the direction of the needle bevel (neutral vs. downward) and the direction of the J-wire tip (upward vs. downward). Under general anesthesia, right infraclavicular subclavian catheterization was attempted using the Seldinger technique. There was no statistically significant difference among the successful and unsuccessful placements in relation to factors including sex, body mass index, and needle bevel direction. The success rate was high when the J-wire tip was directed downward (P = 0.001). These data suggest that the orientation of the J-wire tip downward can increase successful placement rates of right subclavian venous catheterization.