ABSTRACT
BACKGROUND: Cardiac tamponade is a rare but fatal complication of subclavian catheter insertion and maintenance. This happens due to erosion of the cardiac wall or the superior vena cava distal to the CLPR (cephalic limit of pericardial reflection). This study is designed to present a method of locating the catheter tip proximal to the CLPR, and to evaluate its results. METHODS: Forty adult patients with intracranial hemorrhages who needed craniotomies and central venous catheter insertions were recruited. The right subclavian vein was selected as the insertion route. On Chest AP film, clavicle, supraclavicular notch and trachobronchial tree were used as landmarks. The CLPR was assumed to be at the level of the angle between the right main bronchus and the trachea. Needle depth was measured from the skin puncture site to the point where blood was regurgitated by the Chest AP landmarks. Intravascular depth was measured from the point where blood was regurgitated to the CLPR. The sum of these two points was regarded as being the appropriate depth of the subclavian catheter insertion. In the control group (n = 40), the right subclavian catheter was inserted to the depth of height (cm)/10 minus 2 cm. RESULTS: In study group, the catheter tips were located proximal to the CLPR in about 2/3 (27/40) of the patients, and there was no case in which catheter tip was distal to the superior vena cava-right atrium junction. In the control group, catheter tips were proximal to the CLPR in only 10% of the patients and distal to the SVC/RA junction in 42.5%. CONCLUSIONS: This method decreased the incidence of locating the tip of the catheter distal to the CLPR, and prevented any intracardial location of the catheter tip.
Subject(s)
Adult , Humans , Bronchi , Cardiac Tamponade , Catheters , Central Venous Catheters , Clavicle , Craniotomy , Incidence , Intracranial Hemorrhages , Needles , Punctures , Skin , Subclavian Vein , Thorax , Trachea , Vena Cava, SuperiorABSTRACT
BACKGROUND: Cardiac tamponade is a rare but fatal complication of subclavian catheter insertion and maintenance. This happens due to erosion of the cardiac wall or the superior vena cava distal to the CLPR (cephalic limit of pericardial reflection). This study is designed to present a method of locating the catheter tip proximal to the CLPR, and to evaluate its results. METHODS: Forty adult patients with intracranial hemorrhages who needed craniotomies and central venous catheter insertions were recruited. The right subclavian vein was selected as the insertion route. On Chest AP film, clavicle, supraclavicular notch and trachobronchial tree were used as landmarks. The CLPR was assumed to be at the level of the angle between the right main bronchus and the trachea. Needle depth was measured from the skin puncture site to the point where blood was regurgitated by the Chest AP landmarks. Intravascular depth was measured from the point where blood was regurgitated to the CLPR. The sum of these two points was regarded as being the appropriate depth of the subclavian catheter insertion. In the control group (n = 40), the right subclavian catheter was inserted to the depth of height (cm)/10 minus 2 cm. RESULTS: In study group, the catheter tips were located proximal to the CLPR in about 2/3 (27/40) of the patients, and there was no case in which catheter tip was distal to the superior vena cava-right atrium junction. In the control group, catheter tips were proximal to the CLPR in only 10% of the patients and distal to the SVC/RA junction in 42.5%. CONCLUSIONS: This method decreased the incidence of locating the tip of the catheter distal to the CLPR, and prevented any intracardial location of the catheter tip.
Subject(s)
Adult , Humans , Bronchi , Cardiac Tamponade , Catheters , Central Venous Catheters , Clavicle , Craniotomy , Incidence , Intracranial Hemorrhages , Needles , Punctures , Skin , Subclavian Vein , Thorax , Trachea , Vena Cava, SuperiorABSTRACT
BACKGROUND: It is important to control of intracranial pressure(ICP) in patients with intracranial pathology. To decrease ICP and to attenuate the adverse cardiovascular reflexes associated with anesthetic induction and tracheal intubation, we are often administered potent opiates during anesthetic induction. A side effect of these agents when used in large doses is muscle rigidity. We investigated the effects of high dose fentanyl on ICP, central venous pressure (CVP) and mean arterial pressure (MAP) during fentanyl-induced rigidity in rabbits. METHODS: Under halothane anesthesia, polyethylene catheters were surgically inserted into the femoral artery and vein for measurement of MAP and CVP in 10 rabbits. ICP was measured between epidural and subdural space through the burr hole of the frontal bone by means of fiberoptic ICP monitor. The animals were mechanically ventilated to achieve normocarbia. Following instrumentation, halothane was discontinued and fentanyl 50 microgram/kg administered intravenously at the first movement during emergence from halothane anesthesia. RESULTS: In the seven rabbits that developed rigidity, ICP and CVP were increased significantly compared to control value (delta ICP 9.2+/-1.9 mmHg, delta CVP 5.0+/-0.9 cmH2O: P<0.05). But MAP was decreased significantly from 95+/-5 to 74+/-4 mmHg (P<0.05). These variables except MAP were returned to baseline when rigidity was abolished with vecuronium. In three rabbits that did not show rigidity, ICP and CVP did not change following injection of fentanyl. But MAP in the non-rigidity group was significantly decreased like the rigidity group (P<0.05). CONCLUSIONS: These observations suggest that rigidity should be prevented when opiates like fentanyl are used as an induction drug of patients with ICP problems.