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Philippe Goutorbe - One of the best experts on this subject based on the ideXlab platform.
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persistent left vena cava incidentally recognized during Subclavian Vein Catheterization
Critical Care, 2010Co-Authors: Julien Bordes, Yves Asencio, Erwan Darranda, Philippe GoutorbeAbstract:Central venous line insertion is a routine procedure in the intensive care unit. But intensivists should be aware of the possibility of rare anatomic variants. We report an 84-year-old patient who was admitted to the intensive care unit for respiratory distress due to Guillain-Barre syndrome. After intubation of the trachea, a central venous catheter was inserted via the left Subclavian Vein. Th is was accomplished uneventfully with only one puncture. However, the post-procedural chest x-ray showed an unusual left-sided paramediastinal course of the catheter (Figure 1). We evocated an arterial placement fi rst, but the transduced waveform and the blood gas samples were compatible with an intrathoracic Vein placement. So we hypothesized that the patient could present with a persistent left superior vena cava (LSVC). Th is diagnosis was confi rmed by trans oeso phageal echography: the injection of agitated saline via the right cubital Vein resulted in opacifi cation of the dilated coronary sinus prior to reaching the right atrium and right ventricle, and this confi rmed the anatomic variant of LSVC associated with the absence of a right superior vena cava. Th ere were no other abnormalities concern ing heart or great vessels. Persistent LSVC occurs in 0.5% of the population and 5% to 10% of patients with congenital heart diseases. It usually drains into the right atrium through the coronary sinus, and it is associated with an absent right superior vena cava in 20% of cases [1]. Th e diagnosis can be made by bedside transthoracic or transesophageal echocardiography [2,3]. Computed tomography can also be useful [4]. Persistent LSVC is not a contraindication to Subclavian Vein Catheterization but can make diffi cult the attempt to place a central venous line, pulmonary artery catheter, or pacemaker. Some authors described the uneventful use of a catheter placed in the LSVC for several days, after checking that the catheter tip was not in the coronary sinus [3]. Th e use of a pulmonary artery catheter has also been reported [1]. But manipulation of a
Paul F. Mansfield - One of the best experts on this subject based on the ideXlab platform.
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Prospective, randomized trial of Doppler-assisted Subclavian Vein Catheterization.
Archives of Surgery, 1998Co-Authors: Richard J. Bold, David J. Winchester, Alice R. Madary, Mary Ann Gregurich, Paul F. MansfieldAbstract:Objective To examine the rate of success and complications of Doppler-guided Subclavian Vein catheter insertion compared with standard insertion in patients considered at high risk for failure. Design Prospective, randomized, crossover trial. Setting University-affiliated tertiary care medical center. Patients Two hundred forty patients were enrolled in the study. Patients were stratified for 3 known risk factors: (1) prior surgery in the Subclavian Vein region, (2) prior radiotherapy at the attempted Catheterization site, and (3) an abnormal weight-height ratio. Interventions Subclavian Vein Catheterization was performed either in standard or Doppler-guided fashion using the Smart Needle (Peripheral Systems Group, Mountain View, Calif), which is a Doppler probe at the tip of a cannulating needle. If Subclavian Vein Catheterization was unsuccessful after 2 attempts, patients were crossed over to the other technique. Main Outcome Measure Successful cannulation of the Subclavian Vein. Results The success rate, either as an initial technique or as a salvage technique, and complication rate were not significantly different with use of the Smart Needle. A subgroup of physicians had a significantly lower success rate using the Smart Needle. Conclusions Doppler guidance did not increase the success rate or decrease the complication rate of Subclavian Vein Catheterization when compared with the standard technique in high-risk patients. Doppler guidance was not more useful than the standard technique as a salvage technique following a previous failure of Catheterization. Furthermore, real-time Doppler guidance of Subclavian Vein Catheterization is a technique that is highly operator dependent.
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Complications and failures of Subclavian-Vein Catheterization.
The New England journal of medicine, 1995Co-Authors: Paul F. Mansfield, Mary Ann Gregurich, David C. Hohn, Bruno D. Fornage, David M. OtaAbstract:Background Although Catheterization of the Subclavian Vein is a common procedure, the risk factors for complications and failures, with the exception of the physician's experience, are poorly understood. Ultrasonography has been recommended to help guide the placement of central venous catheters. Methods We conducted a prospective randomized trial of ultrasound-guided location of the Subclavian Vein as compared with standard insertion procedures. In the group of patients undergoing Catheterization with ultrasound guidance, the site of the insertion was marked before the Catheterization attempt; real-time ultrasound guidance was not used. The 821 eligible patients (411 in the ultrasound group and 410 in the control group) underwent Catheterization in a single procedure suite under controlled nonemergency conditions, in most cases for the administration of chemotherapy. Results Ultrasound guidance had no effect on the rate of complications or failures of Subclavian-Vein Catheterization (risk ratio for compl...
Youn Joung Cho - One of the best experts on this subject based on the ideXlab platform.
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Effects of ipsilateral tilt position on the cross-sectional area of the Subclavian Vein and the clinical performance of Subclavian Vein Catheterization: a prospective randomized trial.
BMC Anesthesiology, 2020Co-Authors: Hyun Kyu Yoon, Hyung-chul Lee, Pyoyoon Kang, Jung-man Lee, Hee Pyoung Park, Youn Joung ChoAbstract:The cross-sectional area of the Subclavian Vein (csSCV) is a crucial factor in the successful Catheterization of the Subclavian Vein. This randomized controlled study investigated the effects of the csSCV on landmark-based Subclavian Vein Catheterization. This study was performed using a two-stage protocol. During stage I, the csSCV was measured in 17 patients placed in the supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in a random order. During stage II, landmark-based Subclavian Vein Catheterization was randomly performed in patients placed in either the supine (group S, n = 107) or the ipsilateral tilt (group I, n = 109) position. The primary outcome measure was the csSCV in stage I and the primary venipuncture success rate in stage II. Secondary outcome measures were the time to successful venipuncture, the total Catheterization time, the first-pass success rate, and the incidence of mechanical complications during Catheterization. The csSCV was significantly larger in the ipsilateral tilt than in either the supine or contralateral tilt position (1.01 ± 0.35 vs. 0.84 ± 0.32 and 0.51 ± 0.26 cm2, P = .006 and
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effects of ipsilateral tilt position on the cross sectional area of the Subclavian Vein and the clinical performance of Subclavian Vein Catheterization a prospective randomized trial
BMC Anesthesiology, 2020Co-Authors: Hyun Kyu Yoon, Hyung-chul Lee, Pyoyoon Kang, Jung-man Lee, Hee Pyoung Park, Youn Joung ChoAbstract:The cross-sectional area of the Subclavian Vein (csSCV) is a crucial factor in the successful Catheterization of the Subclavian Vein. This randomized controlled study investigated the effects of the csSCV on landmark-based Subclavian Vein Catheterization. This study was performed using a two-stage protocol. During stage I, the csSCV was measured in 17 patients placed in the supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in a random order. During stage II, landmark-based Subclavian Vein Catheterization was randomly performed in patients placed in either the supine (group S, n = 107) or the ipsilateral tilt (group I, n = 109) position. The primary outcome measure was the csSCV in stage I and the primary venipuncture success rate in stage II. Secondary outcome measures were the time to successful venipuncture, the total Catheterization time, the first-pass success rate, and the incidence of mechanical complications during Catheterization. The csSCV was significantly larger in the ipsilateral tilt than in either the supine or contralateral tilt position (1.01 ± 0.35 vs. 0.84 ± 0.32 and 0.51 ± 0.26 cm2, P = .006 and < .001, respectively). The primary venipuncture success rate did not differ significantly between the group S and I (57.0 vs. 64.2%, P = .344). There were also no significant differences in the secondary outcome measures of the two groups. The csSCV was significantly larger in patients placed in the ipsilateral tilt than in the supine position, but the difference did not result in better clinical performance of landmark-based Subclavian Vein Catheterization. NCT03296735 for stage I ( ClinicalTrials.gov , September 28, 2017) and NCT03303274 for stage II ( ClinicalTrials.gov , October 6, 2017).
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Effects of ipsilateral tilt position on the cross-sectional area of the Subclavian Vein and the clinical performance of Subclavian Vein Catheterization: a prospective randomized trial
BMC Anesthesiology, 2020Co-Authors: Hyun Kyu Yoon, Hyung-chul Lee, Pyoyoon Kang, Jung-man Lee, Hee Pyoung Park, Youn Joung ChoAbstract:Background The cross-sectional area of the Subclavian Vein (csSCV) is a crucial factor in the successful Catheterization of the Subclavian Vein. This randomized controlled study investigated the effects of the csSCV on landmark-based Subclavian Vein Catheterization. Methods This study was performed using a two-stage protocol. During stage I, the csSCV was measured in 17 patients placed in the supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in a random order. During stage II, landmark-based Subclavian Vein Catheterization was randomly performed in patients placed in either the supine (group S, n = 107) or the ipsilateral tilt (group I, n = 109) position. The primary outcome measure was the csSCV in stage I and the primary venipuncture success rate in stage II. Secondary outcome measures were the time to successful venipuncture, the total Catheterization time, the first-pass success rate, and the incidence of mechanical complications during Catheterization. Results The csSCV was significantly larger in the ipsilateral tilt than in either the supine or contralateral tilt position (1.01 ± 0.35 vs. 0.84 ± 0.32 and 0.51 ± 0.26 cm^2, P = .006 and
Kai-sheng Hsieh - One of the best experts on this subject based on the ideXlab platform.
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a potentially fatal complication during Subclavian Vein Catheterization in an infant with congenital heart disease puncture to pulmonary artery directly a case report
Journal of Clinical Anesthesia, 2008Co-Authors: Ta-cheng Huang, Jun-yen Pan, Hsiao-ping Wang, Chu-chuan Lin, Ying-yao Chen, Kai-sheng HsiehAbstract:The most frequent and acute complications of Subclavian Vein Catheterization are arterial puncture to the Subclavian artery and pneumothorax. We report an arterial puncture directly to the pulmonary artery in infant during Subclavian Vein Catheterization.
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A potentially fatal complication during Subclavian Vein Catheterization in an infant with congenital heart disease—puncture to pulmonary artery directly: a case report
Journal of clinical anesthesia, 2008Co-Authors: Ta-cheng Huang, Jun-yen Pan, Hsiao-ping Wang, Chu-chuan Lin, Ying-yao Chen, Kai-sheng HsiehAbstract:The most frequent and acute complications of Subclavian Vein Catheterization are arterial puncture to the Subclavian artery and pneumothorax. We report an arterial puncture directly to the pulmonary artery in infant during Subclavian Vein Catheterization.
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supraclavicular versus infraclavicular Subclavian Vein Catheterization in infants
Journal of The Chinese Medical Association, 2006Co-Authors: Meiling Yao, Ta-cheng Huang, Chu-chuan Lin, Ying-yao Chen, Kai-sheng Hsieh, Paochin Chiu, Chuchin ChenAbstract:Background: Central venous Catheterization is an important procedure for infant patients for a number of different purposes, including nutritional support, surgical operation, hemodynamic monitoring, and multiple lines for critical care medications. Subclavian Vein Catheterization (SVC) is one of the central Vein Catheterization techniques. SVC can be performed from 4 different locations: right supraclavicular (RSC), left supraclavicular (LSC), right infraclavicular (RIC), and left infraclavicular (LIC). The purpose of this study was to evaluate the relative effectiveness and complication risks of these 4 SVC locations in infants. Methods: In our pediatric intensive care unit, which is part of a tertiary medical center, a well-trained fellow doctor performed the following Catheterizations: 21 RSC, 24 LSC, 24 RIC, and 22 LIC, for a total of 91 SVC operations in infants. The patients were placed in the Trendelenburg position. The site of puncture was decided by the operator. Statistical significance was analyzed according to Fisher's exact test and 2-sample t test. Results: The overall success rate was 90.1% (82 out of 91 operations). No statistically significant differences were noted among these 4 groups, either in the success or complication rate. There were 6 cases of arterial puncture (5 supraclavicular and 1 infraclavicular, p = 0.09), 2 cases of pneumothorax (1 RSC and 1 RIC), and 2 cases of malpositioned catheter (1 RSC and 1 RIC). There was no mortality. Conclusion: In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the Subclavian arteries through the supraclavicular route. (J Chin Med Assoc 2006;69(4):153-156)
Julien Bordes - One of the best experts on this subject based on the ideXlab platform.
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persistent left vena cava incidentally recognized during Subclavian Vein Catheterization
Critical Care, 2010Co-Authors: Julien Bordes, Yves Asencio, Erwan Darranda, Philippe GoutorbeAbstract:Central venous line insertion is a routine procedure in the intensive care unit. But intensivists should be aware of the possibility of rare anatomic variants. We report an 84-year-old patient who was admitted to the intensive care unit for respiratory distress due to Guillain-Barre syndrome. After intubation of the trachea, a central venous catheter was inserted via the left Subclavian Vein. Th is was accomplished uneventfully with only one puncture. However, the post-procedural chest x-ray showed an unusual left-sided paramediastinal course of the catheter (Figure 1). We evocated an arterial placement fi rst, but the transduced waveform and the blood gas samples were compatible with an intrathoracic Vein placement. So we hypothesized that the patient could present with a persistent left superior vena cava (LSVC). Th is diagnosis was confi rmed by trans oeso phageal echography: the injection of agitated saline via the right cubital Vein resulted in opacifi cation of the dilated coronary sinus prior to reaching the right atrium and right ventricle, and this confi rmed the anatomic variant of LSVC associated with the absence of a right superior vena cava. Th ere were no other abnormalities concern ing heart or great vessels. Persistent LSVC occurs in 0.5% of the population and 5% to 10% of patients with congenital heart diseases. It usually drains into the right atrium through the coronary sinus, and it is associated with an absent right superior vena cava in 20% of cases [1]. Th e diagnosis can be made by bedside transthoracic or transesophageal echocardiography [2,3]. Computed tomography can also be useful [4]. Persistent LSVC is not a contraindication to Subclavian Vein Catheterization but can make diffi cult the attempt to place a central venous line, pulmonary artery catheter, or pacemaker. Some authors described the uneventful use of a catheter placed in the LSVC for several days, after checking that the catheter tip was not in the coronary sinus [3]. Th e use of a pulmonary artery catheter has also been reported [1]. But manipulation of a
