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Nova-Baeza P, Valenzuela-Fuenzalida JJ, Valdivia-Arroyo R, Becerra-Rodríguez ES, Escalona-Manzo C, Castaño-Gallego YT, Luque-Bernal RM, Oyanedel-Amaro G, Suazo-Santibáñez A, Orellana-Donoso M, Bruna-Mejias A, Sanchis-Gimeno J, Gutiérrez-Espinoza H. Systematic Review and Meta-Analysis of Internal Jugular Vein Variants and Their Relationship to Clinical Implications in the Head and Neck. Diagnostics (Basel) 2024; 14:2765. [PMID: 39682673 DOI: 10.3390/diagnostics14232765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/05/2024] [Accepted: 11/18/2024] [Indexed: 12/18/2024] Open
Abstract
Background: The internal jugular vein (IJV) is a vascular structure that is responsible for the venous drainage of both the head and neck and is commonly found posterior to the internal carotid artery and adjacent to cervical lymph nodes or nerve structures such as the glossopharyngeal and accessory nerves. As a vagal nerve, it is an important reference point for surgical access in neck interventions and dissections. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until August 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 10 studies met the established selection criteria in this meta-analysis study. The prevalence of variants of the IJV was 3.36% (CI: 2.81-6.96%), with a heterogeneity of 94.46%. Regarding the subgroup analysis, no study presents statistically significant differences in the studies analyzed for this review. Conclusions: Knowing the IJV variants in detail will make early diagnosis useful, especially in surgeries in the neck region and in classic surgeries such as thyroidectomies and tracheostomies, among others. It will be important to know the position of the IJV.
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Affiliation(s)
- Pablo Nova-Baeza
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7501015, Chile
| | - Juan José Valenzuela-Fuenzalida
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7501015, Chile
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago 8370854, Chile
| | - Rocio Valdivia-Arroyo
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7501015, Chile
| | | | - Catalina Escalona-Manzo
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7501015, Chile
| | | | | | - Gustavo Oyanedel-Amaro
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 8910060, Chile
| | | | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Santiago 8420524, Chile
| | - Alejandro Bruna-Mejias
- Department of Morphology, Faculty of Medicine, Universidad Andres Bello, Santiago 7501015, Chile
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
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Abdo EM, Abouelgreed TA, Elshinawy WE, Farouk N, Ismail H, Ibrahim AH, Kasem SA, Sakr LK, Aboelsoud NM, Abdelmonem NM, Abdelkader SF, Abdelwahed AA, Qasem AA, Alassal MF, Aboomar AA. The outcome of ultrasound-guided insertion of central hemodialysis catheter. Arch Ital Urol Androl 2023; 95:11588. [PMID: 37791552 DOI: 10.4081/aiua.2023.11588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients. METHODS This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk. RESULTS All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion. CONCLUSIONS Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.
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Affiliation(s)
- Ehab M Abdo
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Waleed E Elshinawy
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Nehal Farouk
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Hassan Ismail
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Amal H Ibrahim
- Department of internal medicine, Nephrology Unit, Faculty Medicine, Al-Azhar University, Cairo.
| | - Samar A Kasem
- Department of internal medicine, Nephrology Unit, Faculty Medicine, Al-Azhar University, Cairo.
| | - Lobna Kh Sakr
- Department of Radiology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Naglaa M Aboelsoud
- Department of Radiology, Faculty of medicine, Al-Azhar University, Cairo.
| | | | - Salma F Abdelkader
- Department of Radiology, Faculty of Medicine Ain Shams University, Cairo.
| | - Ahmed A Abdelwahed
- Department of Radiology, Faculty of Medicine Ain Shams University, Cairo.
| | - Anas A Qasem
- Department of Internal Medicine, Faculty Medicine, Zagazig University, Zagazig.
| | - Mosab F Alassal
- Department of Vascular Surgery, Saudi German Hospital, Ajman.
| | - Ahmed A Aboomar
- Department of internal medicine, Nephrology Unit, Faculty Medicine, Tanta University, Tanta.
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Takeshita J, Nakajima Y, Tachibana K, Hamaba H, Yamashita T, Shime N. Combined short-axis out-of-plane and long-axis in-plane approach versus long-axis in-plane approach for ultrasound-guided central venous catheterization in infants and small children: A randomized controlled trial. PLoS One 2022; 17:e0275453. [PMID: 36178956 PMCID: PMC9524688 DOI: 10.1371/journal.pone.0275453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
The ultrasound-guided long-axis in-plane approach for central venous catheterization in infants and small children can prevent posterior wall penetration. The combined short-axis out-of-plane and long-axis in-plane approach reportedly prevents such penetration in adults. To test the hypothesis of non-inferiority of the combined approach to the long-axis in-plane approach, we compared the two approaches in infants and small children. Patients were randomized based on whether they underwent ultrasound-guided internal jugular vein catheterization using the combined or long-axis in-plane approach. Posterior wall penetration rates, first-attempt success rates, overall success rates within 20 min; scanning, puncture, and procedure durations; and number of attempts were compared between the groups. In the combined and long-axis in-plane groups (n = 55 per group), the posterior wall penetration rates were 5.5% (3/55) and 3.6% (2/55) (P = 0.65), the first-attempt success rates were 94.5% (52/55) and 92.7% (51/55) (P = 0.70), and the overall success rates within 20 min were 100% (55/55) and 98.2% (54/55) (P = 0.32), respectively. In the combined and long-axis in-plane groups, the median (interquartile range) scanning durations were 21 (16.5–34.8) s and 47 (29.3–65) s (P<0.0001), the puncture durations were 114 (83–170) s and 74 (52.3–117.3) s (P = 0.0002), and the procedure durations were 141 (99–97.8) s and 118 (88.5–195.5) s (P = 0.14), respectively. The median number of attempts was 1 (interquartile range: 1–1, range: 1–3) in both groups (P = 0.72). Similar to the long-axis in-plane approach, the combined approach for internal jugular vein catheterization prevented posterior wall penetration in infants and small children. Trial registration: This trial was registered before patient enrollment in the University Hospital Medical Information Network Clinical Trials Registry, registration number UMIN000039387 (https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000044907).
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Affiliation(s)
- Jun Takeshita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women’s and Children’s Hospital, Osaka, Japan
- Department of Anesthesiology, Kansai Medical University Hospital, Osaka, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kansai Medical University Hospital, Osaka, Japan
- Outcomes Research Consortium, Cleveland, OH, United States of America
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Hirofumi Hamaba
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Tomonori Yamashita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
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Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A Randomized Controlled Trial. Pediatr Crit Care Med 2020; 21:e996-e1001. [PMID: 32590831 DOI: 10.1097/pcc.0000000000002476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia. DESIGN Prospective randomized controlled trial. SETTING Operating room of Osaka Women's and Children's Hospital. PATIENTS Pediatric patients less than 5 years old who underwent cardiovascular surgery. INTERVENTIONS Ultrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach. MEASUREMENTS AND MAIN RESULTS The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98). CONCLUSIONS The long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.
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Tanabe H, Kawasaki M, Ueda T, Yokota T, Zushi Y, Murayama R, Abe-Doi M, Sanada H. A short bevel needle with a very thin tip improves vein puncture performance of peripheral intravenous catheters: An experimental study. J Vasc Access 2020; 21:969-976. [PMID: 32372685 DOI: 10.1177/1129729820920108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripheral intravenous catheter placement is frequently unsuccessful at the first attempt. One suggested risk factor is a small vein size, because of the consequences of mechanical forces generated by the needle tip. We developed short bevel needles with a very thin tip and evaluated their puncture performance in two in vitro models. METHODS Peripheral intravenous catheters with a new needle ground using the lancet method (experimental catheter (L)) or backcut method (experimental catheter (B)) were compared with a conventional peripheral intravenous catheter (Surshield Surflo®) in a penetration force test and a tube puncture test. Penetration forces were measured when peripheral intravenous catheters penetrated a polyethylene sheet. The tube puncture test was used to evaluate whether the peripheral intravenous catheters could puncture a polyvinyl chloride tube at two positions, at the center and at 0.5 mm from the center of the tube. RESULTS Mean penetration forces at the needle tip produced by experimental catheters (L) (0.05 N) and (B) (0.04 N) were significantly lower than those produced by the conventional catheter (0.09 N) (p < 0.01). At the catheter tip, mean forces produced by experimental catheter (B) and the conventional catheter were 0.16 N and 0.26 N, respectively (p < 0.05). In the tube puncture test, the frequency at which the conventional catheter punctured the center-shifted site on the tube at an angle of 20° and speed of 50 mm/min was low (40%). In contrast, experimental catheters (L) and (B) were 100% successful at puncturing both the center and center-shifted sites at 20°. CONCLUSION Puncture performance was comparable between the lancet-ground and backcut-ground needles except for penetration forces at the catheter tip. The experimental catheters produced lower penetration forces and induced puncture without target displacement at smaller angles compared with the conventional catheter. Therefore, optimization of the needle can prevent vein deformation and movement, which may increase the first-attempt success rate.
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Affiliation(s)
- Hidenori Tanabe
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research and Development Center, Terumo Corporation, Ashigarakami-gun, Japan
| | - Manami Kawasaki
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Japan
| | | | | | - Yasunobu Zushi
- Research and Development Center, Terumo Corporation, Ashigarakami-gun, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Takeshita J, Nishiyama K, Fukumoto A, Shime N. Combined Approach Versus 2 Conventional Approaches in Ultrasound-Guided Central Venous Catheterization: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2019; 33:2979-2984. [DOI: 10.1053/j.jvca.2019.03.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/18/2019] [Accepted: 03/23/2019] [Indexed: 11/11/2022]
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Takeshita J, Nishiyama K, Fukumoto A, Shime N. Comparing Combined Short-Axis and Long-Axis Ultrasound-Guided Central Venous Catheterization With Conventional Short-Axis Out-of-Plane Approaches. J Cardiothorac Vasc Anesth 2019; 33:1029-1034. [DOI: 10.1053/j.jvca.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 11/11/2022]
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8
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Three-step procedure for safe internal jugular vein catheterization under ultrasound guidance. J Med Ultrason (2001) 2018; 45:671-673. [DOI: 10.1007/s10396-018-0885-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022]
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van de Weerdt EK, Biemond BJ, Zeerleder SS, van Lienden KP, Binnekade JM, Vlaar APJ. Prophylactic platelet transfusion prior to central venous catheter placement in patients with thrombocytopenia: study protocol for a randomised controlled trial. Trials 2018; 19:127. [PMID: 29463280 PMCID: PMC5819660 DOI: 10.1186/s13063-018-2480-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe thrombocytopenia should be corrected by prophylactic platelet transfusion prior to central venous catheter (CVC) insertion, according to national and international guidelines. Even though correction is thought to prevent bleeding complications, evidence supporting the routine administration of prophylactic platelets is absent. Furthermore, platelet transfusion bears inherent risk. Since the introduction of ultrasound-guided CVC placement, bleeding complication rates have decreased. The objective of the current trial is, therefore, to demonstrate that omitting prophylactic platelet transfusion prior to CVC placement in severely thrombocytopenic patients is non-inferior compared to prophylactic platelet transfusion. METHODS/DESIGN The PACER trial is an investigator-initiated, national, multicentre, single-blinded, randomised controlled, non-inferior, two-arm trial in haematologic and/or intensive care patients with a platelet count of between 10 and 50 × 109/L and an indication for CVC placement. Consecutive patients are randomly assigned to either receive 1 unit of platelet concentrate, or receive no prophylactic platelet transfusion prior to CVC insertion. The primary endpoint is WHO grades 2-4 bleeding. Secondary endpoints are any bleeding complication, costs, length of intensive care and hospital stay and transfusion requirements. DISCUSSION This is the first prospective, randomised controlled trial powered to test the hypothesis of whether omitting forgoing platelet transfusion prior to central venous cannulation leads to an equal occurrence of clinical relevant bleeding complications in critically ill and haematologic patients with thrombocytopenia. TRIAL REGISTRATION Nederlands Trial Registry, ID: NTR5653 ( http://www.trialregister.nl/trialreg/index.asp ). Registered on 27 January 2016. Currently recruiting. Randomisation commenced on 23 February 2016.
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Affiliation(s)
- Emma K van de Weerdt
- Department of Intensive Care Medicine, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,G3-228; Department of Intensive Care, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sacha S Zeerleder
- Department of Haematology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Krijn P van Lienden
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Jan M Binnekade
- Department of Intensive Care Medicine, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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10
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Takeshita J, Nishiyama K, Beppu S, Sasahashi N, Shime N. Combined short- and long-axis ultrasound-guided central venous catheterization is superior to conventional techniques: A cross-over randomized controlled manikin trial. PLoS One 2017; 12:e0189258. [PMID: 29216331 PMCID: PMC5720625 DOI: 10.1371/journal.pone.0189258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Visualizing the needle tip using the short-axis (SA) ultrasound-guided central venous catheterization approach can be challenging. It has been suggested to start the process with the SA approach and then switch to the long-axis (LA); however, to our knowledge, this combination has not been evaluated. We compared the combined short- and long-axis (SLA) approach with the SA approach in a manikin study. METHODS We performed a prospective randomized controlled cross-over study in an urban emergency department and intensive care unit. Resident physicians in post-graduate years 1-2 performed a simulated ultrasound-guided internal jugular vein puncture using the SA and SLA approaches on manikins. Twenty resident physicians were randomly assigned to two equal groups: (1) one group performed punctures using the SA approach followed by SLA; and (2) the other performed the same procedures in the opposite order. We compared the success rate and procedure duration for the two approaches. Procedural success was defined as insertion of the guide-wire into the vein while visualizing the needle tip at the time of anterior wall puncture, without penetrating the posterior wall. RESULTS Six resident physicians (30%) performed both approaches successfully, while 12 (60%) performed the SLA approach, but not the SA, successfully. Those who performed the SA approach successfully also succeeded with the SLA approach. Two resident physicians (10%) failed to perform both approaches. The SLA approach had a significantly higher success rate than the SA approach (P < 0.001). The median (interquartile range) procedure duration was 59.5 [46.0-88.5] seconds and 45.0 [37.5-84.0] seconds for the SLA and SA approaches, respectively. The difference of the duration between the two procedures was 15.5 [0-28.5] seconds. There was no significant difference in duration between the two approaches (P = 0.12). CONCLUSIONS Using the SLA approach significantly improved the success rate of internal jugular vein puncture performed by novice physicians on a manikin model, without increasing procedural duration. Further clinical trials are warranted to confirm the procedure's utility in actual patients. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000026199.
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Affiliation(s)
- Jun Takeshita
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
- * E-mail:
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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van de Weerdt EK, Biemond BJ, Baake B, Vermin B, Binnekade JM, van Lienden KP, Vlaar AP. Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications. Transfusion 2017; 57:2512-2525. [DOI: 10.1111/trf.14248] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Emma K. van de Weerdt
- Department of Intensive Care Medicine and the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.)Amsterdam the Netherlands
| | | | - Bart Baake
- Department of Intensive Care Medicine and the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.)Amsterdam the Netherlands
| | - Ben Vermin
- Department of Intensive Care Medicine and the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.)Amsterdam the Netherlands
| | - Jan M. Binnekade
- Department of Intensive Care Medicine and the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.)Amsterdam the Netherlands
| | | | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine and the Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.)Amsterdam the Netherlands
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12
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Routine Chest Radiography Is Not Necessary After Ultrasound-Guided Right Internal Jugular Vein Catheterization. Crit Care Med 2017; 44:e804-8. [PMID: 27035241 DOI: 10.1097/ccm.0000000000001737] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Central venous catheter placement is a common procedure performed on critically ill patients. Routine postprocedure chest radiographs are considered standard practice. We hypothesize that the rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low. DESIGN Retrospective chart review. SETTING Adult ICUs, emergency departments, and general practice units at an academic tertiary care hospital system. PATIENTS All 1,322 ultrasound-guided right internal jugular vein central venous catheter attempts at an academic tertiary care hospital system over a 1-year period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data from standardized procedure notes and postprocedure chest radiographs were extracted and individually reviewed to verify the presence of pneumothorax or misplacement, and any intervention performed for either complication. The overall success rate of ultrasound-guided right internal jugular vein central venous catheter placement was 96.9% with an average of 1.3 attempts. There was only one pneumothorax (0.1% [95% CI, 0-0.4%]), and the rate of catheter misplacement requiring repositioning or replacement was 1.0% (95% CI, 0.6-1.7%). There were no arterial placements found on chest radiographs. Multivariate regression analysis showed no correlation between high-risk patient characteristics and composite complication rate. CONCLUSIONS In a large teaching hospital system, the overall rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low. Routine chest radiograph after this common procedure is an unnecessary use of resources and may delay resuscitation of critically ill patients.
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13
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Cabrini L, Pappacena S, Mattioli L, Beccaria P, Colombo S, Bellomo R, Landoni G, Zangrillo A. Administration of blood products to prevent bleeding complications associated with central venous catheter insertion in patients at risk: a systematic review. Br J Anaesth 2017; 118:630-634. [PMID: 28403417 DOI: 10.1093/bja/aex060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Dincyurek GN, Mogol EB, Turker G, Yavascaoglu B, Gurbet A, Kaya FN, Moustafa BR, Yazici T. The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children. Singapore Med J 2016; 56:468-71. [PMID: 25597750 DOI: 10.11622/smedj.2015020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We compared the effects of various surgical positions, with and without the Valsalva manoeuvre, on the diameter of the right internal jugular vein (RIJV). METHODS We recruited 100 American Society of Anesthesiologists physical status class I patients aged 2-12 years. The patients' heart rate, blood pressure, peripheral oxygen saturation and end-tidal CO2 pressure were monitored. Induction of anaesthesia was done using 1% propofol 10 mg/mL and fentanyl 2 µg/kg, while maintenance was achieved with 2% sevoflurane in a mixture of 50/50 oxygen and air (administered via a laryngeal mask airway). The RIJV diameter was measured using ultrasonography when the patient was in the supine position. Thereafter, it was measured when the patient was in the supine position + Valsalva, followed by the Trendelenburg, Trendelenburg + Valsalva, reverse Trendelenburg, and reverse Trendelenburg + Valsalva positions. A 15° depression or elevation was applied for the Trendelenburg position, and an airway pressure of 20 cmH2O was applied in the Valsalva manoeuvre. During ultrasonography, the patient's head was tilted 20° to the left. RESULTS When compared to the mean RIJV diameter in the supine position, the mean RIJV diameter was significantly greater in all positions (p < 0.001) except for the reverse Trendelenburg position. The greatest increase in diameter was observed in the Trendelenburg position with the Valsalva manoeuvre (p < 0.001). CONCLUSION In paediatric patients, the application of the Trendelenburg position with the Valsalva manoeuvre gave the greatest increase in RIJV diameter. The reverse Trendelenburg position had no significant effect on RIJV diameter.
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Affiliation(s)
| | - Elif Basagan Mogol
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Gurkan Turker
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Belgin Yavascaoglu
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Alp Gurbet
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fatma Nur Kaya
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | | | - Tolga Yazici
- Department of Anesthesiology, Uludag University Faculty of Medicine, Bursa, Turkey
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Shrestha GS, Joshi P, Bhattarai K, Chhetri S, Acharya SP. Intranasal midazolam for rapid sedation of an agitated patient. Indian J Crit Care Med 2015. [PMID: 26195863 PMCID: PMC4478678 DOI: 10.4103/0972-5229.158279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rapidly, establishing a difficult intravenous access in a dangerously agitated patient is a real challenge. Intranasal midazolam has been shown to be effective and safe for rapidly sedating patients before anesthesia, for procedural sedation and for control of seizure. Here, we report a patient in intensive care unit who was on mechanical ventilation and on inotropic support for management of septic shock and who turned out extremely agitated after accidental catheter removal. Intravenous access was successfully established following sedation with intranasal midazolam, using ultrasound guidance.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pankaj Joshi
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Krishna Bhattarai
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Santosh Chhetri
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Subhash Prasad Acharya
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Singh SA, Sharma S, Singh A, Singh AK, Sharma U, Bhadoria AS. The safety of ultrasound guided central venous cannulation in patients with liver disease. Saudi J Anaesth 2015; 9:155-160. [PMID: 25829903 PMCID: PMC4374220 DOI: 10.4103/1658-354x.152842] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications. AIM To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy. SETTING AND DESIGN An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center. MATERIALS AND METHODS Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications. RESULTS The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing. CONCLUSION Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.
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Affiliation(s)
- Shweta A. Singh
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
| | - Sandeep Sharma
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
| | - Anshuman Singh
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
| | - Anil K. Singh
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
| | - Utpal Sharma
- Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
| | - Ajeet Singh Bhadoria
- Department of Clinical Research, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India
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17
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Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, Karavergou A, Rapti A, Trakada G, Katsikogiannis N, Tsakiridis K, Karapantzos I, Karapantzou C, Barbetakis N, Zissimopoulos A, Kuhajda I, Andjelkovic D, Zarogoulidis K, Zarogoulidis P. Pneumothorax as a complication of central venous catheter insertion. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:40. [PMID: 25815301 DOI: 10.3978/j.issn.2305-5839.2015.02.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 12/12/2022]
Abstract
The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.
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Affiliation(s)
- Nikolaos Tsotsolis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Katerina Tsirgogianni
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Georgia Pitsiou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Sofia Baka
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Antonis Papaiwannou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Anastasia Karavergou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Aggeliki Rapti
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Georgia Trakada
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Nikolaos Katsikogiannis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Kosmas Tsakiridis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ilias Karapantzos
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Chrysanthi Karapantzou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Nikos Barbetakis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Athanasios Zissimopoulos
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ivan Kuhajda
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Dejan Andjelkovic
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
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Image-guided placement of long-term central venous catheters reduces complications and cost. Am J Surg 2014; 208:937-41; discussion 941. [PMID: 25440481 DOI: 10.1016/j.amjsurg.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/20/2014] [Accepted: 08/20/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The goals of this study were to evaluate the complication rate for intraoperative placement of a long-term central venous catheter (CVC) using intraoperative ultrasound (US) and fluoroscopy and to examine the feasibility for eliminating routine postprocedure chest X-ray. METHODS Retrospective data pertaining to operative insertion of long-term CVC were collected and the rate of procedural complications was determined. RESULTS From January 2008 to August 2013, 351 CVCs were placed via the internal jugular vein using US. Of these, 93% had a single, successful internal jugular vein insertion. The complications included 4 arterial sticks (1.14%). Starting in October 2012, postprocedure chest radiography (CXR) was eliminated in 170 cases, with no complications. A total of $29,750 in charges were deferred by CXR elimination. CONCLUSIONS This review supports the use of US for CVC placement with fluoroscopy in reducing the rate of procedural complications. Additionally, with fluoroscopic imaging, postprocedural CXR can be eliminated with associated healthcare savings.
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Bleeding complications of central venous catheterization in septic patients with abnormal hemostasis. Am J Emerg Med 2014; 32:737-42. [DOI: 10.1016/j.ajem.2014.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022] Open
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Çiftci T, Daskaya H, Yıldırım MB, Söylemez H. A minimally painful, comfortable, and safe technique for hemodialysis catheter placement in children: Superficial cervical plexus block. Hemodial Int 2014; 18:700-4. [DOI: 10.1111/hdi.12164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Taner Çiftci
- Department of Anesthesiology and Reanimation; Medical Faculty; Dicle University; Diyarbakir Turkey
| | - Hayrettin Daskaya
- Department of Anesthesiology and Reanimation; Bezmialem Vakif University; Istanbul Turkey
| | - Mehmet B. Yıldırım
- Department of Anesthesiology and Reanimation; Medical Faculty; Dicle University; Diyarbakir Turkey
| | - Haluk Söylemez
- Department of Urology; Medical Faculty; Dicle University; Diyarbakir Turkey
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Vinson DR, Ballard DW, Stevenson MD, Mark DG, Reed ME, Rauchwerger AS, Chettipally UK, Offerman SR. Predictors of unattempted central venous catheterization in septic patients eligible for early goal-directed therapy. West J Emerg Med 2014; 15:67-75. [PMID: 24578768 PMCID: PMC3935788 DOI: 10.5811/westjem.2013.8.15809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/08/2013] [Accepted: 08/13/2013] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Central venous catheterization (CVC) can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED) patients eligible for early goal-directed therapy (EGDT) have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg), obesity (body mass index [BMI] ≥30), moderate thrombocytopenia (platelet count <50,000 per μL), and coagulopathy (international normalized ratio ≥2.0) with unattempted CVC in EGDT-eligible patients. METHODS This was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian) CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral) with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs). RESULTS In our study, 364 (86.5%) patients underwent attempted thoracic CVC and 57 (13.5%) did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6-4.3), as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.1) and coagulopathy (AOR 2.7; 95% CI, 1.3-5.6). When assessing for attempted catheterization of any central venous site (thoracic or femoral), 382 (90.7%) patients underwent attempted catheterization and 39 (9.3%) patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2-4.5) and moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.3) were significantly associated with unattempted CVC, whereas coagulopathy was not (AOR 0.6; 95% CI, 0.2-1.8). Obesity was not significantly associated with unattempted CVC, either thoracic in location or at any site. CONCLUSION Septic patients eligible for EGDT with relative normotension and those with moderate thrombocytopenia were less likely to undergo attempted CVC at any site. Those with coagulopathy were also less likely to undergo attempted thoracic central line placement. Knowledge of the decision-making calculus at play for physicians considering central venous catheterization in this population can help inform physician education and performance improvement programs.
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Affiliation(s)
- David R. Vinson
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Roseville Medical Center, Roseville, California
| | - Dustin W. Ballard
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | | | - Dustin G. Mark
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Mary E. Reed
- Kaiser Permanente Division of Research, Oakland, California
| | | | - Uli K. Chettipally
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, California
| | - Steven R. Offerman
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente South Sacramento Medical Center, Sacramento, California
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Nguyen CT, Lee E, Luo H, Siegel RJ. Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures. Cardiovasc Diagn Ther 2013; 1:11-36. [PMID: 24282682 DOI: 10.3978/j.issn.2223-3652.2011.09.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/24/2011] [Indexed: 11/14/2022]
Abstract
Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes.
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Affiliation(s)
- Cam Tu Nguyen
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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Left atrium penetration and tamponade: a rare complication of right subclavian permanent dialysis catheter. J Vasc Access 2013; 15:139-40. [PMID: 24101414 DOI: 10.5301/jva.5000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/20/2022] Open
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Potet J, Thome A, Curis E, Arnaud FX, Weber-Donat G, Valbousquet L, Peroux E, Flor E, Dody C, Konopacki J, Malfuson JV, Cartry C, Lahutte M, de Revel T, Baccialone J, Teriitehau CA. Peripherally inserted central catheter placement in cancer patients with profound thrombocytopaenia: a prospective analysis. Eur Radiol 2013; 23:2042-8. [PMID: 23440314 DOI: 10.1007/s00330-013-2778-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/16/2012] [Accepted: 12/19/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE No studies have specifically evaluated the safety of peripherally inserted central catheter (PICC) placement in patients with profound thrombocytopaenia. We prospectively determined the frequency of haemorrhagic complications of PICC placement in cancer patients with uncorrected profound thrombocytopaenia. METHODS Profound thrombocytopaenia was defined as a platelet count <50 × 10(9)/l. No patients received transfusions before or after the procedure. Three types of adverse effects were analysed: minor oozing, mild haematoma and major haemorrhage. RESULTS One hundred and forty-three PICC implantations in 101 cancer patients were prospectively included in the study: seven patients (7 %) had a solid tumour and 94 (93 %) a haematological malignancy. Among these 143 procedures in thrombocytopaenic patients, 93 (65 %) were performed with a platelet count 20-50 × 10(9)/l and 50 (35 %) had lower than 20 × 10(9)/l. No major haemorrhage was observed. Minor oozing was observed in six implantations (4 %) and mild haematoma in two (1.5 %), for a total of eight minor haemorrhagic adverse events (5.5 %). In patients with a platelet count <20 × 10(9)/l, 1/50 (2 %) had minor oozing and none had minor haematoma. CONCLUSIONS In cancer patients with uncorrected profound thrombocytopaenia, the incidence of adverse events after PICC implantation was low, and was limited to minor haemorrhagic adverse events. KEY POINTS • PICC placement has high technical success in profound thrombocytopaenic cancer patients. • Few adverse events are encountered after PICC placement, limited to minor haemorrhage. • PICC placement does not routinely require platelet transfusion in patients with thrombocytopaenia. • Such PICC placement still seems safe when the platelet count is <20 × 10 (9) /l.
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Affiliation(s)
- Julien Potet
- Radiology Department, Percy Military Hospital, Avenue Henri Barbusse, 92140 Clamart, France.
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Ultrasound-Guided Procedures in the Emergency Department—Needle Guidance and Localization. Emerg Med Clin North Am 2013. [DOI: 10.1016/j.emc.2012.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Santana-Cabrera L, Martín-García JA, Villanueva-Ortiz A, Sánchez-Palacios M. Extrapleural hematoma secondary to subclavian vein canalization. Int J Crit Illn Inj Sci 2012. [PMID: 23181216 PMCID: PMC3500014 DOI: 10.4103/2229-5151.100938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luciano Santana-Cabrera
- Department of Intensive Care, Universitary Hospital Insular in Gran Canaria, Las Palmas of Gran Canaria, Spain
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Placement of hemodialysis catheters with a technical, functional, and anatomical viewpoint. Int J Nephrol 2012; 2012:302826. [PMID: 22966456 PMCID: PMC3433137 DOI: 10.1155/2012/302826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 11/23/2022] Open
Abstract
Aims. Vascular access is of prime importance for hemodialysis patients. We aimed to study early complications of hemodialysis catheters placed in different central veins in patients with acute or chronic renal failure with or without ultrasound (US ) guidance. Material and Methods. Patients who were admitted to our unit between March 2008 and December 2010 with need for vascular access have been included. 908 patients were examined for their demographic parameters, primary renal disease, and indication for catheterization, type and location of the catheter, implantation technique, and acute complications. Results. The mean age of the patients was 60.6 ± 16.0 years. 643 (70.8 %) of the catheters were temporary while 265 (29.2%) were permanent. 684 catheters were inserted to internal jugular veins, 213 to femoral, and 11 to subclavian veins. Arterial puncture occurred in 88 (9.7%) among which 13 had resultant subcutaneous hematoma. No patient had lung trauma and there had been no need for removal of the catheter or a surgical intervention for complications. US guidance in jugular vein and experience of operator decreased arterial puncture rate. Conclusion. US-guided replacement of catheter to internal jugular vein would decrease complication rate. Referral to invasive nephrologists may decrease use of subclavian vein. Experience improves complication rates even under US guidance.
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AKOGLU HADIM, PISKINPASA SERHAN, YENIGUN EZGIC, OZTURK RAMAZAN, DEDE FATIH, ODABAS ALIR. Real-time ultrasound guided placement of temporary internal jugular vein catheters: Assessment of technical success and complication rates in nephrology practice. Nephrology (Carlton) 2012; 17:603-6. [DOI: 10.1111/j.1440-1797.2012.01637.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Read H, Holdgate A, Watkins S. Simple external rotation of the leg increases the size and accessibility of the femoral vein. Emerg Med Australas 2012; 24:408-13. [PMID: 22862758 DOI: 10.1111/j.1742-6723.2012.01568.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if external rotation of the leg increases the size and accessibility of the femoral vein compared with a neutral position. METHODS One hundred patients presenting to a tertiary teaching hospital were prospectively recruited. The right common femoral vein of each subject was scanned with a linear probe (5-10 MHz) inferior to the inguinal ligament, with the leg in a neutral position and then in the externally rotated position. The transverse diameter of the femoral vein, the accessible diameter of the vein (lying medial to the femoral artery) and the depth of the vein were measured. RESULTS The mean diameter of the femoral vein in the externally rotated leg was greater than with the leg in the neutral position (15.4 mm vs 13.8 mm); the mean difference was 1.6 mm (95% CI 1.3-1.9). The mean accessible diameter of the femoral vein was larger with the leg externally rotated (13.8 mm vs 11.7 mm, mean difference 2.1 mm, 95% CI 1.8-2.5). The depth from the skin to the femoral vein was less with the leg in external rotation (20.9 mm vs 22.6 mm, mean difference 1.7 mm, 95% CI 1.2-2.2). The mean diameter and depth were greater in patients with overweight or obese body mass index (BMI) measurements in both leg positions. The increase in femoral vein diameter and accessibility with external rotation was observed in all BMI groups. CONCLUSION The total and accessible femoral vein diameter is increased and the surface depth of the vein is decreased by placing the leg in external rotation compared with the neutral position.
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Affiliation(s)
- Hamish Read
- Department of Emergency Medicine, Liverpool Hospital South West Clinical School, University of New South Wales, Sydney, NSW 1871, Australia
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Put the bevel down and visualize the needle tip when puncturing the internal jugular vein. Crit Care Med 2012. [DOI: 10.1097/ccm.0b013e318255d78e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kawai N, Minamiguchi H, Sato M, Nakai M, Sanda H, Tanaka T, Ikoma A, Nakata K, Shirai S, Sonomura T. Evaluation of vascular puncture needles with specific modifications for enhanced ultrasound visibility: In vitro study. World J Radiol 2012; 4:273-7. [PMID: 22778880 PMCID: PMC3391673 DOI: 10.4329/wjr.v4.i6.273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine which modification to a vascular puncture needle results in increased visualization during ultrasound (US)-guided vascular puncture.
METHODS: We evaluated US images of a phantom made of degassed gelatin and each of the following four modified versions of a commercially available vascular puncture needle (18 G): re-cut needle, dimple needle, rough-surface needle (rough over the sections of needle located 3-6 mm from the tip), and a needle with four side holes (side holes covered by the sheath). An unmodified commercially available puncture needle was used as a control. Five interventional radiologists evaluated image quality according to the following classification grade: I, invisible; II, poor; III, moderate; IV, good; V, excellent.
RESULTS: The highest score for needle visualization was obtained for the needle with four side holes. The re-cut needle scored the same as the control. Multiple comparisons were conducted using overall evaluation scores among the commercially available needle, dimple needle, rough-surface needle (3-6 mm), and the needle with four side holes. A significantly higher score was obtained for the needle with four side holes (P < 0.05/6).
CONCLUSION: The needle with four side holes was prominently visualized and gained a significantly higher score (compared with the other needles) in a phantom evaluation.
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Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, Reeves ST. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2012; 24:1291-318. [PMID: 22115322 DOI: 10.1016/j.echo.2011.09.021] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher A Troianos
- Department of Anesthesiology, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
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The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking. J Emerg Med 2012; 42:174-7. [DOI: 10.1016/j.jemermed.2011.05.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 09/20/2010] [Accepted: 05/20/2011] [Indexed: 11/24/2022]
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Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, Reeves ST. Guidelines for Performing Ultrasound Guided Vascular Cannulation. Anesth Analg 2012; 114:46-72. [DOI: 10.1213/ane.0b013e3182407cd8] [Citation(s) in RCA: 232] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gong Y, Xu HX, Lin M, Gu Y. An iatrogenic complication of internal jugular vein catheterization for hemodialysis. Ir J Med Sci 2011; 181:135-7. [PMID: 21290197 DOI: 10.1007/s11845-011-0694-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 01/19/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Central venous catheterization is increasingly performed as a temporary vascular access for hemodialysis therapy in developing countries and it can be associated with serious complications. Iatrogenic common carotid artery-jugular vein arteriovenous fistula is a rare but serious complication of internal jugular vein catheterization for hemodialysis access. Few cases of such complication of uremic patients on hemodialysis have been reported in the literature. AIM To report a case of iatrogenic common carotid artery-jugular vein arteriovenous fistula caused by internal jugular vein catheterization of a hemodialysis patient and its surgical repair. RESULT The iatrogenic arteriovenous fistula was repaired. CONCLUSION Acquaintance of anatomical landmarks, careful preparation, experience of the physician and the ultrasound guidance are important factors to reduce the risk of complications during internal jugular vein catheterization. Surgical repair should be performed earlier in order to avoid the development of other serious complications.
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Affiliation(s)
- Yu Gong
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Joo WJ, Fukui M, Kooguchi K, Sakaguchi M, Shinzato T. Transcutaneous pressure at which the internal jugular vein is collapsed on ultrasonic imaging predicts easiness of the venous puncture. J Anesth 2011; 25:308-11. [DOI: 10.1007/s00540-010-1077-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 11/30/2010] [Indexed: 12/25/2022]
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Theodoro D, Krauss M, Kollef M, Evanoff B. Risk factors for acute adverse events during ultrasound-guided central venous cannulation in the emergency department. Acad Emerg Med 2010; 17:1055-61. [PMID: 21040106 DOI: 10.1111/j.1553-2712.2010.00886.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ultrasound (US) greatly facilitates cannulation of the internal jugular vein. Despite the ability to visualize the needle and anatomy, adverse events still occur. The authors hypothesized that the technique has limitations among certain patients and clinical scenarios. OBJECTIVES The purpose of this study was to identify characteristics of adverse events surrounding US-guided central venous cannulation (CVC). METHODS The authors assembled a prospective observational cohort of emergency department (ED) patients undergoing consecutive internal jugular CVC with US. The primary outcome of interest was a composite of acute mechanical adverse events including hematoma, arterial cannulation, pneumothorax, and unsuccessful placement. Physicians performing the CVC recorded anatomical site, reason for insertion, and acute complications. The patients with catheters were followed until the catheters were removed based on radiographic evidence or hospital nursing records. ED charts and pharmacy records contributed variables of interest. A self-reported online survey provided physician experience information. Logistic regression was used to calculate the odds of an adverse outcome. RESULTS Physicians attempted 289 CVCs on 282 patients. An adverse outcome occurred in 57 attempts (19.7%, 95% confidence interval [CI] = 15.5 to 24.7), the most common being 31 unsuccessful placements (11%, 95% CI = 7.7 to 14.8). Patients with a history of end-stage renal disease (odds ratio [OR] = 3.54, 95% CI = 1.59 to 7.89), and central lines placed by operators with intermediate experience (OR = 2.26, 95% CI = 1.19 to 4.32), were most likely to encounter adverse events. Previously cited predictors such as body mass index (BMI), coagulopathy, and pulmonary hyperinflation were not significant in our final model. CONCLUSIONS Acute adverse events occurred in approximately one-fifth of US-guided internal jugular central line attempts. The study identified both patient (history of end-stage renal disease) and physician (intermediate experience level) factors that are associated with acute adverse events.
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Affiliation(s)
- Daniel Theodoro
- Washington University School of Medicine, St. Louis, MO, USA.
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Ultrasound-Guided Central Venous Catheter Placement by Surgical Trainees: A Safe Procedure? J Vasc Access 2010; 11:288-92. [DOI: 10.5301/jva.2010.2372] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Central venous catheters (CVCs) are widely used to create a temporary or long-term access to the central venous system. A variety of treatments require a functional central venous access, including hemodialysis, administration of drugs, plasmapheresis and parenteral nutrition. The aim of this study was to evaluate the results of CVC placement performed by surgical trainees, according to a strict protocol of ultrasound-guided puncture and fluoroscopy-guided catheter insertion in a large teaching hospital in an outpatient setting. Methods Between 1 January 2006 and 31 December 2008, 539 CVCs were placed, of which 486 were primary inserted by surgical trainees. All placements were ultrasound- and fluoroscopy-guided. After every placement operators recorded type of catheter, type of anesthesia, subcutaneous tunneling, technique of insertion and complications. Results The study population consisted of 52% males. Access sites of CVCs were the internal jugular vein (91%), subclavian vein (5%) and other veins (3%). Technical success rate was 96.5%. Complication rate was 8.4%, of which 93% were arterial punctures. Pneumothorax occurred in three patients. Conclusions CVC placement by surgical trainees is a safe procedure when using a strict protocol of ultrasound-guided vessel puncture and fluoroscopic-guided catheter placement.
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Jauch KW, Schregel W, Stanga Z, Bischoff SC, Brass P, Hartl W, Muehlebach S, Pscheidl E, Thul P, Volk O. Access technique and its problems in parenteral nutrition - Guidelines on Parenteral Nutrition, Chapter 9. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc19. [PMID: 20049083 PMCID: PMC2795383 DOI: 10.3205/000078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 02/08/2023]
Abstract
Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7-10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7-10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site.
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Affiliation(s)
- K W Jauch
- Dept. Surgery Grosshadern, University Hospital, Munich, Germany
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Serafimidis K, Sakorafas GH. Ultrasonographically guided catheterization of the internal jugular vein. ANZ J Surg 2009; 79:585-7. [PMID: 19895511 DOI: 10.1111/j.1445-2197.2009.05010.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Konstantinos Serafimidis
- Fourth Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, Athens, Greece
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Della Vigna P, Monfardini L, Bonomo G, Curigliano G, Agazzi A, Bellomi M, Orsi F. Coagulation Disorders in Patients with Cancer: Nontunneled Central Venous Catheter Placement with US Guidance—A Single-Institution Retrospective Analysis. Radiology 2009; 253:249-52. [DOI: 10.1148/radiol.2531081963] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ultrasound-guided catheterization of the internal jugular vein in oncologic patients; comparison with the classical anatomic landmark technique: a prospective study. Int J Surg 2009; 7:526-8. [PMID: 19751852 DOI: 10.1016/j.ijsu.2009.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 08/17/2009] [Indexed: 01/15/2023]
Abstract
AIM To compare the traditional anatomic landmark technique with the ultrasound-guided method for central venous catheterization. MATERIAL AND METHODS During three years, 551 patients underwent internal jugular vein catheterization; in 347 patients, the ultrasound-guided technique was used, while in the other 204 patients the catheter was introduced by using the classical anatomic landmark method. Operating time, complications (pneumothorax, puncture of carotid artery with or without hematoma formation), and number of attempts to achieve central venous catheterization were recorded. RESULTS The ultrasound-guided technique was associated with significantly shorter operating time (9.83+/-3.1 vs. 20+/-4.4 min, p<0.001) and less morbidity (pneumothorax, 0 vs. 2 patients [p<0.05], carotid artery puncture with or without hematoma formation, 1 vs. 16 patients [p<0.05]). Moreover, the ultrasound-guided technique was highly successful in achieving central venous catheterization (failure, 0 vs. 18 patients [p<0.05]), with significantly fewer attempts (1-3 attempts in 204 vs. 283 [p<0.01]), compared to the classical anatomic landmark technique. CONCLUSION The ultrasound-guided method is faster, more efficient, and less morbid procedure compared with the classical anatomic landmark technique. Therefore, it should be preferred over the classical landmark method, especially in high-risk patients for the development of complications.
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An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med 2009; 37:2345-9; quiz 2359. [PMID: 19531950 DOI: 10.1097/ccm.0b013e3181a067d4] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the frequency of unsuspected posterior vessel wall penetration of the internal jugular vein during ultrasound-guided needle cannulation. DESIGN Prospective, single-blinded observational study. SETTING Urban level I emergency department with an annual census of 80,000. PATIENTS Residents who had previously completed a 2-day ultrasound course including a 3-hr didactic and hands-on session on ultrasound-guided central venous cannulation. INTERVENTIONS Residents were asked to place an ultrasound-guided catheter on a human torso mannequin. Residents used a short-axis approach for ultrasound guidance. During the procedure, an 8-4 MHz convex (endocavity) transducer was used to observe the path of the resident's needle without interference with the placement procedure. MEASUREMENTS AND MAIN RESULTS Unknown to residents, researchers tracked the frequency of posterior wall penetration and the final needle location when the resident felt that optimal needle placement was achieved in the lumen of the internal jugular. Residents were also asked to rate their confidence regarding appropriate final needle position on a 10-point Likert scale. Statistical analysis consisted of descriptive statistics and Spearman correlation analysis. A total of 25 residents participated. All had placed at least one ultrasound-guided central catheter previously. The median number of previous ultrasound-guided cannulations was 8.0. Sixteen (64%) residents accidentally penetrated the posterior wall of the internal jugular vein during cannulation. The median number of posterior wall penetrations was 1.0 for all residents. In six cases the final location of the needle was through the posterior wall and deep to the venous lumen. In five of these cases the carotid artery was actually mistakenly penetrated. Median confidence by residents regarding appropriate needle placement was 8.0 out of 10. More training and more ultrasound-guided catheters placed were associated with fewer posterior wall penetrations (p = .04). CONCLUSIONS In this study, residents accidentally penetrated the posterior vessel wall of the internal jugular in a lifelike vascular access mannequin in the majority of cases. These results suggest that care must be taken even with ultrasound-guided central catheter placement and that alternative ultrasound guidance techniques, such as visualization of the vein and needle in longitudinal axis, should be considered.
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Coignet Y, Combes JC, Duvillard C, Freysz M. Hématome rétropharyngé asphyxiant après tentative de pose d’une voie veineuse jugulaire interne. ACTA ACUST UNITED AC 2008; 27:431-3. [DOI: 10.1016/j.annfar.2008.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 02/05/2008] [Indexed: 11/16/2022]
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Tercan F, Oguzkurt L, Ozkan U, Eker HE. Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations. Cardiovasc Intervent Radiol 2008; 31:575-80. [DOI: 10.1007/s00270-008-9315-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/07/2008] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
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Lyon SM, Given M, Marshall NL. Interventional radiology in the provision and maintenance of long-term central venous access. J Med Imaging Radiat Oncol 2008; 52:10-7. [DOI: 10.1111/j.1440-1673.2007.01904.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Seo IS, Kim BS. Incidental Contralateral Retrograde Internal Jugular Venous Catheterization via a Right External Jugular Venous Route - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.3.s55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Il Sook Seo
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Bum Soo Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Olivier AF, Copeland JG. Real-time sonography in central venous access for endomyocardial biopsy in cardiac transplantation patients. J Am Coll Surg 2007; 205:13-8. [PMID: 17617327 DOI: 10.1016/j.jamcollsurg.2007.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 02/18/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endomyocardial biopsy remains the gold standard to assess cardiac rejection in cardiac transplantation patients. The aim of this study is to evaluate the supportive role and benefits of real-time sonography in central venous access for cardiac biopsy. STUDY DESIGN Between January and September 2006, a retrospective review was carried out for the performance of central venous access using real-time sonography on 74 transplantion patients undergoing 305 cardiac biopsies by a single operator. The study included 56 male and 18 female patients, some of whom had severe dyspnea, obesity, dehydration, peripheral and pulmonary edema. RESULTS All patients underwent successful central venous access using real-time ultrasonic guidance. With increasing experience as a sonographer, central venous access became less invasive and traumatic and more precise and successful. The supportive role of real-time sonography was associated with less major complications and greater patient comfort, even among conscious patients with severe dyspnea and obesity in non-Trendelenburg position using routine local anesthesia. CONCLUSIONS Use of real-time sonography during percutaneous sheath insertion of the right internal jugular vein and the right subclavian vein provides an improved means to safe and quick access for cardiac biopsies with high success rates and low complication rates.
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Affiliation(s)
- Albert F Olivier
- Cardiothoracic Unit, Department of Surgery, University Medical Center, Tucson, AZ, USA.
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