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At least 19 recordsLinked to original sources
PubMed1998

Technical aspects of central venous catheterization.

Central venous access has been widely used in the treatment of different categories of patients but it is associated with a wide range of complications. Different catheters, approaches and techniques have been employed to minimize those complications related to catheter insertion as well as those related to the prolonged use of catheters. This article reviews the technical aspects of central venous catheterization and associated complications.

Arm↗
PubMed1982

Internal thoracic vein cannulation as a complication of central venous catheterization.

Central venous catheterization is utilized in resuscitation and evaluation of the severely ill patient. It is also employed for total parenteral nutrition. The list of potential complications is extensive and includes catheter malposition, with its attendant morbidity, as the most frequent complication. Inaccurate venous pressure measurements and mediastinal phlebitis have been cited as natural sequelae of inadvertent catheterization of the internal thoracic (mammary) vein (ITV). The histories of four patients who had ITV cannulation are analyzed as to indications for central venous catheterizations, site of insertion, time of delayed recognition, and attendant complications. In addition, the records of 150 consecutive patients who underwent central venous line placement were reviewed to determine the number of lines placed (242), the number and percentage of postcatheterization chest films obtained with standard posterior-anterior (P-A) and lateral technique (70, 29%), the number and incidence of catheterization-associated complications (78, 32%), and the number and incidence of ITV cannulation (5, 2%). No untoward results were seen as a result of this complication in the nine patients discovered, although the potential for morbidity was present. Subtle changes on portable chest films and standard technique P-A and lateral films remain the best protection against complications associated with ITV cannulation.

Adult↗
PubMed2006

Life threatening mediastinal haematoma: a complication of central venous catheterization.

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve. One should be careful in selection of venous access and be aware of alternatives routes.

Catheterization, Central Venous↗
PubMed2002

Brachiocephalic veins: an overlooked approach for central venous catheterization.

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

Adolescent↗
PubMed1985

Supraclavicular central venous catheterization.

Percutaneous central venous catheterization is a well-accepted procedure for cardiac monitoring, total parenteral nutrition, and long-term drug therapy. The supraclavicular approach was used for 90 catheterizations in 81 gynecologic patients to evaluate ease of insertion, complication rate, and patient compliance. Anatomic considerations, insertion technique, and the rationale for the supraclavicular approach are discussed in detail. A successful catheterization rate of 91% was achieved with acceptable morbidity. There were three instances each of pneumothorax, catheter malposition, and catheter infection. Advantages of the supraclavicular approach include a wider target area, a more direct route to the superior vena cava, and less pain on insertion. With reliable and constant landmarks, relative ease of and comfort on insertion, and low complication rate, the supraclavicular technique is the preferred method when percutaneous central venous catheterization is indicated.

Adult↗
PubMed2005

Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

Adult↗
PubMed1981

Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.

Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized.

Adolescent↗
PubMed1979

Complications of central venous catheterization.

The complications of central venous catheterization are discussed in a review of experience and of the literature. The anatomy surrounding the subclavian and internal jugular veins is described. Indications and contraindications of catheterization are reported. Common and unusual complications are discussed and illustrated. Laceration of pleura, subclavian artery puncture, hematoma, catheter malposition, fragment embolization, air embolism, venous thrombosis, and infection are included. The radiologist is responsible for recognizing immediate, as well as delayed, complications of central venous catheterization.

Blood Vessels↗
PubMed2006

The accuracy of the central landmark used for central venous catheterization of the internal jugular vein.

We simulated needle paths based on the central landmark used for central venous catheterization of the internal jugular vein. We obtained ultrasound images to quantify the landmark's accuracy (precision and bias) in 107 subjects placed in Trendelenburg position with their heads turned 30-35 degrees. We also determined the frequency of simulated carotid artery puncture. The simulated needle path missed the middle 80% of the lumen of the internal jugular vein in 34% of subjects (95% confidence interval [CI], 25% to 44%) and traversed the carotid artery in 26% of subjects (95% CI, 18% to 35%). Both events occurred in 20% of subjects (95% CI, 13%-29%). The landmark had a medial bias of 3.7 mm (95% CI, 2.7 to 4.8); it was more often (77 of 104 subjects) medial to the center of the right internal jugular vein (P < 0.001). The landmark was more likely to miss the internal jugular vein (odds ratio, 3.11; P < 0.016) and intersect the carotid (odds ratio, 3.03; P < 0.024) in obese patients. The central landmark should not be expected to yield frequent success on first needle pass without risk of carotid puncture because of its imprecision and bias. The measured bias should be considered when the central landmark is used for central venous catheterization.

Adolescent↗
PubMed1999

Fatal cardiac tamponade as a late complication of central venous catheterization: a case report.

Central venous catheterization is a reliable technique in neonatal surgery. Nevertheless, the rate of mechanical catheter-related complications remains high. We report a neonate with gastroschisis in which the successful placement of a central venous catheter was followed later by a cardiac tamponade with a fatal outcome. This complication occurred without perforation of the cardiac wall. A similar finding has been reported in only one other pediatric patient. Vigilant observation is required in any neonate with a central venous line in place to prevent the occurrence of this life-threatening event.

Cardiac Tamponade↗
PubMed1987

Central venous catheterization and fatal air embolism.

Central venous catheterization is an established procedure in medical, surgical and anaesthetic practice. However, the procedure is not without hazard. One complication that may be life-threatening is air embolism. This article considers the causes of air embolism related to central venous catheterization, its treatment and methods of prevention.

Catheterization, Central Venous↗
PubMed1992

[Central venous catheterization via the axillary vein].

Central venous catheterization is a common procedure in the intensive care unit. The vessels usually selected for access include those of the arm and the external and internal jugular, subclavian and femoral veins. We find the axillary vein also suitable. It is a safe and reliable route with few complications, and is especially recommended in ventilated and/or tracheotomized patients. We describe our experience in 80 patients, with a success rate of 90% and very few complications.

Axillary Vein↗
PubMed1992

Emergency central venous catheterization during resuscitation of trauma patients.

Central venous catheterization during resuscitation of trauma patients remains controversial. Such catheterizations performed at the UMDNJ-Robert Wood Johnson Medical School at Camden Cooper Hospital/University Medical Center (Camden, NJ) trauma center for the period January 1, 1988 to December 31, 1989 were retrospectively reviewed. Patients with underlying hemothorax, pneumothorax, or resuscitative thoracotomy were excluded. There were 269 catheters inserted using the Seldinger technique. Catheters were placed via the internal jugular or subclavian veins by attending traumatologists or emergency medicine and surgical house staff under direct attending supervision. Of 238 patients ages 6 to 90 years, 156 were men. Mean Trauma Score and Injury Severity Score were 9 and 30, respectively. Patients were divided into two groups: patients undergoing cardiopulmonary resuscitation or in shock (systolic bp less than 90) during resuscitation (Group 1: n - 161); and patients not in shock (Group 2: n - 77). Thirty patients (Group 1a) expired in the resuscitation area. The remainder (Group 1b) with 150 catheterizations had 12 complications (8%): pneumothorax (8), hemothorax (1), and malposition (3). Group 2, with 80 catheterizations, had 6 complications (7.5%): pneumothorax (4), hematoma (1), and malposition (1). The complication rate for patients surviving the resuscitation (230 catheterizations) was 7.8 per cent. There were no catheter-related deaths. In conclusion, emergency central venous catheterization during resuscitation of trauma patients carries a relatively low risk of serious complications when performed by experienced physicians.

Adolescent↗
PubMed1997

Surgical management of Candida suppurative thrombophlebitis of superior vena cava after central venous catheterization.

Septic deep venous thrombosis is a major complication associated with central venous catheterization in intensive care units. The most common causative organisms are Staphylococcus aureus, gram-negative bacilli and Candida species. The incidence of Candida infections is increasing, especially in intensive care patients receiving total parenteral nutrition and long-term broad-spectrum antibiotics. Although intravascular catheter-induced septic thrombophlebitis is quite common, superior vena cava obstruction is a rare complication. However, few data exist concerning the best strategy for managing septic thrombophlebitis, especially when medical therapy fails. We report successful surgical management of Candida albicans suppurative thrombosis of the superior vena cava in a young patient.

Adolescent↗
PubMedDate not supplied

Hemidiaphragmatic paralysis as a complication of central venous catheterization in a neonate.

Central venous catheter placement has become commonplace in the care of the premature infant because of the need for long-term venous access. Although generally considered safe, there have been numerous reports of complications from the use of these catheters. We report the case of an infant in whom right hemidiaphragmatic paralysis developed after extravasation of fluid from a central venous catheter. The case emphasizes the need for continued vigilance of central venous catheter location and function.

Catheterization, Central Venous↗
PubMedDate not supplied

Subclavian central venous catheterization complicated by guidewire looping and entrapment.

The placement of central venous catheters is a technically challenging procedure with known risks and complications. We report an attempted left subclavian central venous catheterization that was complicated by looping and entrapment of the guidewire. We hypothesize that this complication occurred because the straight guidewire that was used may have perforated the wall of the vein, allowing the guidewire to loop upon itself. Although catheter looping and knotting are well known potential complications of central venous catheterization, similar complications are rarely reported with guidewires. Clinicians should be aware of these potential complications when performing or teaching central venous catheterization.

Catheterization, Central Venous↗
PubMedDate not supplied

Neonatal dural venous sinus thrombosis associated with central venous catheterization: CT and MR studies.

We report a case of extensive thrombosis of dural venous sinuses associated with placement of a central venous catheter in the jugular vein. Cases such as this one, though uncommon, underscore a potentially devastating complication associated with central venous catheterization and emphasize caution in catheter placement particularly in neonates.

Catheterization, Central Venous↗