The insertion site is the main risk factor for central venous catheter‐related complications in patients with hematologic malignancies

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

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Venous anomalies as potentially lethal risk factors during ordinary catheterization

Veins and Lymphatics ◽

10.4081/vl.2015.5098 ◽

2015 ◽

Vol 4 (2) ◽

Author(s):

Savino Occhionorelli ◽

Sergio Gianesini ◽

Lorenzo Marinelli ◽

Marianna Daniele ◽

Sara Chierici ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Central Venous Catheter ◽

Literature Review ◽

Venous Catheter ◽

Clinical Implications ◽

Venous Malformations ◽

Central Venous ◽

Venous Anomalies ◽

Technology Advancement

Venous malformations are rare but possible findings too, constituting a further risk factor for central venous catheter procedures. Herein we describe a case of death because of an innominate vein perforation by a catheter that incidentally was tucked into a sacciform malformation. Even if the technology advancement is constantly offering us new investigation tools, up to now diagnostic options are limited in the detection of those malformations that could potentially lead to dramatic complications as the described one. The present work raises the awareness about rare venous anomalies and their potential clinical implications. A proper literature review and diagnostic implementation proposal are reported.

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Comparison of mechanical complications of central venous catheter according to the insertion site in an intensive care unit of Bangladesh

BIRDEM Medical Journal ◽

10.3329/birdem.v10i2.47742 ◽

2020 ◽

Vol 10 (2) ◽

pp. 115-119

Author(s):

Debasish Kumar Saha ◽

Suraiya Nazneen ◽

ASM Areef Ahsan ◽

Madhurima Saha ◽

Kaniz Fatema ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Insertion Site ◽

Venous Catheter ◽

Arterial Puncture ◽

Central Venous ◽

Femoral Site ◽

Mechanical Complications ◽

Catheter Tip

Background: Central venous catheter (CVC) insertion is very common in intensive care unit (ICU). CVC is usually inserted in subclavian, internal jugular and femoral veins. However, CVC insertion may lead to significant mechanical complications. Our aim was to detect the occurrence of CVC related mechanical complications according to different insertion site. Methods: This prospective observational study was carried out during the period of May 2016 to July 2019 in Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, enrolling 349 adult patients requiring new CVC insertion in ICU. Results: Among 349 study subjects, 167 CVC were inserted through subclavian vein, 88 through internal jugular and 94 through femoral vein. There was no significant difference among three groups (subclavian / internal jugular / femoral) in terms of age, gender distribution, presence of co-morbid illness.Total mechanical complicationsin study population was 43 (12.3 %) including pneumothorax (14, 4.0%), arterial puncture (10, 2.9%), hemorrhage (11, 3.2%), catheter tip malposition (6, 1.7%), hemothorax (1, 0.3%) and lost guidewire (1, 0.3%). Pneumothorax was more with internal jugular (9.1%) than subclavian (3.6 %) route, which was statistically significant (p=0.007). Although hemorrhage and arterial puncture events were higher with femoral site than subclavian or internal jugular, which were not significant. Catheter tip malposition occurred in 4 (2.4%) patients with subclavian insertion and 2 (2.3%) patients with internal jugular site, no such event in femoral site. Hemothorax and lost guidewire occurred in only 1 patient with subclavian and internal jugular site respectively. Site-wise total mechanical complications were higher in internal jugular (17.0%) followed bysubclavian (10.8%) site and femoral site (10.6%). Conclusion: In this study, though not statistically significant, CVC related mechanical complications occurred more in subclavian site than in internal jugular or femoral insertion site. Birdem Med J 2020; 10(2): 115-119

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Air Embolism after Central Venous Catheter Removal: Fibrin Sheath as the Portal of Persistent Air Entry

Case Reports in Critical Care ◽

10.1155/2013/403243 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Meggiolaro Marco ◽

Erik Roman-Pognuz ◽

Baritussio Anna ◽

Scatto Alessio

Keyword(s):

Central Venous Catheter ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Insertion Site ◽

Venous Catheter ◽

Air Bubbles ◽

Left Internal Jugular Vein ◽

Central Venous ◽

Occlusive Dressing ◽

Vascular Ultrasonography

Central venous catheterization is of common practice in intensive care units; despite representing an essential device in various clinical circumstances, it represents a source of complications, sometimes even fatal, related to its management. We report the removal of a central venous catheter (CVC) that had been wrongly positioned through left internal jugular vein. The vein presented complete thrombosis at vascular ultrasonography. An echocardiogram performed 24 hours after CVC removal showed the presence, apparently unjustified, of microbubbles in right chambers of the heart. A neck-thorax CT scan showed the presence of air bubbles within the left internal jugular vein, left innominate vein, and left subclavian vein. A vascular ultrasonography, focused on venous catheter insertion site, disclosed the presence of a vein-to-dermis fistula, as portal of air entry. Only after air occlusive dressing, we documented echographic disappearance of air bubbles within the right cardiac cavity. This report emphasizes possible air entry even many hours after CVC removal, making it mandatory to perform 24–72-hour air occlusive dressing or, when inadequate, to perform a purse string.

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1090: Central Venous Catheter Dressing Disruptions as a Risk Factor for Catheter-Related Infections

Critical Care Medicine ◽

10.1097/01.ccm.0000730248.76156.f4 ◽

2020 ◽

Vol 49 (1) ◽

pp. 546-546

Author(s):

Ahmed Alsaei ◽

Farid Sadaka

Keyword(s):

Risk Factor ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous

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Clinical Performance of a New Transparent Chlorhexidine Gluconate Central Venous Catheter Dressing

Journal of the Association for Vascular Access ◽

10.2309/java.13-1-4 ◽

2008 ◽

Vol 13 (1) ◽

pp. 13-19 ◽

Cited By ~ 8

Author(s):

Carol Olson ◽

James M. Heilman

Keyword(s):

Health Care ◽

Central Venous Catheter ◽

Vascular Access ◽

New Technologies ◽

Insertion Site ◽

Venous Catheter ◽

Chlorhexidine Gluconate ◽

Ease Of Use ◽

Central Venous ◽

Or Education

Abstract As the sciences of vascular access and infection prevention rapidly advance healthcare professionals are often faced with new technologies designed to help, but which are often so complicated to use that they cause unforeseen problems. As a vascular access team at a major mid-western hospital, we evaluated the ease-of-use and the performance characteristics of a new transparent catheter dressing, 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) containing the antimicrobial chlorhexidine gluconate (CHG), with a variety of central venous catheters insertion sites in comparison to a standard non-antimicrobial dressing Tegaderm® (3M Health Care™, St. Paul, MN). Following IRB approval, sixty-three consenting patients were enrolled and randomized; 33 in the CHG antimicrobial dressing group and 30 in the standard dressing group. Thirty six patients had peripherally inserted central catheters (PICCs), 20 had intrajugular insertions (IJ), and 7 had subclavian insertions. The new 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) was evaluated for its ability to permit visualization of the insertion site, ease of use, ease of using correctly, ability to secure the catheter and absorb exudates and remain transparent. The new 3M Tegaderm CHG IV Securement Dressing® (3M Health Care™, St. Paul, MN) was found to be as easy to use in central venous catheter care clinical practice as the standard of care non-antimicrobial transparent adhesive dressing. No additional training or education was required to properly use it. This dressing was applied and removed like standard transparent adhesive dressings, but offered many advantages over standard dressings. Advantages include that it is antimicrobial, handles moderate bleeding, remains transparent and appears to offer greater catheter securement than the Tegaderm® (3M Health Care™, St. Paul, MN) standard dressing. The CHG gel pad also conformed well to the catheter.

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Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

10.21203/rs.3.rs-663239/v1 ◽

2021 ◽

Author(s):

JingMei Li ◽

JiaFei Zhang ◽

Bo Feng ◽

ChunHui Wang ◽

MeiLing Wang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Intravenous Infusion ◽

Insertion Site ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Venous ◽

Puncture Site

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.

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Ultrasound guidance and risk for central venous catheter-related infections in the ICU. A post hoc analysis of individual data of three multi-centric randomized trials

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1817 ◽

2020 ◽

Author(s):

Niccolò Buetti ◽

Olivier Mimoz ◽

Leonard Mermel ◽

Stéphane Ruckly ◽

Nicolas Mongardon ◽

...

Keyword(s):

Central Venous Catheter ◽

Insertion Site ◽

Venous Catheter ◽

Quality Data ◽

Individual Data ◽

Central Venous ◽

Post Hoc Analysis ◽

Us Guidance ◽

Infectious Risk ◽

Post Hoc

Abstract Background Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial and randomized-controlled trials (RCTs) assessed mainly non-infectious complications. This study assessed infectious risk associated with catheters inserted with US guidance versus use of anatomical ‘landmarks’ (AL). Methods We used individual data from three large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICU) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSI, primary outcome) and major catheter-related infections (MCRI, secondary outcome).We also evaluated insertion site colonization at catheter removal. Results Our post hoc analysis included 4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral and 1681 subclavian veins, respectively, in 19 ICUs. US was used for 2147 catheter insertions. Among jugular and femoral CVCs and after weighting, we found an association between US and CRBSI (HR 2.21, 95% CI 1.17-4.16, p=0.014) and between US and MCRI (HR 1.55, 95% CI 1.01-2.38, p=0.045). Catheter insertion site colonization at removal was more common in the US-guided group (p=0.0045) among jugular and femoral CVCs in situ for ≤7 days (n=606). Conclusions In prospectively collected data in which catheters were not randomized to insertion by US or AL, US guidance was associated with increased risk of infection.

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Prevention of Coagulase-Negative Staphylococcal Central Venous Catheter–Related Infection Using Urokinase Rinses: A Randomized Double-Blind Controlled Trial in Patients With Hematologic Malignancies

Journal of Clinical Oncology ◽

10.1200/jco.2007.11.7754 ◽

2008 ◽

Vol 26 (3) ◽

pp. 428-433 ◽

Cited By ~ 40

Author(s):

Cornelis J. van Rooden ◽

Emile F. Schippers ◽

Henri F.L. Guiot ◽

Renée M. Barge ◽

Marcel M.C. Hovens ◽

...

Keyword(s):

Central Venous Catheter ◽

Controlled Trial ◽

Venous Catheter ◽

Hematologic Malignancies ◽

Bleeding Complications ◽

Severe Bleeding ◽

Central Venous ◽

Coagulase Negative Staphylococci ◽

Double Blind ◽

Cytotoxic Treatment

PurposeFibrin deposition at the intraluminal surface of the indwelling part of the central venous catheter (CVC) surface increases the risk of CVC-related coagulase-negative staphylococci (CoNS) infection. Therefore, repetitive enzymatic dissolution of fibrin by urokinase might reduce the risk of CVC-related infection. We undertook this study to investigate whether three times weekly urokinase rinsing of CVC reduces the incidence or severity of CVC-related infections by CoNS in patients undergoing intensive cytotoxic treatment for hematologic malignancies.Patients and MethodsIn a double-blind setting, all consecutive patients with a CVC were randomly allocated to receive either urokinase rinses (5 mL of 5,000 U/mL) or placebo (saline), both three times weekly.ResultsThe percentage of patients with at least one positive culture with CoNS was lower in patients receiving urokinase compared with patients receiving placebo (26% v 42%, respectively; relative risk [RR] = 0.61; 95% CI, 0.39 to 0.94). Major CVC-related CoNS infection occurred less frequently in patients receiving urokinase versus placebo (1.2% v 14.1%, respectively; RR = 0.09; 95% CI, 0.01 to 0.50). Secondary complications, including CVC-related thrombosis, were observed less frequently in the urokinase group compared with the placebo group (1.3% v 9.0%, respectively; RR = 0.14; 95% CI, 0.02 to 0.82). No severe bleeding complications attributable to urokinase were observed.ConclusionThree times weekly urokinase rinsing reduces the incidence of CVC-related CoNS infection in patients treated with intensive cytotoxic therapy for hematologic malignancies, with acceptable safety.

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