![]() ![]() Among 36 females, 25 (69.44%) had right IJV catheters, whereas 11 (30.55%) had left IJV catheters.Īfter observing the position of the catheter tip in post procedure chest radiograph, catheter repositioning was required in 15 of 71 males and 14 of 36 females. Total number of right IJV catheters was 83 (77.57%) and that of left IJV catheters was 24 (22.43%).Īmong the 71 male patients, 58 (81.69%) had right IJV catheters, whereas 13 (18.3%) had left IJV catheters. Of the 107 patients evaluated, there were 71 male and 36 female patients. The depth of insertion of the catheter after repositioning was noted and was confirmed by a repeat chest radiograph. Catheters were repositioned after checking the tip position in the chest radiograph. CVC tip position was judged as correct if the tip was positioned just above the level of carina for right IJV catheters and just below the level of carina for left IJV catheters. A post procedure portable chest radiograph was performed in all the cases in supine position, for assessing the position of the tip of the catheter. The catheters were inserted to a length of 13-14 cm in right-sided catheters and to a length of 14-15 cm in left-sided catheters. All catheters were placed by intensivists and trained doctors.Īll catheters (double/triple lumen Certofix B Braun) were placed blindly through the central approach using the Seldinger's technique. Patients with altered coagulation parameters, arrhythmias, pacemaker in situ, short neck, burn contractures of the neck and cervical spine injury were excluded from the study. CVCs placed through the right and left internal jugular veins (IJVs) were evaluated. The position of the CVC tip was considered correct in the chest radiograph if it was just above the carina in right-sided catheters and just below the carina in left-sided catheters.Īfter approval by the institutional ethics committee, 107 patients in the age group of 20-60 years were enrolled in this prospective observational study. The position of the tip of the catheter and the rate of repositioning was observed. In this study, we evaluated 107 patients in whom CVCs were placed as part of the management. Various methods such as anatomical landmarks, simple formulae, right atrial electrocardiography and echocardiography have been used to ensure correct placement of the CVC tip. It is also recommended that the catheter tip should lie in the long axis of the SVC, without acute abutment to the vein wall. The correct position of the tip of CVC is considered to be in the superior vena cava (SVC) above the level of pericardial reflection. Apart from thrombosis and infections, their use is associated with many mechanical complications such as cardiac tamponade, perforation, pneumothorax and life-threatening arrhythmias.įor proper monitoring of central venous pressure and to avoid some of the life-threatening mechanical complications it is mandatory that the tip of the catheter lies in the correct position. 8.5 Fr Cordis/introducer sheath with pressure bag: 20.Central venous catheters (CVC) play a very important role in the management of critically ill patients in both ICUs and special wards.8.5 Fr Cordis/introducer sheath: 7.6 L/hr.However, consider giving FFP if patient has hemophilia įlow rate depends on diameter and length of IV the Hagen–Poiseuille equation.No benefit to giving FFP unless artery is punctured.Preferentially use a compressible site such as the femoral location (avoid the IJ and subclavian if possible, though IJ preferred over subclavian). ![]() Distortion of landmarks by trauma or congenital anomalies.Subclavian - trauma/fracture to ipsilateral clavicle or proximal ribs.Anatomic obstruction (thrombosis of target vein, other anatomic variance).Insertion of pulmonary artery catheters.Insertion of transvenous cardiac pacemakers.Administering hyperalimentation, vasopressors, caustic agents, or other concentrated fluids.Inability to obtain peripheral venous access.Administration of multiple medications and drips.Peripherally Inserted Central Catheter (PICC).Although subclavian lines appear to have a lower infection rate, there is greater incidence of mechanical complications. The 3SITES Trial study, a multicenter randomized trial, investigated the complications of the three anatomic sites for CVC insertion in relation to blood stream infections or DVTs. The major complications of concern include: catheter-related bloodstream infections (CRBI), DVT, and mechanical complications (e.g. The sites of insertion fall into three locations: Internal jugular (IJ), subclavian, and femoral. Central venous catheters(CVCs) are often required to establish venous access in critically ill patients in order to administer rapid fluid resuscitation, blood products, and vasopressors. ![]()
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