Among 36 females, 25 After 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. Repositioning was done in 13 of 58 After repositioning, chest radiograph was repeated to confirm the position of the tip and the catheter insertion depth was noted. CVC insertion is associated with many mechanical complications with an incidence varying from 6.
Vessel wall and cardiac perforation can occur immediately during the procedure either by guidewire, dilator or over insertion of the catheter. It can occur late as well, as either secondary to catheter advancement with head, arm and trunk movement or by tissue erosion caused by catheter tip abutting against vessel or cardiac wall, which is further aggravated by cardiac contractions. Over insertion of the catheter can also lead to various arrhythmias including atrial and ventricular premature beats, ventricular tachycardia or fibrillation.
These rhythm disturbances are usually resistant to drug suppression and require withdrawal of the catheter from the cardiac chambers. McGee et al. Several recommendations have been made to decrease the risk of vessel or cardiac perforation, which include omission of beveled or hard tip catheter, avoidance of left-sided approach and immobilization of the catheter.
According to the recommended guidelines CVC tip should lie in the SVC above the pericardial reflection to prevent such potential and serious complications. Schematic zones for catheter tip positioning can be categorized into three zones [ Figure 1 ]. In this zone CVCs placed from the left side are likely to lie parallel to the vessel walls.
This may represent a necessary compromise for left-sided CVCs to ensure that they lie parallel to the vessel wall. Right-sided CVCs in this zone, however, should be pulled back to zone B. Zone B represents the area around the junction of the left and right innominate veins and the upper SVC. This is a suitable area for CVCs placed from the right side; however, left-sided CVCs will enter this area at a steep angle and are at risk of abutting the lateral wall of the SVC and should ideally be advanced into zone A.
Zone C represents the left innominate vein proximal to the SVC. CVCs in zone C are probably suitable for short-term fluid therapy and CVP monitoring, but not for inotrope infusions or long-term use. The safety of this site has been questioned. Stylized anatomical Figure dividing the great veins and upper RA into three zones A-C , representing different areas of significance for placement of CVCs. The upper limit of the pericardial reflection cannot be seen on plain chest X-ray but is generally accepted to be approximately 0.
Hence, carina has been considered as a radiological landmark for CVC tip position. Site of insertion, patient's height and body habitus are significant factors that influence the appropriate catheter insertion length.
Right atrial electrocardiography has been used to guide the catheter tip to the suitable position but it requires special gadgets, which may not be readily available in certain emergency situations. In a study, Peres utilized patients' height to develop formulas to predict the optimum length of the catheter to be inserted for right internal or external jugular catheters, right infraclavicular subclavian catheters and left external jugular catheters.
But Peres' formula does not take into account the probable differences in catheter insertion length due to variation in same side approach, that is, high vs cricoid internal jugular approaches or medial vs lateral subclavian approaches.
Moreover, in certain emergency situations time and circumstances may not permit rough measurement of the patient's height. In such situations average catheter insertion length calculated for each site may be used for correct placement of the catheter tip and avoid unnecessary complications.
In our study, we concluded that post procedure chest radiograph is helpful in evaluating the position of the tip of the catheter in relation to the carina. While inserting the CVC in the IJV via the central approach, the depth of insertion could be at cm in males and cm in females in right-sided catheters, whereas at a depth of cm in males and cm in females in left-sided ones. At this length the catheter tip could lie in an optimum position. In this way number 13 may not be lucky for all.
A depth of 16 cm may be adequate for western population, but Indian population may require shorter length of placement. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian J Crit Care Med.
Rash Kujur , S. A p eripherally inserted central catheter PICC line is placed into a vein in the arm. A tunneled catheter is surgically placed into a vein in the chest or neck and then passed under the skin. One end of the catheter comes out through the skin so medicines can be given right into the catheter. An implanted port is similar to a tunneled catheter, but an implanted port is placed entirely under the skin. Medicines are given by a needle placed through the skin into the catheter.
Where are central venous catheters used? Additional Resources. Get Email Updates. To receive email updates about this page, enter your email address: Email Address. What's this? Links with this icon indicate that you are leaving the CDC website. It also can be used to draw blood. Most of the time, central lines do not cause any problems. If problems do happen, it is usually because the line gets infected or stops working. Very rarely, a central line can cause a blood clot. Doctors review the risks with families before placing the central line.
If your child has a central line, you can help care for it to prevent infection and keep it working well. It's normal to feel a little bit nervous caring for the central line at first, but soon you'll feel more comfortable. You'll get supplies to use at home, and a visiting nurse may come to help you when you first get home.
0コメント