MISPLACEMENTS OF CENTRAL VENOUS CATHETERS: INTERNAL JUGULAR VERSUS SUBCLAVIAN ACCESS IN CRITICAL CARE PATIENTS

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MISPLACEMENTS OF CENTRAL VENOUS CATHETERS: INTERNAL JUGULAR VERSUS SUBCLAVIAN ACCESS IN CRITICAL CARE PATIENTS

Aim; In central venous catheterization (CVC), misplacement is not a rare complication since this is a blinded procedure. The aim of this study was to compare the misplacement risks of the access of internal jugular vein with that of subclavian vein catheterizations. Methods;The records of a total of 1092 patients in whom central venous catheters were placed between 2002 and 2006 in Anesthesiology Intensive Care Unit and the location of the tips was confirmed radiologically were retrospectively evaluated. Neck and infraclavicular region were cleaned by antiseptic solution after routine monitorization. CVC were easily inserted with Seldinger’s technique after blood aspiration through internal jugular vein or subclavian vein. Results; In adult patients, six internal jugular catheter misplacements were seen (0.80%); among them five were kinking and one was intrapleural location of the catheter tip. Six subclavian misplacements (2.02 %) were detected, five of them were located in contralateral subclavian vein, and one was located in ipsilateral internal jugular vein. In children, two subclavian misplacements were seen as crossing to contraleteral subclavian vein, and there were no internal jugular misplacement. There was no statistically difference for misplacement between the access sites (in adult p= 0.110, in children p=0.501). Conclusion; We have concluded that experience of operator should be taken into account for choice of catheterization site

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  • Wicky S, Meuwly JY, Doenz F et al. Life- threatening vascular complications after central venous catheter placement. Eur Radiol 2002;12:901-7
  • Polderman KH, Girbes ARJ. Central venous catheter use Part 1: Mechanical complications. Intensive Care Med 2002; 28:1-17
  • 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
  • Boardman P, Hughes JP. Pictorial review. Radiological evaluation and management of catheters. Clin Radiol 1998; 53:10–6
  • 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
  • Ruesch S, Walder B, Tramer MR. Complications catheters: subclavian access –a systematic review. Crit Care Med 2002; 30:454-60 venous versus internal
  • Lefrant JY, Muller L, De La Coussaye JE et al. Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients. Intensive Care Med 2002;28: 1036-41
  • Mansfield PF, Hohn DC, Fornage BD et al. Complications and failures of subclavian- vein catheterization. N Eng J Med 1994; 331:1735-8
  • Iovino F, Pittiruti M, Buononato M, Lo Schiavo F. Central venous catheterization: complications of different placements . Ann Chir 2001; 126:1001-6
  • 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
  • Timsit JF. What is the best side for central venous catheter insertion in critically ill patients? Critical Care 2003; 7:397-9
  • Dane TE, King EG. Fatal cardiac tamponade complications of central venous catheters. Br J Surg 1975; 62:6-10 mechanical
  • 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
  • Randolph AG, Cook DJ, Gonzales CA et al. Ultrasound guidance for placement of central venous catheters: a metaanalysis of the literature. Crit Care Med 1996; 24: 2053-8
  • Ambesh SP, Dubey PK, Matreja P et al. 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
  • Guth AA. Routine chest X-rays after insertion of implantable long-term venous catheters: necessary or not? Am. Surg 2001;67:26-9
  • Gladwin MT, Slonim A, Landucci DL et al. Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary? Crit CareMed 1999; 27:1819-23
  • Ambesh SP, Pandey JC, Dubey PK. Internal jugular vein occlusion test for rapid diagnosis of misplaced subclavian vein catheter into the internal jugular vein. Anesthesiology 2001; 95:1377-9
European Journal of General Medicine-Cover
  • Başlangıç: 2015
  • Yayıncı: Sağlık Bilimleri Araştırmaları Derneği