Transient right phrenic nerve palsy associated with central venous catheterization

An 85-yr-old woman with advanced sigmoid colon cancer developedright phrenic nerve palsy following central venous catheterizationfor preoperative nutritional and fluid balance improvement.The central venous catheter was successfully placed via theleft subclavian vein at the first attempt. Blood returned freelythrough the catheter. The chest x-ray film taken immediatelyafter the catheterization showed the proper placement of thecatheter, but it revealed a significant right hemidiaphragmaticelevation indicating phrenic nerve palsy. A chest computed tomographyscan and bronchoscopy were normal. As the patient did not complainof dyspnoea and vital signs were normal, tumour resection wasperformed. The operative and postoperative course was uneventful.The chest x-ray film after the surgery still showed the elevationof the right hemidiaphragm. It resolved completely within 3days of withdrawing the central venous catheter by 3 cm on thefourth postoperative day. We concluded the likely cause of thephrenic nerve palsy was that the catheter tip impinged uponthe thin venous wall and compressed the phrenic nerve runningalongside the superior vena cava. Br J Anaesth 2001; 87: 510–11     

Glomerulonephritis associated with chronic infection from long-term central venous catheterization

There have been few reports on immune complex-mediated glomerulonephritis associated with chronic infection from long-term central venous catheterization in adulthood. We report here on a 13-year-old boy with nephritis who exhibited glomerulonephritis that had been induced by the long-term use of central venous catheters, and its resolution after extraction of the central venous catheter. A diagnosis of glomerulonephritis associated with chronic infection caused by long-term central venous catheterization was made, based on the absence of clinical findings after removal of the catheter, hypocomplementemia, pathology findings resembling membranoproliferative glomerulonephritis, and detection of Staphylococcus epidermidis from culture of the removed catheter culture. For clinicians using long-term central venous access for parenteral feeding, rapid catheter exchange is necessary for patients with fever of unknown origin.     

Calcification of thrombus associated with central venous catheter: unusual complication

Thrombosis originating from the tip of central venous catheter is a well known complication. The calcification of such a thrombus is very rare. Until now, only two cases had been described with long-term indwelling central venous catheters used for total parenteral nutrition. We report the first case of a calcified thrombus occurred during a short-term central venous catheterisation. The presumptive mechanism of thrombus calcification is precipitation of calcium salts and its deposition on a pre-existent thrombus. In total parenteral nutrition the mechanism of calcification seems to be multifactorial. Thus, the precipitation of calcium phosphate is increased by the following factors: higher calcium and phosphate concentrations, the use of calcium chloride instead of calcium gluconate, lower pH solutions, slow infusion rate.     

Right atrial thrombus formation following central venous dialysis catheter placement

Silicone rubber central venous dialysis catheters are used to provide vascular access in acute renal failure patients and in chronic dialysis patients in whom conventional vascular access cannot be achieved or maintained. The use of these catheters is not without hazard. The first reported case of right atrial thrombus formation associated with the use of a double lumen silicone rubber central hemodialysis catheter is described. This patient's course points out another potential complication of this type of vascular access and emphasizes the importance of removing such catheters in a timely fashion when they are no longer required for dialysis.     

A review in emergency central venous catheterization

Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate.     

Case report: central venous catheterization via internal jugular vein with associated formation of perioperative venous thrombosis during surgery in the prone position

An unusual case of central venous catheter (CVC)-related thrombosis during supine surgery in the prone position is presented. A 76-year-old woman was scheduled for elective surgery to repair a broken lumbar instrument. A single-lumen CVC was inserted via the right internal jugular vein. Surgery was performed in the prone position, with the patient's face directed downward in the standard median position (i.e., no rotation), but with slight forward flexion at the neck. After the surgery, the external jugular vein was dilated, and a postoperative X-ray revealed an infiltrative shadow in the right thoracic cavity. Because cervical echography showed dilated cervical veins with a "moyamoya-type" echo, possibly indicating a thrombus, contrast-enhanced computed tomography was performed, revealing a venous thrombus in the right internal jugular vein. An internal jugular venous-velocity measurement suggested that her slightly flexed neck position and her prone position during surgery may have kinked the internal jugular vein, causing engorgement with venous blood. The presence of the internal jugular venous catheter may have created thrombogenic conditions. A patient's position during surgery can reduce deep venous-flow velocity, and venous blood may stagnate, contributing greatly to thrombogenicity. We should consider a patient's position during surgery as a risk factor for thrombus formation, and a careful preoperative evaluation should be made as to which route should be chosen for CVC.     

Mechanical complication of central venous catheterization

Central venous catheterization is a procedure with a high success rate. However, life-threatening complications are occasionally caused by mechanical injury during the catheterization process. Therefore, surgeons should have sufficient knowledge of the potential complications and the effective use of preventative measures when performing catheterization. We herein review and discuss the mechanical complications previously reported to have occurred in association with central venous catheterization. Comprehensive knowledge about various complication-inducing factors, the ability to make a quick and accurate diagnosis of such complications, and sufficient skill to prevent worsening of these complications can thus help patients from suffering lethal complications due to central venous catheterization.     

Arteriovenous fistula following central venous catheterization

We surgically obliterated arteriovenous fistulas in three cases that developed after subclavian catheterization. The first patient presented with heart failure two years after the catheterization, and the other two presented with asymptomatic continuous bruits. The intervals between the removal of the catheter and the appearance of the bruit were 1.5 years, three days, and two months. It took another six months for the appearance of heart failure in the first case. The feeder of the fistula was a branch of the subclavian artery in all cases. In previously reported cases, there was usually some interval between the removal of the catheter and detection of the fistula, and the feeder was much more commonly one of the branches of the subclavian artery than the subclavian artery itself.     

A preparation to study simultaneous arterial and venous thrombus formation in rabbits.

Injury to an artery induces formation of a platelet-rich thrombus, while stasis or trauma to a vein induces a fibrin-rich thrombus. We have implemented preparations for evolving both platelet-rich and fibrin-rich thrombi simultaneously in rabbits for use to define the efficacy of novel antithrombotic agents. For platelet-rich thrombosis, a carotid artery and contralateral jugular vein were dissected and an arteriovenous shunt inserted distally to prevent cerebral infarction during thrombus formation. The shunted artery was then instrumented with a proximal Doppler probe for measuring flow velocity and a distal transluminal needle electrode. Electrical injury to the artery was induced by application of 250 microA of anodal current to the indwelling needle electrode. Thrombotic occlusion was consistently observed within 60 min, permitting measurements of the effects on the incidence and time of occlusion of antithrombotic agents administered over 2 h. For fibrin-rich thrombosis, an external jugular vein was dissected, including the distal bifurcation. One of the branches was catheterized and a copper wire with cotton threads attached was advanced through the catheter into the superior vena cava, allowing exposure of the threads to flowing blood. A 25- to 30-mg thrombus was formed within 2 h, permitting reliable measurements of effects on thrombus weight of antithrombotic agents administered during this interval. Implementing both arterial and venous thrombosis simultaneously did not change measurements compared with either method alone. This approach may facilitate recognition of differences in efficacy of selected agents against thrombi of diverse composition.