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Claudia Schummer

Publications and source records attributed to Claudia Schummer.

At least 19 recordsLinked to original sources
PubMed2006

Implication of the anatomy of the pericardial reflection on positioning of central venous catheters.

OBJECTIVE: Central venous catheterization is associated with a significant incidence of complications (5%-20%). The incidence of perforation is approximately 0.25% to 0.4%. To prevent cardiac tamponade associated with a high risk of death, Food and Drug Administration guidelines state that the tip of a central venous catheter (CVC) should not be placed in, or allowed to migrate into, the heart. Therefore, in order to prevent cardiac tamponade, a catheter should be placed above the pericardial reflection. Thus, the intrapericardial length of the superior vena cava (SVC) was studied. Neither the pericardial reflection nor the exact entrance to the right atrium (RA) can be identified by chest x-ray. The goal of this study was to evaluate the variability of the intrapericardial section in relation to the SVC. DESIGN: Observational study. INTERVENTIONS: The absolute length of the SVC, the upper edge of the pericardial reflection on the SVC, and the lateral and the medial intrapericardial sections of the SVC were recorded and statistically analyzed. SETTING: Medical school: dissecting room at the Department of Anatomy. STUDY POPULATION: Eighteen formalin-preserved adult cadavers. MEASUREMENTS AND MAIN RESULTS: The median lengths measured were as follows: total SVC, 61 mm; intrapericardial section of the medial SVC, 32.5 mm; and lateral SVC, 20.5 mm. The intrapericardial section was related to the total length of the SVC on both sides (Spearman rank order, p < 0.05). The median difference of the SVC covered with pericardium between the lateral and medial side was 11 mm (range, 5-21). In 15 of 18 cadavers, the pericardial reflection ran within the medial third of the SVC. The lower third of the SVC was regularly covered by the pericardium. The duplication of the pericardium crossed the SVC in the medial third at a diagonal to horizontal angle. CONCLUSIONS: Catheters ending below the pericardial reflection, hence positioned in the caudal third of the SVC, are likely to run along the long axis of the vein and the risk for perforation is minimized. Therefore, the authors recommend placing all catheters below the pericardial reflection. According to the present data, CVCs placed approximately 30 mm above the RA border, thus complying with the Food and Drug Administration guidelines, still may have their tips positioned below the pericardial reflection. In this position, pericardial tamponade still may occur. Perforation above the pericardial reflection will result in a hemo- or hydrothorax/mediastinum. A bedside method to determine the position of the CVC with respect to the pericardial reflection (eg, electrocardiographic guidance) should be used.

Adult↗
PubMed2006

Ultrasound-guided central venous cannulation: is there a difference between Doppler and B-mode ultrasound?

STUDY OBJECTIVE: To compare the success of Doppler and B-mode ultrasound-guided internal jugular vein (IJV) catheterization with respect to body mass index (BMI). STUDY DESIGN: Prospective, randomized study. SETTING: Section for cardiovascular anesthesia of a university hospital. PATIENTS: 338 consenting patients were analyzed. INTERVENTIONS: Subjects receiving central venous catheters for scheduled cardiac surgery were divided into two groups. After induction of general anesthesia, the right or left IJV was assessed for midcervical cannulation approach. In the Doppler group (n = 189), a SonoGuide2 with a 5.0-MHz probe was used. In the B-mode group (n = 149), the SiteRite II ultrasound system with a 7.5-MHz transducer was used. MEASUREMENTS AND MAIN RESULTS: There was a significant difference in the success rate of first needle pass between the two groups: Doppler group, 91% (172/189); B-mode group, 96.6% (144/149) (P = 0.045). A BMI of 30 and greater was associated with a significantly lower first needle pass success rate in the Doppler group (Doppler group, 77.1% [27/35]; B-mode group, 97.4% [38/39]; P = 0.011). The success rates in patients with a BMI below 30 for both methods were not different (Doppler group, 94.2% [145/154]; B-mode group, 96.4% [106/110]; P = 0.567). Arterial punctures occurred three times under Doppler guidance and twice under B-mode guidance. CONCLUSION: Cannulation of the IJV can be ensured and first needle pass success rate maximized by both ultrasound techniques. In patients with a BMI greater than 30, B-mode technique is superior to Doppler ultrasound.

Adolescent↗
PubMed2005

Extravasation injury in the perioperative setting.

Extravasation is an unintentional injection or leakage of fluid in the perivascular or subcutaneous space. Extravasation injury results from a combination of factors, including solution cytotoxicity, osmolality, vasoconstrictor properties, infusion pressure, regional anatomical peculiarities, and other patient factors. We reviewed the hospital files of patients who had sustained a significant extravasation injury in the perioperative setting at two German hospitals. These cases highlight the risk of devastating consequences from extravasation injury. Vasoactive drugs and hyperosmolar and concentrated electrolyte solutions are the predominant vesicants in the perioperative setting. Prompt and appropriate intervention is important for avoiding or minimizing extensive tissue injury.

Adult↗
PubMed2004

Expect the unexpected: malposition of a large-bore central venous catheter in the urinary bladder.

We report the case of a femoral vein cannulation in a critically ill trauma patient with the malposition of a large-bore central venous catheter in the urinary bladder. Recognition of the malposition was hampered by bloody tamponade of the bladder in the context of blunt thoraco-abdominal trauma with kidney and liver laceration. A high index of clinical suspicion and the institution of adequate therapy were the key to achieving a successful clinical outcome. We discuss the anatomy of femoral veins, including their close relation to a distended bladder. The application of ultrasound even in emergency situations is stressed.

Accidents, Traffic↗
PubMed2004

The anterior jugular venous system: variability and clinical impact.

The anterior jugular venous system, with its interconnections to the subclavian and deep jugular veins, provides a collateral venous network across the midline of the neck area, which is especially important in unilateral occlusion of an innominate vein. We illustrate the variability of this system and its clinical impact on catheterization by three cases of landmark-guided central venous cannulation. Case 1: Cannulation of the left internal jugular vein with a central venous catheter and of the left innominate vein (LIV) with a pulmonary artery catheter resulted in correctly positioned catheter tips. However, these catheters were actually not placed in the innominate vein but coursed through the jugular venous arch. Case 2: Cannulation of the left subclavian vein was complicated by resistance of guidewire advancement at 13 cm. Occlusion of the LIV and enlargement of the jugular venous arch were present. Case 3: Insertion of a pulmonary artery catheter and a central venous catheter through the LIV. The pulmonary artery catheter was correctly placed. The tip of the central venous catheter was mistakenly positioned in the left anterior jugular vein. We describe the normal anatomy of the anterior jugular venous system and its role as a major collateral. Correct placement of central venous catheters may be possible via the anterior jugular venous system. Conversely, central venous catheters malpositioned in the anterior jugular vein can increase the risk for complications and should be removed.

Abscess↗
PubMed2003

Doppler-guided cannulation of internal jugular vein, subclavian vein and innominate (brachiocephalic) vein--a case-control comparison in patients with reduced and normal intracranial compliance.

OBJECTIVE: A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance. DESIGN: A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position. SETTING: We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital. PATIENTS AND PARTICIPANTS: The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out. MEASUREMENTS AND RESULTS: The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%. CONCLUSIONS: This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.

Adolescent↗
PubMed2003

Delayed diagnosis of right-sided diaphragmatic rupture.

Diaphragmatic rupture is uncommon and results from either blunt or penetrating trauma. Right-sided traumatic diaphragmatic ruptures are easily missed. We present a case of rupture of the right diaphragm, which highlights the difficulty of confirming the correct diagnosis.

Accidents, Traffic↗