Arterial puncture central venous line

About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications...

INTRODUCTION: Inadvertent subclavian artery puncture during attempted central venous catheterization can be devastating. Percutaneous stent grafting, closure devices and conventional surgery have been described to effect repair. Balloon occlusion has also been described and often recommended. Numerous publications advise use of balloon expanded to no less than the diameter of the punctured artery. CASE PRESENTATION: We describe the case of a 21 year-old male whose right subclavian artery was inadvertently punctured after central-line removal...

BACKGROUND: Radial artery cannulation is usually done for monitoring invasive blood pressure during intraoperative period. The dynamic needle tip positioning approach allows continuous visualization of the needle tip during ultrasound-guided cannulation. The acoustic shadowing technique, using two lines on the ultrasound probe, might be used to facilitate radial artery puncture. We aimed to compare these two ultrasound-guided techniques of radial artery cannulation with the traditional palpation method in adult patients...

Subclavian artery injury during central venous line placement is a potentially life-threatening complication. Due to historically high mortality rates with attempted manual pressure for haemostasis, the current favoured method of repair is by open or endovascular means. This case describes the management of a central venous catheter placed through the internal jugular vein into the subclavian artery via a supraclavicular puncture. CT angiography revealed the arterial injury located 1 cm distal to the vertebral artery origin...

Central venous catheters (CVCs), regarded as lines of life, are helpful in hemodynamic monitoring and delivering medications to patients. However, there are several complications that can result from the placement of CVCs. This includes accidental arterial puncture, which has a temporal association with hemorrhage, hematoma, and stroke. Infusion of vasopressors through such a mispositioned arterial CVC further increases the risk of these complications with potential end-organ ischemia. Here, we discuss the case of a 76-year-old woman who developed a myocardial infarction, heart failure, and subarachnoid hemorrhage following the arterial infusion of vasopressors through a malpositioned CVC...

OBJECTIVES: This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). DESIGN: A prospective, single-blinded, open label, parallel-group, randomized trial. SETTING: Two university-affiliated ICUs in Poland (Opole and Lublin). PATIENTS: Mechanically ventilated intensive care patients with clinical indications for central venous line placement...

While central venous access is necessary for a variety of situations including inadequate peripheral venous access, medication administration, hemodynamic monitoring, vasopressor administration, and hemodialysis, complications during the insertion process are not uncommon. In the United States, in both critically ill medical patients and surgical patients, millions of central venous catheters are inserted yearly. Complications occurring during or immediately following insertion include cardiac, pulmonary, and vascular injuries as well as issues with catheter placement...

BACKGROUND: Establishing central venous access is important to provide fluid resuscitation or medications intravenously to patients. OBSERVATIONS: Although accidental cannulation of the internal carotid artery has been reported in the literature, to our knowledge this report is the first documented intraoperative ultrasound video demonstrating accidental and simultaneous common carotid artery and internal jugular cannulation during central line placement in the internal jugular vein...

BACKGROUND: In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. METHODS: The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes...

Central venous catheterization plays a key role in patients that require immediate resuscitation, long-term fluid management, and invasive monitoring. The supraclavicular (SC) and infraclavicular (IC) approaches are utilized for central venous catheterization and both have their benefits and limitations. In this systematic review, we aim to explore the success rate and various complications of the SC technique. A literature review was conducted on the PubMed, EMBASE, Scopus, CINAHL, and Cochrane databases. All relevant original articles that evaluated success rates and complications of SC access were retrieved and included for qualitative synthesis...

Objective For further evaluating the feasibility and safety of wire-in-needle (WIN) technique application for ultrasound-guided central venous catheter (USG-CVC) insertion in a pediatric intensive care unit (PICU). Methods We prospectively monitored all patients who underwent central line insertion guided by ultrasound from March 2018 to March 2019. An independent nurse recorded the patient's age, gender, weight and BMI, diagnosis, indication for insertion, blood pressure state, insertion time, line size, number of pricks, and arterial punctures...

Peripherally inserted central catheters (PICC) are useful access devices that allow for longer-term intravenous access. This allows patients requiring an extended period of intravenous medication to have this administered without the need for repeat vascular punctures. Even minimally invasive procedures such as line insertion come with risks. Of particular interest to this article is a limb threatening complication soon after line placement. We discuss the PICC line catheter tip as the likely cause for arrhythmia that lead to an embolic occlusion of an upper limb and required acute surgical intervention for limb salvage...

BACKGROUND AND AIMS: Subclavian vein (SCV) cannulation can be performed using either supraclavicular (SC) or infraclavicular (IC) long-axis approach under ultrasound guidance (USG). However, their relative efficacy remains debatable. The aim of this study was to compare these two approaches in terms of safety, ease, success rate, and record the incidence of complications. METHODS: We studied 90 adult patients distributed into two groups of 45 each. Data regarding the time taken for first venous puncture, the time required for inserting the catheter, the total number of attempts, the incidence of guidewire misplacement, and other mechanical complications were compared using Student's t-test for quantitative data and Chi-square test for qualitative value...

BACKGROUND: This case report describes a subclavian vein cannulation that inadvertently led to an arterial puncture with the catheter tip radiologically seen at the level of the aorta. This case emphasizes the importance of postprocedural imaging and the disadvantages of not using ultrasound guidance in central venous catheterization. CASE PRESENTATION: A 24-year-old Caucasian man with diabetes mellitus type 1 presented himself to the emergency department due to abdominal pain accompanied by nausea and vomiting...

BACKGROUND: Training programs for resident physicians struggle to balance the need for clinical experience with the impact of fatigue on patient safety. The length of shifts worked by emergency medicine (EM) residents is likely an important determinant of resident fatigue. OBJECTIVE: Assess the impact of a longer clinical shift on procedural competency. METHODS: We conducted a retrospective chart review of arterial line placements, central venous catheterizations, tube thoracostomies, endotracheal intubations, and lumbar punctures performed by EM residents working 12-h shifts in the emergency department of an academic medical center over an academic year...

BACKGROUND: Arterial catheter (A-line) is essential for managing severely ill patients, and the radial artery is the most common insertion site in the intensive care unit (ICU). However, many accidental removals occur because the insertion site of A-line in the traditional radial approach (TRA) overlaps with the joint flexion. Recent reports have shown no significant difference in the complication rates between coronarography using the distal radial approach (DRA) and that using TRA. However, to date, no report has examined accidental removals of DRA in the ICU...

CONTEXT: Vasopressors are commonly administered through Central Venous Catheters (CVCs) as it is considered unsafe to administer them via peripheral IVs, mainly due to the concern of local tissue injury. Unlike peripheral IVs, midline catheters provide a wider lumen with the catheter tip ending in a large peripheral vein. The use of vasopressors through midline catheters has not yet been evaluated. OBJECTIVE: The primary objective of this study is to determine the safety and efficacy of long term administration of vasopressors through a midline catheter...

Some patients with intestinal failure, who are dependent on total parenteral nutrition for long periods, suffer from a lack of suitable conventional venous access points, including axillary, external jugular, internal jugular, subclavian, saphenous, and the brachio-cephalic and femoral veins, due to their occlusion. Furthermore, extensive central venous stenosis and/or thrombosis of the superior and inferior vena cava may preclude further catheterization, so uncommon routes must be used, which can be challenging...

INTRODUCTION: Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. OBJECTIVES: Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc...

BACKGROUND: The objective of this study was to validate the transfer of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) placement skills from training on a Dynamic Haptic Robotic Trainer (DHRT), to placing US-IJCVCs in clinical environments. DHRT training greatly reduces preceptor time by providing automated feedback, standardizes learning experiences, and quantifies skill improvements. METHODS: Expert observers evaluated DHRT-trained (N = 21) and manikin-trained (N = 36) surgical residents on US-IJCVC placement in the operating suite using a US-IJCVC evaluation form...