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Correction of malposition of central venous catheter with 9-Fr introducer sheath assisted by mobile type diagnostic X-ray apparatus: a case report.

Ryu J, Yoon JH, Lee EJ, Lee CA, Woo SC, Jeong CY - Korean J Anesthesiol (2015)

Bottom Line: They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation.Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance.Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesioloy and Pain Medicine, Eulji University School of Medicine, Daejeon, Korea.

ABSTRACT
Central venous catheters provide long-term available vascular access. They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation. Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance. The complications of central venous catheterization are frequent, which include malposition, pneumothorax, hemothorax, chylothorax, arterial puncture, hematoma, air embolism and infection. Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade. In this case, we report a malposition of central venous catheter with 9-Fr introducer sheath which is located in the right subclavian vein via ipsilateral internal jugular vein and the correction of this misplacement assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope).

No MeSH data available.


Related in: MedlinePlus

Correction of the malposition of central venous catheter assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope). The central venous catheter tips are located (A) in the right subclavian vein and (D) in the superior vena cava. The J-wire tips are located (B) in the junction of the right internal jugular vein and (C) in superior vena cava.
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Figure 2: Correction of the malposition of central venous catheter assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope). The central venous catheter tips are located (A) in the right subclavian vein and (D) in the superior vena cava. The J-wire tips are located (B) in the junction of the right internal jugular vein and (C) in superior vena cava.

Mentions: In order to expand the internal jugular vein for central venous catheter insertion, the patient had her right arm fixed to the trunk in the Trendelenburg position. With a small pillow placed underneath the right shoulder and head turned to the left, the position facilitated access to the right internal jugular vein. A venipuncture site was sterilized for an aseptic procedure. Left-handed palpation was performed on the internal carotid artery, lying between and beneath two bodies of the right sternocleidomastoid muscle and located 3 cm above the superior border of the clavicle. An 18-gauge central venous needle was inserted towards the ipsilateral nipple at a point 1.5 cm medial to the external jugular vein. A 5 ml syringe connected to the inserted needle was used for aspiration, and the color and pressure of the blood confirmed that it was venous blood. After removal of the syringe, a J-tip guide wire was inserted with its end pointing toward the heart. The guide wire was inserted smoothly up to 20 cm. After removal of the needle and the incision on the skin, a 9-Fr introducer sheath (Advanced Venous Access HF®, Edwards Lifesciences, Irvine, USA) accompanying dilator for the catheter was pushed in along the guide wire. There was a slight feeling of something getting stuck in the middle, which is normally experienced during successful central venous catheter placement. The insertion was made without much resistance, and the aspiration of blood from all three lumens of the catheter was successful. An intravenous catheter (PreSep™-central venous oximetry catheter set, Edwards Lifesciences, Irvine, USA) with each of its lumens filled with saline solution was inserted up to 20 cm through the introducer. Then, it was pulled back 3 cm to check again for blood aspiration. No noticeable resistance, arrhythmia, or changes in vital signs were observed during the insertion of the intravenous catheter. Monitoring of central venous pressure or central vein oxygen saturation was yet to be performed, and there were no signs of abnormal placement of the central venous catheter or other complications related to the procedure. However, a portable X-ray performed immediately after the procedure revealed that the end of the catheter was inserted to the ipsilateral subclavian vein (Figs. 1 and 2A). The authors first considered removing the inserted catheter entirely and using the left internal jugular vein but finally decided to correct the placement under image guidance with the catheter inserted after taking various circumstances into account.


Correction of malposition of central venous catheter with 9-Fr introducer sheath assisted by mobile type diagnostic X-ray apparatus: a case report.

Ryu J, Yoon JH, Lee EJ, Lee CA, Woo SC, Jeong CY - Korean J Anesthesiol (2015)

Correction of the malposition of central venous catheter assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope). The central venous catheter tips are located (A) in the right subclavian vein and (D) in the superior vena cava. The J-wire tips are located (B) in the junction of the right internal jugular vein and (C) in superior vena cava.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524941&req=5

Figure 2: Correction of the malposition of central venous catheter assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope). The central venous catheter tips are located (A) in the right subclavian vein and (D) in the superior vena cava. The J-wire tips are located (B) in the junction of the right internal jugular vein and (C) in superior vena cava.
Mentions: In order to expand the internal jugular vein for central venous catheter insertion, the patient had her right arm fixed to the trunk in the Trendelenburg position. With a small pillow placed underneath the right shoulder and head turned to the left, the position facilitated access to the right internal jugular vein. A venipuncture site was sterilized for an aseptic procedure. Left-handed palpation was performed on the internal carotid artery, lying between and beneath two bodies of the right sternocleidomastoid muscle and located 3 cm above the superior border of the clavicle. An 18-gauge central venous needle was inserted towards the ipsilateral nipple at a point 1.5 cm medial to the external jugular vein. A 5 ml syringe connected to the inserted needle was used for aspiration, and the color and pressure of the blood confirmed that it was venous blood. After removal of the syringe, a J-tip guide wire was inserted with its end pointing toward the heart. The guide wire was inserted smoothly up to 20 cm. After removal of the needle and the incision on the skin, a 9-Fr introducer sheath (Advanced Venous Access HF®, Edwards Lifesciences, Irvine, USA) accompanying dilator for the catheter was pushed in along the guide wire. There was a slight feeling of something getting stuck in the middle, which is normally experienced during successful central venous catheter placement. The insertion was made without much resistance, and the aspiration of blood from all three lumens of the catheter was successful. An intravenous catheter (PreSep™-central venous oximetry catheter set, Edwards Lifesciences, Irvine, USA) with each of its lumens filled with saline solution was inserted up to 20 cm through the introducer. Then, it was pulled back 3 cm to check again for blood aspiration. No noticeable resistance, arrhythmia, or changes in vital signs were observed during the insertion of the intravenous catheter. Monitoring of central venous pressure or central vein oxygen saturation was yet to be performed, and there were no signs of abnormal placement of the central venous catheter or other complications related to the procedure. However, a portable X-ray performed immediately after the procedure revealed that the end of the catheter was inserted to the ipsilateral subclavian vein (Figs. 1 and 2A). The authors first considered removing the inserted catheter entirely and using the left internal jugular vein but finally decided to correct the placement under image guidance with the catheter inserted after taking various circumstances into account.

Bottom Line: They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation.Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance.Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesioloy and Pain Medicine, Eulji University School of Medicine, Daejeon, Korea.

ABSTRACT
Central venous catheters provide long-term available vascular access. They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation. Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance. The complications of central venous catheterization are frequent, which include malposition, pneumothorax, hemothorax, chylothorax, arterial puncture, hematoma, air embolism and infection. Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade. In this case, we report a malposition of central venous catheter with 9-Fr introducer sheath which is located in the right subclavian vein via ipsilateral internal jugular vein and the correction of this misplacement assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope).

No MeSH data available.


Related in: MedlinePlus