One case of patient with bilateral ectopic subclavian vein catheterization / 中华烧伤杂志

One female patient aged 18 years, with severe burns and inhalation injury was admitted to our unit on June 5th, 2013. After admission, the right subclavian vein catheterization was performed for rapid fluid infusion against shock. Escharectomy on both upper extremities was planned to carry out and repaired with medium-thickness skin on right thigh 52 hours after injury. However, after general anesthesia, the right subclavian vein catheter was with poor fluid infusion, and the left subclavian vein catheterization was performed. Supraventricular tachycardia and decreased blood pressure occurred followed by fluid replacement and dilatation, cardiotonics, and diuretics. Postanesthetic 1.3 hours, the patient′s vital signs were stable, and the operation began. Postoperative chest X-ray film showed that distal ends of the left and right subclavian vein catheters were respectively located in the right atrium and the right internal carotid vein, and the catheters were removed immediately. This case suggests that clinical physician should be careful to prevent catheter heterotopia in subclavian vein catheterization, and postoperative routine chest X-ray examination is necessary to identify position of the catheter.

Effect of different subclavian vein catheterization methods on catheter-related bloodstream infection in critically ill patients / 中国感染控制杂志

Objective To evaluate the effect of different subclavian vein catheterization methods on catheter-related bloodstream infection(CRBSI) in critically ill patients.Methods Patients with subclavian vein catheterization for more than 7 days in the intensive care unit of a hospital between May 2008 and December 2015 were investigated retrospectively.They were divided into three groups:ultrasound-guided catheterization group(group A),conventional single lumen subclavian vein catheterization without skin expansion group(group B),conventional double lumen subclavian vein catheterization group(control group).The survey included name,age,diagnosis,APACHE Ⅱ score,catheterization sites and methods,whether or not succeeded in single catheterization,duration of catheterization,occurrence of CRBSI,and isolation of pathogens.Incidence of CRBSI,CRBSI per 1 000 catheter-days,and distribution of pathogens causing CRBSI were compared respectively among patients with different catheterization methods.Results A total of 2 366 patients were surveyed (group A,n =789;group B,n =786;control group,n =791).In group A,B,and control group,13,15,and 40 cases developed CRBSI respectively,incidence of CRBSI were 1.65％,1.91％,and 5.06％ respectively,incidence of CRBSI per 1 000 catheter-days were 1.09‰,1.27‰,and 3.36％‰ respectively,the percentage of success in single catheterization were 97.47％,88.80％,87.23％ respectively.There were significant difference in incidence,incidence of CRBSI per 1 000 catheter-days,and percentage of success in single catheterization among three groups(all P＜0.01).Pairwise comparison showed that percentage of success in single catheterization in group A was higher than group B and control group,difference were significant (x2 =46.25,58.50,both P＜0.01);incidence of CRBSI in control group was higher than group A and B(x52 =12.82,18.35 respectively,both P＜0.01);incidence of CRBSI per 1 000 catheter-days in control group was higher than group A and B(x2 =13.74,11.22 respectively,both P＜0.01).13,15,40 strains of pathogens were isolated from three groups,Staphylococcus epidermidis and Staphylococcus aureus were the main pathogens in three groups,the proportion of coagulase negative staphylococcus infection in control group was higher than group A and B.Conclusion Compared with conventional catheterization methods (single lumen,double lumen),ultasound-guided subclavian vein catheterization can effectively improve the success rate of puncture.Ultrasoundguided catheterization and conventional single lumen subclavian vein catheterization without skin expansion can reduce the occurrence of CRBSI compared with double lumen subclavian vein catheterization.

Improve cleaning and disinfectant methods for subclavian vein catheteriza-tion dressing change / 中国感染控制杂志

Objective To evaluate the effect of improved cleaning and disinfection method for subclavian venipunc-ture dressing change to prevent catheter-associated infection. Methods 120 hospitalized patients with right subcla-vian venipuncture at an intensive care unit in January-June 2012 were divided into control group (n= 60)and experi-mental group(n= 60)according to venipuncture date. Control group adopted conventional dressing change :disin-fected skin at and around puncture point by 2% iodine tincture,then used 75% alcohol for deiodination;experimen-tal group adopted improved dressing change :Wiped skin at and around puncture point three times by normal saline, cleaned catheter,disinfected skin around puncture point (avoid puncture point)three times by 75% alcohol,disin-fected skin at and around puncture point three times by 0 .5% iodine tincture ,then disinfected catheter . Associated infection rate between two groups were compared . Results Focal infection rate and CRBI rate of experimental group were both lower than control group(5.00% vs 16.67% ;1.67% vs 13.33% ),the difference was statistically different (P< 0.05 ). Conclusion Effect of improved dressing method is better than the conventional dressing method,it can effectively prevent occurrence of focal infection and CRBI.

Interpleural Displacement of Subclavian Catheter During Thoracotomy: A Case Report / 고신대학교의과대학학술지

Central venous catheterization is well used to provide a large mount of fluid and monitor central venous pressure. However, the procedure accompany various complication including pneumothorax, vascular injury, nerve injury and arrhythmia. To verify correct position of catheter, we checked free regurgitation of blood during catheterization. We experienced a case report of right hemothorax that occurred after right central venous catheterization nevertheless checking correct position by free regurgitation.

Percutaneous Retrieval of an Intravascular Catheter Embolus / 대한내과학회지

Intravascular catheter embolism is common and the most important complication of subclavian catheterization. The catheter fragment can lead to pulmonary embolism, vascular perforation, sepsis, arrhythmia, and even death. The intravascular foreign body can be removed using surgical or non-surgical methods. With technological advances, the percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. A commonly used method for retrieving intravascular foreign bodies is the loop snare. Sometimes biopsy forceps can be used. We experienced a case of non-surgical retrieval of an intravascular foreign body. We used the standard loop snare technique to remove a 5-cm catheter fragment from the left pulmonary artery.

A New Landmark Using the Clavicular Head of the Sternocleidomastoid Muscle for Infraclavicular Subclavian Vein Catheterization / 대한마취과학회지

BACKGROUND: Invasive central venous catheterization is necessary in critically ill patients for hemodynamic monitoring and for administration of hypertonic fluids, drugs, and parenteral nutrition. Common access sites are the internal jugular veins, subclavian veins, and femoral veins. Yoffa's percutaneous supraclavicular subclavian vein catheterization technique has some disadvantages and difficulties which include dislodgement of the puncture needle and difficult enhancement of the guide wire. To overcome these problems, we modified Yoffa's technique as a symmetrical puncture against the clavicle. METHODS: A patient was placed supine with his/her head turned to the opposite side with the arm at the side. The needle was inserted through the skin at a point around 1 cm below the clavicle, toward the imaginary midline of the clavicular head of the sternocleidomastoid muscle (SCM). The guide wire was inserted with a J-wire. Measurements were made to determine the length from the puncture site to the lower border of the clavicle, the depth and angles from the needle to mid sagittal line, the coronary line and skin (Fig. 2). We also evaluated the No. of punctures, wire insertions, and complications. RESULTS: Our success rate was 95.1% and 6 cases with complications (5.9%) occurred in 102 attempts. The most serious complication was a delayed tension pneumothorax 6 h postoperatively. CONCLUSIONS: These results suggest that the new landmark for infraclavicular subclavian vein catheterization is an easy and safe procedure for an experienced physician. We also recommend close observation postoperatively for at least 24 h for complications.

Unusual Location of the Hemodialysis Catheter in Persistent left Superior Vena Cava in a Patient with Chronic Renal Failure / 대한신장학회잡지

A persistent left superior vena cava(SVC) is found in about 0.3% of healthy individuals and 4.3% of patients with congenital heart disease. This anomaly is most frequently found in conjunction with a right-sided SVC, but may also be solitary. Recently, we experienced a case of persistent left SVC in patient with chronic renal failure. He required subclavian catheterization for hemodialysis due to leakage of peritoneal dialysate into external genitalia and pleural cavity. Because he had had a history of right subclavian catheterization for hemodialysis 3 months ago, the hemodialysis catheter was inserted in the left subclavian vein without any complication. Chest X-ray after insertion of the catheter showed that the distal tip of the catheter seemed to be within the aorta. Venography showed that the catheter was located within the left SVC and MRI showed isolated two SVC. He is receiving hemodialysis through the left subclavian catheter which is positioned within the left SVC without any problem.