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Towards Optimal Central Venous Catheter Tip Position

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 2008))

Abstract

Central venous catheters (CVCs) are required in many critically ill patients. They are usually inserted through the subclavian or internal jugular veins. As with most invasive procedures, central venous catheterization is associated with numerous potential complications, many of which are associated with the access procedure. The use of ultrasound guidance during CVC placement is among the top 10 evidence-based tools that health care providers can use to improve patient safety [1]. However, serious complications may also occur due to catheter tip malposition. Generally, these complications have only been reported in small studies or case reports, thus underreporting is likely. As a result, exact figures regarding the magnitude of risk of specific complications are not available. Venous or right heart perforations, causing pericardial tamponade or hemothoraces, are associated with a high mortality rate of 65 to 91% [2]. Despite the low incidence of severe complications, there is a wide range of clinically relevant drawbacks related to catheter tip malposition (e.g., venous thrombosis, catheter dysfunction).

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References

  1. Rothschild J (2001) Ultrasound guidance of central vein catheterization. In: Markowitz A (ed) On Making Health Care Safer: A critical analysis of patient safety practices. AHRQ Publications, Rockville, MD, pp 245–255

    Google Scholar 

  2. Booth SA, Norton B, Mulvey DA (2001) Central venous catheterization and fatal cardiac tamponade. Br J Anaesth 87:298–302

    Article  CAS  PubMed  Google Scholar 

  3. Fletcher SJ, Bodenham AR (2000) Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth 85:188–191

    Article  CAS  PubMed  Google Scholar 

  4. Kim FM, Burrows PE, Hoffer FA, Chung T (1996) Interpreting the results of pediatric central venous catheter studies. Radiographics 16:747–754

    CAS  PubMed  Google Scholar 

  5. Puel V, Caudry M, Le Metayer P, et al (1993) Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports. Cancer 72:2248–2252

    Article  CAS  PubMed  Google Scholar 

  6. Pithie A, Soutar JS, Pennington CR (1988) Catheter tip position in central vein thrombosis. JPEN J Parenter Enteral Nutr 12:613–614

    Article  CAS  PubMed  Google Scholar 

  7. Luciani A, Clement O, Halimi P, et al (2001) Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 220:655–660

    Article  CAS  PubMed  Google Scholar 

  8. Food and Drug Administration (1989) Precautions necessary with central venous catheters. FDA Task Force. FDA Drug Bulletin:15–16

    Google Scholar 

  9. Vesely TM (2003) Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 14:527–534

    PubMed  Google Scholar 

  10. Schummer W, Schummer C, Bayer O, Muller A, Bredle D, Karzai W (2005) Extravasation injury in the perioperative setting. Anesth Analg 100:722–727

    Article  PubMed  Google Scholar 

  11. Wu X, Studer W, Skarvan K, Seeberger MD (1999) High incidence of intravenous thrombi after short-term central venous catheterization of the internal jugular vein. J Clin Anesth 11: 482–485

    Article  CAS  PubMed  Google Scholar 

  12. Domino KB, Bowdle TA, Posner KL, Spitellie PH, Lee LA, Cheney FW (2004) Injuries and liability related to central vascular catheters: a closed claims analysis. Anesthesiology 100: 1411–1418

    Article  PubMed  Google Scholar 

  13. Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG (2007) Mechanical complications and malpositions of central venous cannulations by experienced operators: A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med 33:1055–1059

    Article  PubMed  Google Scholar 

  14. Robinson JF, Robinson WA, Cohn A, Garg K, Armstrong JD 2nd (1995) Perforation of the great vessels during central venous line placement. Arch Intern Med 155:1225–1228

    Article  CAS  PubMed  Google Scholar 

  15. Mukau L, Talamini MA, Sitzmann JV (1991) Risk factors for central venous catheter-related vascular erosions. JPEN J Parenter Enteral Nutr 15:513–516

    Article  CAS  PubMed  Google Scholar 

  16. Xiang DZ, Verbeken EK, Van Lommel AT, Stas M, De Wever I (1998) Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg 28:260–271

    Article  CAS  PubMed  Google Scholar 

  17. Müller K (1981) Komplikation durch Kava-Katheter und ihr pathologisch-anatomisches Substrat. In: Lawin P, Hartenauer U (eds) Der intravasale Katheter. Thieme, Stuttgart, pp 73–81

    Google Scholar 

  18. Hoshal VL, Jr., Ause RG, Hoskins PA (1971) Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 102:253–258

    Google Scholar 

  19. Winn MP, McDermott VG, Schwab SJ, Conlon PJ (1997) Dialysis catheter ‘fibrin-sheath stripping’: a cautionary tale! Nephrol Dial Transplant 12:1048–1050

    Article  CAS  PubMed  Google Scholar 

  20. Borow M, Crowley JG (1985) Evaluation of central venous catheter thrombogenicity. Acta Anaesthesiol Scand Suppl 81:59–64

    Article  CAS  PubMed  Google Scholar 

  21. Gault DT (1993) Extravasation injuries. Br J Plast Surg 46:91–96

    Article  CAS  PubMed  Google Scholar 

  22. Upton J, Mulliken JB, Murray JE (1979) Major intravenous extravasation injuries. Am J Surg 137:497–506

    Article  CAS  PubMed  Google Scholar 

  23. Yosowitz P, Ekland DA, Shaw RC, Parsons RW (1975) Peripheral intravenous infiltration necrosis. Ann Surg 182:553–556

    Article  CAS  PubMed  Google Scholar 

  24. Wallenborn J, Kuhnert I (2002) [Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording — a case report]. Anaesthesiol Reanim 27:131–137

    CAS  PubMed  Google Scholar 

  25. Walker C, Jackson D, Dolan S (1997) The potential for extravasation using a new five lumen catheter. Anaesthesia 52:716–717

    CAS  PubMed  Google Scholar 

  26. Chalkiadis GA, Goucke CR (1998) Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position. Anaesth Intensive Care 26: 61–66

    CAS  PubMed  Google Scholar 

  27. Stuart RK, Shikora SA, Akerman P, et al (1990) Incidence of arrhythmia with central venous catheter insertion and exchange. JPEN J Parenter Enteral Nutr 14:152–155

    Article  CAS  PubMed  Google Scholar 

  28. Morris D, Mulvihill D, Lew WY (1987) Risk of developing complete heart block during bedside pulmonary artery catheterization in patients with left bundle-branch block. Arch Intern Med 147:2005–2010

    Article  CAS  PubMed  Google Scholar 

  29. Sprung CL, Elser B, Schein RM, Marcial EH, Schrager BR (1989) Risk of right bundle-branch block and complete heart block during pulmonary artery catheterization. Crit Care Med 17:1–3

    Article  CAS  PubMed  Google Scholar 

  30. Garden AL, Laussen PC (2004) An unending supply of ‘unusual’ complications from central venous catheters. Paediatr Anaesth 114:905–909

    Article  PubMed  Google Scholar 

  31. Forßmann W (1929) Die Sondierung des rechten Herzens. Klin Wochenschr 8:2085–2087

    Article  Google Scholar 

  32. Webb W (2005) Pulmonary edema, the acute respiratory distress syndrome and radiology in the intensive care unit. In: Webb W (ed) Thoracic imaging: Pulmonary and cardiovascular radiology. Lippincott Williams & Wilkins, Philadelphia, pp 331–355

    Google Scholar 

  33. Aslamy Z, Dewald CL, Heffner JE (1998) MRI of central venous anatomy: implications for central venous catheter insertion. Chest 114:820–826

    Article  CAS  PubMed  Google Scholar 

  34. Defalque RJ, Campbell C (1979) Cardiac tamponade from central venous catheters. Anesthesiology 50:249–252

    Article  CAS  PubMed  Google Scholar 

  35. Greenall MJ, Blewitt RW, McMahon MJ (1975) Cardiac tamponade and central venous catheters. BMJ 2:595–597

    Article  CAS  PubMed  Google Scholar 

  36. Collier PE, Blocker SH, Graff DM, Doyle P (1998) Cardiac tamponade from central venous catheters. Am J Surg 176:212–214

    Article  CAS  PubMed  Google Scholar 

  37. Hobbs G, Mahajan R (2000) Radiology for Anesthesia. Churchill Livingstone, New York

    Google Scholar 

  38. Vail CM, Ravin CE (1992) Cardiovascular monitoring devices. In: Goodman LR, Putman CE (eds) Critical Care Imaging. W. B. Saunders, Philadelphia, pp 3–12

    Google Scholar 

  39. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B (2000) The carina as a landmark in central venous catheter placement. Br J Anaesth 85:192–194

    Article  CAS  PubMed  Google Scholar 

  40. Stonelake PA, Bodenham AR (2006) The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth 96:335–340

    Article  CAS  PubMed  Google Scholar 

  41. Hsu JH, Wang CK, Chu KS, et al (2006) Comparison of radiographic landmarks and the echocardiographic SVC/RA junction in the positioning of long-term central venous catheters. Acta Anaesthesiol Scand 50:731–735

    Article  PubMed  Google Scholar 

  42. Gravenstein N, Blackshear RH (1991) In vitro evaluation of relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane. J Clin Monit 7:1–6

    Article  CAS  PubMed  Google Scholar 

  43. Reynolds N, McCulloch AS, Pennington CR, MacFadyen RJ (2001) Assessment of distal tip position of long-term central venous feeding catheters using transesophageal echocardiology. JPEN J Parenter Enteral Nutr 25:39–41

    Article  CAS  PubMed  Google Scholar 

  44. Andropoulos DB, Stayer SA, Bent ST, et al (1999) A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients. Anesth Analg 89:65–70

    Article  CAS  PubMed  Google Scholar 

  45. Chu KS, Hsu JH, Wang SS, et al (2004) Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography. Anesth Analg 98:910–914

    Article  PubMed  Google Scholar 

  46. Jeon Y, Ryu HG, Yoon SZ, Kim JH, Bahk JH (2006) Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anaesth 53:978–983

    Article  PubMed  Google Scholar 

  47. Schummer W, Schummer C, Schelenz C, Schmidt P, Frober R, Huttemann E (2005) [Modified ECG-guidance for optimal central venous catheter tip positioning. A transesophageal echocardiography controlled study]. Anaesthesist 54:983–990

    Article  CAS  PubMed  Google Scholar 

  48. McGee WT, Ackerman BL, Rouben LR, Prasad VM, Bandi V, Mallory DL (1993) Accurate placement of central venous catheters: a prospective, randomized, multicenter trial. Crit Care Med 21:1118–1123

    Article  CAS  PubMed  Google Scholar 

  49. Schummer W, Schummer C, Paxian M, Stock U, Richter K, Bauer M (2005) [Extravasal position of central venous catheters despite unsuspicious ECG-guidance]. Anasthesiol Intensivmed Notfallmed Schmerzther 40:91–96

    Article  CAS  PubMed  Google Scholar 

  50. Schummer W, Schummer C, Schelenz C, et al (2004) Central venous catheters — the inability of ‘intra-atrial ECG’ to prove adequate positioning. Br J Anaesth 93:193–198

    Article  CAS  PubMed  Google Scholar 

  51. Oliver WC Jr, Nuttall GA, Beynen FM, Raimundo HS, Abenstein JP, Arnold JJ (1997) The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation. J Cardiothorac Vasc Anesth 11:851–855

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dept of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 101, 07747, Jena, Germany

    W. Schummer & C. Schummer

  2. Dept of Anesthesiology and Intensive Care, Friedrich-Schiller University, Erlanger Allee 103, 07743, Jena, Germany

    Y. Sakr

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  3. C. Schummer
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© 2008 Springer-Verlag Berlin Heidelberg

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Schummer, W., Sakr, Y., Schummer, C. (2008). Towards Optimal Central Venous Catheter Tip Position. In: Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 2008. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77290-3_54

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  • DOI: https://doi.org/10.1007/978-3-540-77290-3_54

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77289-7

  • Online ISBN: 978-3-540-77290-3

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