Arterial Placement of Central Venous Catheters Beyond Prevention to Management

Main Article Content

Dr. B.T. Wierstra, MD, FRCP(C), CCFP
Dr. Selena Au, MD, FRCP(C)
Dr. Paul M. Cantle, MD, MBT, FRCSC
Dr. Kenton L. Rommens, MD, FRCSC

Abstract

Arterial misplacement of central venous catheters can often be avoided with the use of real-time ultrasound-guided procedural competency.  However, misplacement can still occur and is more likely to occur when the internal jugular vein is located directly above the common carotid injury.  The resultant injury to the common carotid artery occurs through the posterior wall of the internal jugular vein.  Arterial injury may also occur when the subclavian vein is attempted in a non-ultrasound-guided fashion.  Optimal management requires a coordinated evaluation of the catheter misplacement by Interventional Radiology and Vascular Surgery to ensure maximum patient safety during catheter removal.  This article reviews the literature around this topic and provides a summary of the best approach to safely remove the misplaced catheter.


Resume


Le mauvais positionnement artériel des cathéters veineux centraux peut souvent être évité grâce à l'utilisation de compétences procédurales guidées par ultrasons en temps réel.  Cependant, un mauvais positionnement peut toujours se produire et est plus susceptible de se produire lorsque la veine jugulaire interne est située directement au-dessus de la lésion carotidienne commune.  La lésion de l'artère carotide commune qui en résulte se produit à travers la paroi postérieure de la veine jugulaire interne.  Une lésion artérielle peut également se produire lorsque la veine sous-clavière n'est pas guidée par un ultrason.  Une gestion optimale nécessite une évaluation coordonnée du mauvais positionnement du cathéter par la radiologie interventionnelle et la chirurgie vasculaire afin de garantir une sécurité maximale au patient lors du retrait du cathéter.  Cet article passe en revue la littérature sur ce sujet et fournit un résumé de la meilleure approche pour retirer en toute sécurité le cathéter mal placé.


 

Abstract 265 | pdf Downloads 97 HTML Downloads 27 xml Downloads 0

References

1. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348(12):1123–33.
2. Bowdle A. Vascular complications of central venous catheter placement: evidence-based methods for prevention and treatment. J Cardiothorac Vasc Anesth 2014;28(2):358–68.
3. Randolph AG, Cook DJ, Gonzales CA, Pribble CG. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 1996;24(12):2053–58.
4. Lalu MM, Fayad A, Ahmed O, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med 2015;43(7):1498–507.
5. Fragou M, Gravvanis A, Dimitriou V, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med 2011;39(7):1607–12.
6. Stefanidis K, Fragou M, Pentilas N, et al. Optimization of cannula visibility during ultrasound-guided subclavian vein catheterization, via a longitudinal approach, by implementing echogenic technology. Crit Care Res Pract 2012;2012:617149.
7. Blaivas M. Video analysis of accidental arterial cannulation with dynamic ultrasound guidance for central venous access. J Ultrasound Med 2009;28(9):1239–44.
8. Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Crit Care Med 2009;37(8):2345–49; quiz 2359.
9. Dixon OG, Smith GE, Carradice D, Chetter IC. A systematic review of management of inadvertent arterial injury during central venous catheterisation. J Vasc Access 2017;18(2):97–102.
10. Murarka S, Movahed MR. The use of micropuncture technique for vascular or body cavity access. Rev Cardiovasc Med 2014;15(3):245–51.
11. Bogabathina H, Singireddy S, Shi R, et al. Does micropuncture technique really help reduce vascular complications? Cardiovasc Revasc Med 2018;19(7 Pt A):762–65.
12. Guilbert MC, Elkouri S, Bracco D, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg 2008;48(4):918–25; discussion 925.
13. Abi-Jaoudeh N, Turba UC, Arslan B, et al. Management of subclavian arterial injuries following inadvertent arterial puncture during central venous catheter placement. J Vasc Interv Radiol 2009;20(3):396–402.
14. Ananthakrishnan G, White RD, Bhat R, Chakraverty S. Inadvertent subclavian artery cannulation: endovascular repair using a collagen closure device-report of two cases and review of the literature. Case Rep Vasc Med 2012;2012:150343.
15. Pikwer A, Acosta S, Kölbel T, Malina M, Sonesson B, Akeson J. Management of inadvertent arterial catheterisation associated with central venous access procedures. Eur J Vasc Endovasc Surg 2009;38(6):707–14.
16. Chen X, Bai J, Han F, Zhou D, Su Y. Percutaneous closure of the inadvertent subclavian artery cannulation during pacemaker implantation. Cardiol J 2017;24(4):452–54.