Fatal complication from central venous cannulation in a paediatric liver transplant patient

We report a fatal complication from central venous cannulation in a child undergoing heterotropic liver transplantation. Following the attempted placement of a cannula in the left internal jugular vein, extravasation of blood products via the cannula resulted in haemothorax, hypotension and eventual brain death. Possible causes and strategies for prevention of this complication are discussed.     

Bilateral consolidation of the lungs in a preterm infant: an unusual central venous catheter complication

We describe a case of bilateral parenchymal consolidation with sudden respiratory distress in a preterm baby as a complication of peripherally inserted central catheter (PICC) dislocation. The X-rays showed bilateral pulmonary consolidation with the catheter tip initially located in the right, and later in the left pulmonary artery. The catheter was withdrawn. As soon as the catheter was repositioned all clinical signs and symptoms disappeared. Neonatologists should consider the possibility of dramatic respiratory distress deriving from PICC dislocation. Careful tip catheter placement and conscientious monitoring may reduce morbidity.     

Delayed pneumothorax and hydrothorax with central venous catheter migration

We report a case of delayed pneumothorax, central venous catheter migration and iatrogenic hydrothorax in a 22-year-old female. The left subclavian central venous catheter initially transfixed the lung apex; pneumothorax occurred 24 h later following initiation of positive pressure ventilation. Lung collapse as a result of the pneumothorax caused catheter migration and hydrothorax. Catheter removal and chest drainage led to an uneventful recovery.     

Delayed hydrothorax induced by a pericutaneous central venous catheter; report of a case

We report herein a case of 53-year-old woman who suffered a hydrothorax induced by a central venous catheter which had been placed to facilitate total parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. Chest X-ray film after insertion revealed proper position of the tip. She suddenly developed dyspnea and tachycardia due to right-sided hydrothorax 21 days after the insertion of the catheter. Chest X-ray showed massive pleural effusion in the right thorax, and the catheter tip inadvertently turned upward. The continuous mechanical force of the catheter tip against the SVC wall was considered to be the cause of this life-threatening delayed hydrothorax.     

Usefulness of a central venous catheter during hepatic surgery

Aim: Central venous catheter (CVC) is often inserted during liver resection because a low central venous pressure (CVP) reduces blood loss and the procedure may be associated with circulatory impairment. The aim of the study was to evaluate the usefulness of a CVC besides the measurements of CVP, and whether peripheral venous pressure (PVP) measurement could be used reliably in place of CVP.
Methods: We conducted an observational study during a 16-month period. Number of CVC inserted, expected surgical difficulties, and intraoperative complications which could lead to treatment involving a CVC were prospectively recorded and analysed. Measurements of CVP and PVP were simultaneously obtained at different times during surgery. Bias and limits of agreement with their 95% confidence interval (95% CI) were calculated.
Results: Of the 101 patients included, 28 had expected surgical difficulties. Of the 75 CVCs inserted, only six (8%) were used for another purpose that CVP measurement in patients with expected surgical difficulties. A total of 124 measurements in 23 patients were recorded. Mean CVP was 4.8 ± 2.9 mmHg and mean PVP was 6.9 ± 3.1 mmHg ( P <0.0001). The bias was −2.1 ± 1.1 mmHg (95% CI: −2.3 to −1.9). When adjusted by the average bias of −2 mmHg, PVP predicted a CVP≤5 mmHg with a sensitivity and a specificity of 93% and 87%, respectively.
Conclusion: Routine insertion of a CVC should be discussed in patients without expected surgical difficulties. Thus, PVP monitoring may suffice to estimate CVP in uncomplicated cases.     

Complications of short term multilumen central venous cannulation in children—a prospective study

A prospective study of the incidence of complications, when using multiple lumen central venous catheters in a paediatric intensive care unit, undertook to survey the normal practice of central venous cannulation at the Birmingham Children's Hospital, using a variety of devices and approaches over a period of a year from May 1991. Ninety five percent of the total of 252 devices used were triple lumen, the rest being double lumen catheters. There were 19 failures to secure access at the initial site chosen, but central venous access was secured in all cases. The complication rate during insertion was 18.5%. There were three major and 20 minor non-infective complications with a total incidence of 7.9%. Twenty seven cases (10.8%) suffered infective complications. The incidence of all complications were comparable to those obtained in studies involving the use of single lumen devices. This fact, coupled with the high success rate in catheter placement by operators of varying experience, suggests that multiple lumen central venous devices can be considered as a safe alternative to single lumen catheters for short term use in children.     

Long-term central venous access

Br J Anaesth 2004, 92: 722–34     

Late mediastinitis with bilateral hydrothorax after vessel perforation by a central venous catheter

A central venous catheter was inserted into the right internal jugular vein of a 67-year-old woman to provide parenteral nutrition on the 7th day after surgery. Five days later, mediastinitis with bilateral hydrothorax had developed and was causing respiratory failure and systemic inflammatory response syndrome secondary to documented vascular perforation by the catheter. Four factors have been associated with increased risk of perforation: catheter rigidity and diameter, the angle between the tip of the catheter and the vessel wall, and insertion from the left. Three catheter positions have been described as safe when radiologically confirmed: the superior vena cava, the point where the superior vena cava meets the atrium, and the midpoint of the innominate vein. However, it should not be forgotten that a radiograph is 2-dimensional and a single image of a catheter tip can correspond to a variety of locations (superior vena cava, vena innominata, extravascular location, and more). Even when there is clinical and radiologic evidence of catheter positioning, vascular perforation should be suspected in patients with a central venous catheter and bilateral pleural effusion who present respiratory insufficiency and hemodynamic instability.     

An unusual complication of a central venous catheter in a neonate

The use of central venous catheters in neonates is associated with early and late complications. It is recognized that catheter tip migration and perforation of a viscus can occur at any time with a potentially fatal outcome. We present a case in which the successful placement of a central line was followed 2 weeks later by a sudden respiratory deterioration necessitating intubation and ventilation. The catheter tip had eroded through the wall of a pulmonary artery and a bronchus into the bronchial tree. The report highlights the serious morbidity arising from the use of central venous lines in neonates and stresses the importance of X-rays in establishing the correct position of all catheters. A sudden change in the condition of a patient should raise the suspicion of a catheter-related problem.     

Verification of the position of a central venous catheter by intra-atrial ECG. When does this method fail?

The purpose of this study was to determine why intra-atrial ECG tracing for checking the position of a central venous catheter fails in certain patients. Three hundred and fifty prospective and consecutive patients scheduled for central venous catheterization using various puncture sites and techniques were investigated. The catheters were 20 cm in length. After its introduction, the catheter was connected to an Alphacard® (Sterimed, Saarbrücken) for the intra-atrial ECG tracing. The method failed in 29 patients, of whom nine had manifest myocardial pathology. In two patients the catheter looped, while in the remaining 18 the catheter proved to be too short. In these 18 patients, the cannulation was mainly performed via the external jugular vein and/or from the left side. Most of the patients were elderly males, and 11 of the 18 patients showed radiological signs of pulmonary emphysema. In such individuals it is advisable to use a catheter longer than 20 cm.     

Tension hydrothorax induced by central venous catheter migration in a patient with burns

Editor—We describe an unusual complication of tensionhydrothorax, induced by migration of a central venous catheterin an ICU patient with burns. Correct clinical diagnosis resultedin an immediate intervention and insertion of pleural drainage. A 48-yr-old male was referred to our hospital with deep, thirddegree 30% total body surface area flame burns. He had attemptedsuicide by self-immolation. He was transferred to burn ICU.According to standard protocol, his trachea was intubated becauseof suspected     

中心静脉导管室医护一体急救管理模式的构建与实施

目的构建中心静脉导管室的急救管理模式,保障中心静脉置管过程的安全。方法成立中心静脉导管室急救小组,从健全各种急救制度、急救人员统一培训等方面构建一个全方位、多学科参与的“医护一体”急救管理模式。结果2012年1月至2013年10月共置管30674例次,置管过程中共进行61例次急救,抢救成功率100％,且患者转归良好。2013年置管并发症低于2012年。结论对医院中心静脉导管室实施“医护一体”急救管理模式提高了置管人员的风险防范能力,提升了护理专业水平,保障了患者安全。     

Bacterial colonization and peripheral bacteraemia associated with central venous haemodialysis catheters: A cross-sectional study

Summary: Septicaemia related to internal luminal colonization of central venous catheters has been described in many clinical settings including haemodialysis. the prevalence and consequence of intraluminal colonization of central venous haemodialysis catheters is unknown. A cross-sectional study of asymptomatic patients receiving haemodialysis through central venous catheters was performed. Differential (central line and peripheral) quantitative blood cultures were taken on three occasions. Twenty-one patients were studied and 20 had colonized central venous catheters. the organisms isolated were Coagulase negative Staphylococci (16 cases), Bacillus species (three), Corynebacterium (three), Pseudomonas species (three), and others (three). Fifteen patients also had significant peripheral bacteraemia associated with the same organism that was cultured from their central line. Seven patients had septic episodes associated with these same organisms. Swabs taken of the internal catheter surfaces also cultured these organisms. the vast majority (95%) of central venous haemodialysis catheters are colonized by bacteria. Seventy-six per cent have associated peripheral bacteraemia, which can lead to systemic infection.     

CVP catheter electrocardiography: an alternative to radiographic control after cannulation of central veins?

We evaluated 160 electrocardiograms taken after placement of central venous catheters (CVC) to determine their locations. Usable recordings were obtained in 154 patients. Subsequent radiographs revealed 30 misplaced catheters. Twenty-five of those were detected by CVC electrocardiograms. There were five false positive and five false negative traces. The sensitivity of CVC electrocardiography was 96%, the specificity 83.3%, and the total predictive power 93.5%. Electrocardiograms obtained from guide-wires were of significantly better quality than those from 0.9% NaCl filled catheters. The technique is accurate, safe and easy to learn. It may reduce the need for routine radiographic control to less than 10% of patients.     

血栓弹力图指导下肝硬化患者三腔中心静脉置管的临床应用

目的观察肝硬化合并肾功能衰竭、伴凝血异常的患者应用血栓弹力图（TEG）监测在中心静脉置管中的临床应用。方法选择肝硬化合并肾功能衰竭、伴凝血功能异常的患者共40例,经颈内静脉穿刺置入三腔静脉导管,随机分成两组,每组各20例。对照组（A组）患者根据实验室凝血检测结果常规输注血浆和血小板;治疗组（B组）患者根据TEG监测结果输注血浆和血小板。同时观察两组病例穿刺后TEG的变化、伤口渗血以及感染情况。结果两组患者穿刺后TEG测定反应时间（R）、凝血酶形成时间（K）、最大振幅（MA）和α角值差异均具有统计学意义（P均＜0.05）,采用TEG监测治疗的患者伤口出血减少,且局部感染率降低。结论肝硬化患者通过TEG监测数据及时纠正血液低凝状态,可减少伤口出血和感染,同时可对肝硬化患者进行有创诊治提供帮助。     

Cardiac tamponade associated with a peripheral vein central venous catheter

We present a case of cardiac tamponade associated with placement of a central venous catheter (CVC) via a peripheral vein in a 14-year-old girl with idiopathic scoliosis undergoing corrective surgery. A number of complications have been described in association with CVC misplacement. Sporadic cases of cardiac tamponade from this have been reported, but the actual incidence is unknown. Death from cardiac tamponade attributed to CVCs ranges from 65 to 100%. In our patient, cannulation of the pericardiophrenic vein was probably the cause of cardiac tamponade, based on radiological evidence that the initial location of the catheter was near the right atrium and possibly at the outlet of the pericardiophrenic vein. The catheter could have advanced into the vein and then to the pericardial sac with postural changes. The acute clinical course of cardiac tamponade in our patient had potentially lethal hemodynamic repercussions. The main diagnostic test for this condition is echocardiography and the only effective treatment is drainage of the pericardial effusion. Echocardiography should be performed before pericardiocentesis except in life-threatening situations or high clinical suspicion. Although they are rare, it is important to be aware of the potential for CVC complications.