Bebekte ilginç bir santral venöz kateter yanlış yerleşimi: (Olgu sunumu)

Pediyatrik hastalarda santral venöz girişime, gerek cerrahi gerekse tıbbi amaçla ihtiyaç olabilmektedir. Ayrıca bu kateterler kısa veya uzun süreli beslenme tedavilerinde de kullanılmaktadır. Birbuçuk yaşında erkek bebek status epileptikus nedeniyle Anesteziyoloji Yoğun Bakım Ünitesine alındı. Sıvı tedavisi ve beslenme amacıyla sağ subklaviyen vene santral venöz kateter yerleştirildi. Kateterin yerini doğrulamak için çekilen radyografide kateterin ucunun sol internal juguler vene yerleştiği görüldüğü için kateter geri çekildi ve J teli üzerinden yenisi ile değiştirildi. Bu olgu ile özellikle bebeklerde kateterin yerinin radyografi ile doğrulanması gerekliliğine dikkat çekmek istedik.

Anahtar Kelimeler:

Kateterizasyon, santral venöz, Süt çocuğu, Status epileptikus

An interesting misplacement of central venous catheter in an infant: (Case report)

Central venous catheterization may be required in pediatric patients both for surgical and medical purposes. In addition, these catheters are also used for short or long term nutritional therapy. A 1.5 year-old male infant was admitted to the Anesthesiology Intensive Care Unit because of status epilepticus. A central venous catheter was placed in the right subclavian vein for fluid replacement and parenteral nutrition. On the x-ray taken to confirm the placement of the catheter, it was detected that the tip of the catheter had been misplaced in the left internal jugular vein, so the catheter was pulled back and replaced with a new one through the J-guide. This case draws attention to the need for confirmation of the location of the central venous catheter using radiography, especially in infants.

Keywords:

Catheterization, Central Venous, Infant, Status Epilepticus,

PDF

___

1. Wicky S, Meuwly JY, Doenz F, Uske A, Schnyder P, Denys A. Life-threatening vascular complications after central venous catheter placement. Eur Radiol 2002; 12:901-7.
2. Janik JE, Conlon SJ, Janik JS. Percutaneous central access in patients younger than 5 years: size does matter. J Pediatr Surg 2004; 39:1252-6.
3. Polderman KH, Girbes AR. Central venous catheter use Part 1: mechanical complications. Intensive Care Med 2002; 28:1-17.
4. de Jonge RC, Polderman KH, Gemke RJ. Central venous catheter use in the pediatric patient: Mechanical and infectious complications. Pediatr Crit Care Med 2005; 6:329-39.
5. Boardman P, Hughes JP. Radiological evaluation and management of malfunctioning central venous catheters. Clin Radiol 1998; 53:10–6.
6. Collier PE, Goodman GB. Cardiac tamponade caused by central venous catheter perforation of the heart: a preventable complication. J Am Coll Surg 1995; 181:459-63.
7. Lefrant JY, Muller L, De La Coussaye JE ve ark. Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients. Intensive Care Med 2002; 28:1036-41.
8. Timsit JF. What is the best site for central venous catheter insertion in critically ill patients? Crit Care 2003; 7:397-9
9. Parigi GB, Verga G. Accurate placement of central venous catheters in pediatric patients using endocavitary electrocardiography: reassessment of a personal technique. J Pediatr Surg 1997; 32:1226-8.
10. Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a metaanalysis of the literature. Crit Care Med 1996; 24:2053-8.
11. Ambesh SP, Dubey PK, Matreja P, Tripathi M, Singh S. Manual occlusion of the internal jugular vein during subclavian vein catheterization: a maneuver to prevent misplacement of catheter into internal jugular vein. Anesthesiology 2002; 97:528-9.
12. Guth AA. Routine chest X-rays after insertion of implantable long-term venous catheters: necessary or not? Am Surg 2001;67:26-9.
13. Gladwin MT, Slonim A, Landucci DL, Gutierrez DC, Cunnion RE. Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary? Crit Care Med 1999; 27:1819-23.
14. Tan PL, Gibson D. Central venous catheters: the role of radiology. Clin Radiol 2006; 61:13-22.