Review Article
Current Concepts
Preventing Complications of Central Venous Catheterization
N Engl J Med 2003; 348:1123-1133March 20, 2003
- Article
Video
Central Venous Catheterization.
In the United States, physicians insert more than 5 million central venous catheters every year.1 Central venous catheters allow measurement of hemodynamic variables that cannot be measured accurately by noninvasive means and allow delivery of medications and nutritional support that cannot be given safely through peripheral venous catheters. Unfortunately, the use of central venous catheters is associated with adverse events that are both hazardous to patients and expensive to treat.2-4 More than 15 percent of patients who receive these catheters have complications.5-7 Mechanical complications are reported to occur in 5 to 19 percent of patients,5,6,8 infectious complications in 5 to 26 percent,5,7,9 and thrombotic complications in 2 to 26 percent.5 In this review, we explain methods for reducing the frequency of complications in adult patients.
Types of Catheters
Antimicrobial-Impregnated Catheters
Catheters impregnated with chlorhexidine and silver sulfadiazine and catheters impregnated with minocycline and rifampin are the most frequently used types of antimicrobial-impregnated catheters. In randomized clinical trials, the use of these catheters has been shown to lower the rate of catheter-related bloodstream infections9,10 (Table 1Table 1
Interventions to Prevent Complications.). The use of catheters impregnated with chlorhexidine and silver sulfadiazine lowered the rate of catheter-related bloodstream infections from 7.6 infections per 1000 catheter-days (4.6 percent of catheters) to 1.6 infections per 1000 catheter-days (1.0 percent) (relative risk, 0.21; 95 percent confidence interval, 0.03 to 0.95; P=0.03).10 A cost-effectiveness analysis concluded that using these catheters would decrease direct medical costs by $196 per catheter inserted.11 The use of antimicrobial-impregnated catheters should be considered in all circumstances, especially when the institutional rate of catheter-related bloodstream infections is higher than 2 percent, which is the threshold at which chlorhexidine-and-silver-sulfadiazine–impregnated catheters may reduce overall costs.10 Current evidence suggests that minocycline-and-rifampin–impregnated catheters are even more effective for minimizing the risk of infection than those that are impregnated with chlorhexidine and silver sulfadiazine.29 However, this evidence comes from a single randomized trial, and the cost effectiveness of these catheters relative to those that are impregnated with chlorhexidine and silver sulfadiazine has not been formally evaluated. Thus, either chlorhexidine-and-silver-sulfadiazine–impregnated catheters or minocycline-and-rifampin–impregnated catheters may be used.
The emergence of resistant organisms resulting from the use of antimicrobial-impregnated catheters remains a potentially important concern. Continued surveillance will be needed as the use of antimicrobial-impregnated catheters increases.
Single-Lumen and Multilumen Catheters
The number of lumina does not directly affect the rate of catheter-related complications.30-32 Therefore, the choice of either a single-lumen or a multilumen catheter should be made according to the type required to deliver the needed medications or nutritional support.
Insertion Sites
Characteristics of Patients
There are multiple approaches for internal jugular, subclavian, and femoral venous catheterization.33 Successful catheterization by either the internal jugular or the subclavian route relies on a thorough understanding of the anatomy of the neck (Figure 1Figure 1
Technique for Catheterization at the Internal Jugular and Subclavian Sites.). The internal jugular vein is located at the apex of the triangle formed by the heads of the sternocleidomastoid muscle and the clavicle. The subclavian vein crosses under the clavicle just medial to the midclavicular point. When it is difficult to identify the landmarks for one type of catheterization, another route should be considered. All patients should be assessed for factors that might increase the difficulty of catheter insertion, such as a history of failed catheterization attempts or the need for catheterization at a site of previous surgery, skeletal deformity, or scarring.8 When a difficult catheterization is anticipated, the importance of patient safety dictates that the procedure be performed or supervised by an experienced physician.Internal jugular catheterization can be difficult in morbidly obese patients, in whom the landmarks of the neck are often obscured. Subclavian venous catheterization should be avoided in patients with severe hypoxemia, because the complication of pneumothorax is more likely to occur at this site and is less likely to be tolerated by such patients. Femoral catheterization should be avoided in patients who have grossly contaminated inguinal regions because femoral insertion places these patients at high risk for the development of catheter-related infections. If central venous access is needed for resuscitation from shock, femoral venous access should be considered because of the speed with which it can be performed, especially if it is believed that internal jugular or subclavian venous catheterization will be difficult. After resuscitation, the catheter can be replaced at the most appropriate site for the patient.
Mechanical Complications
Arterial puncture, hematoma, and pneumothorax are the most common mechanical complications during the insertion of central venous catheters (Table 2Table 2
Frequency of Mechanical Complications, According to the Route of Catheterization.). Overall, internal jugular catheterization and subclavian venous catheterization carry similar risks of mechanical complications. Subclavian catheterization is more likely than internal jugular catheterization to be complicated by pneumothorax and hemothorax, whereas internal jugular catheterization is more likely to be associated with arterial puncture. Hematoma and arterial puncture are common during femoral venous catheterization. Because mechanical complications are most likely during catheterization at the femoral site, the internal jugular or subclavian venous route should be chosen unless contraindicated. However, the rate of serious mechanical complications (e.g., pneumothorax requiring insertion of a chest tube or hemorrhage requiring blood transfusion or surgery) associated with subclavian insertion is similar to that associated with femoral insertion.5 Infectious Complications
Catheter-related infections are thought to arise by several different mechanisms: infection of the exit site, followed by migration of the pathogen along the external catheter surface; contamination of the catheter hub, leading to intraluminal catheter colonization; and hematogenous seeding of the catheter. A randomized trial found that subclavian venous catheterization was associated with a significantly lower rate of total infectious complications than femoral venous catheterization and a trend toward a lower rate of suspected or confirmed catheter-related bloodstream infections (1.2 infections per 1000 catheter-days, vs. 4.5 infections per 1000 with femoral catheterization; P=0.07).5 Available evidence suggests that subclavian catheterization is less likely to result in catheter-related infection than internal jugular catheterization, although the two approaches have not been compared in randomized trials.9,12,13 Thus, selection of the subclavian site appears to minimize the risk of infectious complications.
Thrombotic Complications
Patients who require central venous catheterization are at high risk for catheter-related thrombosis. Used routinely, ultrasonography with color Doppler imaging detects venous thrombosis in 33 percent of patients in medical intensive care units34 and in approximately 15 percent of these patients the thrombosis is catheter-related. The risk of catheter-related thrombosis varies according to the site of insertion. In one trial, catheter-related thrombosis occurred in 21.5 percent of the patients with femoral venous catheters and in 1.9 percent of those with subclavian venous catheters (P<0.001).5 In an observational study, the risk of thrombosis associated with internal jugular insertion was approximately four times the risk associated with subclavian insertion.28 Subclavian venous catheterization carries the lowest risk of catheter-related thrombosis. The clinical importance of catheter-related thrombosis remains undefined, although all thromboses have the potential to embolize.
Insertion Technique
Preparation
When inserting a catheter, one should use maximal sterile-barrier precautions, including a mask, a cap, a sterile gown, sterile gloves, and a large sterile drape. This approach has been shown to reduce the rate of catheter-related bloodstream infections and to save an estimated $167 per catheter inserted.14 The use of chlorhexidine-based solutions for skin preparation may be preferable to the use of povidone–iodine solutions, because chlorhexidine reduces the risk of catheter colonization.35,36 A video that shows the insertion of catheters at the internal jugular and subclavian sites is available with the full text of the article at http://www.nejm.org.
Experience with Catheterization
As with most medical procedures, the level of experience of the physician reduces the risk of complications.6,37 Insertion of a catheter by a physician who has performed 50 or more catheterizations is half as likely to result in a mechanical complication as insertion by a physician who has performed fewer than 50 catheterizations.6 If a physician is unable to insert a catheter after three attempts, he or she should seek help rather than continue to attempt the procedure. The incidence of mechanical complications after three or more insertion attempts is six times the rate after one attempt.8
Ultrasound Guidance
The use of ultrasound guidance has been promoted as a method for reducing the risk of complications during central venous catheterization. In this technique, an ultrasound probe is used to localize the vein and to measure its depth beneath the skin. Under ultrasound visualization, the introducer needle is then guided through the skin and into the vessel. During internal jugular venous catheterization, ultrasound guidance reduces the number of mechanical complications, the number of catheter-placement failures, and the time required for insertion.25,26 However, its use during subclavian venous catheterization has had mixed results in clinical trials,26,38,39 probably for anatomical reasons. The fixed anatomical relation between the subclavian vein and the clavicle makes ultrasound-guided catheter insertion more difficult and less reliable than landmark-based insertion. As with all new techniques, ultrasound-guided catheterization requires training. In hospitals where ultrasound equipment is available and physicians have adequate training, the use of ultrasound guidance should be routinely considered for cases in which internal jugular venous catheterization will be attempted.
Recognition of Arterial Puncture and Prevention of Air Embolism
In a patient with normal blood pressure and normal arterial oxygen tension, arterial puncture is usually easy to identify by the pulsatile flow into the syringe and the bright-red color of the blood. However, in patients with profound hypotension or marked arterial desaturation, these findings may not be present. If there is any doubt as to whether the introducer needle is in the artery or the vein, an 18-gauge, single-lumen catheter (included in most kits) should be inserted over the wire and into the vessel. This step does not require the use of a dilator. This catheter can then be connected to a pressure transducer to confirm the presence of venous waveforms and venous pressure. Simultaneous samples for measurement of blood gases can then be drawn, one from the catheter and another from an artery. There should be a substantial difference in the oxygen tension if the catheter is located in a vein.
A spontaneously breathing patient generates negative intrathoracic pressure during inspiration. If a catheter is open to room air, this negative intrathoracic pressure can draw air into the vein, resulting in air embolism. Even small amounts of air can be fatal, especially if transmitted to the systemic circulation through an atrial or ventricular septal defect. To prevent this complication, catheter hubs should be occluded at all times, and the patient should be placed in Trendelenburg's position during insertion. If air embolism occurs, the patient should be placed in Trendelenburg's position with a left lateral decubitus tilt to prevent the movement of air into the right ventricular outflow tract. One hundred percent oxygen should be administered to speed the resorption of the air. If a catheter is located in the heart, aspiration of the air should be attempted.
Prophylactic Antibiotics
Most studies of the use of prophylactic antibiotics have demonstrated that this strategy is associated with reductions in the rate of catheter-related bloodstream infections.40-42 However, this use of antibiotics is discouraged because of concern that it will encourage the emergence of antibiotic-resistant organisms.43
Maintenance of the Insertion Site
Ointments, Subcutaneous Cuffs, and Dressings
Application of antibiotic ointments (e.g., bacitracin, mupirocin, neomycin, and polymyxin) to catheter-insertion sites increases the rate of catheter colonization by fungi,15 promotes the emergence of antibiotic-resistant bacteria,16 and has not been shown to lower the rate of catheter-related bloodstream infections.17 These ointments should not be used.44 Likewise, the use of silver-impregnated subcutaneous cuffs has not been shown to reduce the incidence of catheter-related bloodstream infections and therefore is not recommended.15,45,46 Because there are conflicting data on the optimal type of dressing (gauze vs. transparent material)47,48 and the optimal frequency of dressing changes,49,50 evidence-based recommendations cannot be made.
Hubs and Needleless Access Devices
Catheter hubs are a common source of contamination,18 especially during prolonged catheterization.51 The use of two types of antiseptic-containing hub has been shown to decrease the risk of catheter-related bloodstream infections.52,53 In some hospitals, the introduction of needleless access devices has been linked to an increase in the rate of these infections.54,55 In one instance, this increase was due to a high rate of noncompliance with the manufacturer's recommendations to change the end cap with each use and to change the device every three days.54 In another, more frequent hub changes were required before the rate of catheter-related bloodstream infection returned to base line.55
Catheter Maintenance
Every catheter should be removed as soon as it is no longer needed, since the probability of catheter-related infections increases over time. The risks of catheter colonization and catheter-related bloodstream infection are low until the fifth to seventh days of catheterization, at which time the risks increase.9,10,21 Multiple trials have tested strategies for reducing the risk of catheter-related infections, including scheduled, routine replacement of catheters by exchange over a guide wire and scheduled, routine replacement at a new site. However, none of these strategies have been shown to decrease the rate of catheter-related bloodstream infections.19,20,56 In fact, scheduled, routine exchanges of catheters over a guide wire are associated with a trend toward an increased rate of catheter-related infections.19 Furthermore, the more frequently a catheter is replaced with a new catheter at a new site, the more likely it is that the patient will have a mechanical complication during insertion.19,27 A meta-analysis of 12 randomized trials of catheter-replacement strategies concluded that the data do not support either scheduled, routine exchange of catheters over a guide wire or scheduled, routine replacement at a new site.19 Accordingly, central venous catheters should not be replaced on a scheduled basis.44
Suspected Catheter-Related Bloodstream Infection
Even with optimal efforts to prevent infectious complications of central venous catheterization, catheter-associated infections will develop in some patients (Table 3Table 3
Types of Catheter-Associated Infections.). In any patient who has a central venous catheter, symptoms and signs of infection without another confirmed source should raise the concern that the catheter may be the source of the infection (Figure 2Figure 2
Management of Suspected Catheter-Related Bloodstream Infection.). Once a catheter-associated infection is suspected, two samples of blood should be drawn for culture to evaluate the possibility of bacteremia. Two cultures of blood from peripheral sites should be evaluated because it is difficult to determine whether a positive culture of blood from a central venous catheter indicates contamination of the hub, catheter colonization, or a catheter-related bloodstream infection.65,66 However, a negative culture from a catheter indicates that the presence of a catheter-related bloodstream infection is unlikely.67 The catheter site should be examined carefully. If there is any purulence or erythema, an exit-site infection is likely, and the catheter needs to be removed. If the patient has signs of either sepsis or septic shock, empirical antibiotic therapy should be begun to treat Staphylococcus epidermidis or S. aureus infections. Antibiotic therapy for gram-negative organisms should be added, especially if the patient is immunocompromised or has neutropenia or has other risk factors for infection with gram-negative organisms. The catheter should be changed over a guide wire.56,62,63 This technique reduces the number of insertion-related complications and is safe, even in patients with sepsis, as long as antibiotic therapy has been initiated.56,63 In patients who have septic shock and no other source of infection, the catheter should be removed and replaced with a new one at a new site.
If a culture of the catheter tip is positive, the patient has either catheter colonization or a catheter-related bloodstream infection, and a catheter that was replaced over a guide wire should be removed. If the catheter-tip culture is negative, then catheter colonization and catheter-related bloodstream infection are unlikely, and efforts should be made to identify another source of infection.
Supported in part by a Research Career Development Award from the Department of Veterans Affairs Health Services Research and Development Service (to Dr. Gould).
We are indebted to Drs. Deborah Cook and Stephen Ruoss for reviewing a previous version of the manuscript.
Source Information
From the Division of Pulmonary and Critical Care Medicine (D.C.M., M.K.G.), the Department of Health Research and Policy (M.K.G.), and the Center for Primary Care and Outcomes Research (M.K.G.), Stanford University School of Medicine, Stanford, Calif.; and the Health Services Research and Development Service and Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (M.K.G.).
Address reprint requests to Dr. Gould at the Pulmonary and Critical Care Section (111P), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304.
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Hsiang-Chun Jan, Shao-Jiun Chou, Tzu-Hung Chen, Chuin-I Lee, Tze-Kai Chen, Mary Ann Lou. (2012) Management and prevention of complications of subcutaneous intravenous infusion port. Surgical Oncology 21:1, 7-13
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Kimito Mimami, Miki Iida, Hiroki Iida. (2012) Case report: central venous catheterization via internal jugular vein with associated formation of perioperative venous thrombosis during surgery in the prone position. Journal of Anesthesia
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S. C. LEE, S. S. HAN, S. Y. SHIN, Y. J. LIM, J. T. KIM, Y. H. KIM. (2012) Relationship between positive end-expiratory pressure and internal jugular vein cross-sectional area. Acta Anaesthesiologica Scandinavican/a-n/a
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Shubhada N. Ahya, Jeffrey H. Barsuk, Elaine R. Cohen, Jennifer Tuazon, William C. McGaghie, Diane B. Wayne. (2012) Clinical Performance and Skill Retention after Simulation-based Education for Nephrology Fellows. Seminars in Dialysisno-no
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Heath E. Latham, Scott T. Rawson, Timothy T. Dwyer, Chirag C. Patel, Jo A. Wick, Steven Q. Simpson. (2012) Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring. Journal of Clinical Monitoring and Computing
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Daniel L. Chan, Lisa M. Freeman. 2012. Parenteral Nutrition. , 605-622.
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Christopher A. Troianos, Gregg S. Hartman, Kathryn E. Glas, Nikolaos J. Skubas, Robert T. Eberhardt, Jennifer D. Walker, Scott T. Reeves. (2012) Guidelines for Performing Ultrasound Guided Vascular Cannulation. Anesthesia & Analgesia 114:1, 46-72
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P. Merino, J. Alvarez, M. C. Martin, A. Alonso, I. Gutierrez, . (2011) Adverse events in Spanish intensive care units: the SYREC study. International Journal for Quality in Health Care
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Seok Hui Kang, Won Kyu Park, Jun Young Do, Kyu Hyang Cho, Jong Won Park, Kyung Woo Yoon. (2011) J-tip guide wire entrapment within the heart during central venous catheterization. Hemodialysis Internationaln/a-n/a
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Kazuhide Matsushima, Heidi L. Frankel. (2011) Beyond focused assessment with sonography for trauma. Current Opinion in Critical Care 17:6, 606-612
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Ana E. Sirvent, Ricardo Enríquez, Isabel Millán, Jose M. García-Marco, Elías Rodríguez-Czaplicki, Maria D. Redondo-Pachón, César González, Francisco Amorós. (2011) Severe hemorrhage because of delayed iliac vein rupture after dialysis catheter placement: Is it preventable?. Hemodialysis Internationaln/a-n/a
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Mary E. Meek. (2011) Diagnosis and Treatment of Central Venous Access–Associated Infections. Techniques in Vascular and Interventional Radiology 14:4, 212-216
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Christopher A. Troianos, Gregg S. Hartman, Kathryn E. Glas, Nikolaos J. Skubas, Robert T. Eberhardt, Jennifer D. Walker, Scott T. Reeves. (2011) Guidelines for Performing Ultrasound Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Journal of the American Society of Echocardiography 24:12, 1291-1318
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Abderhmane Elwali, Mohamed Drissi, Mustapha Bensghir, Redouane Ahtil, Hicham Azendour, Nouredine-Drissi Kamili. (2011) Évolution fatale d’une perforation du tronc veineux brachio-céphalique gauche par un cathéter d’hémodialyse. Néphrologie & Thérapeutique 7:7, 562-564
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Kannaiyan Samuel Rabindranath, Emil Kumar, Ranjit Shail, Emma Vaux. (2011) Use of Real-Time Ultrasound Guidance for the Placement of Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials. American Journal of Kidney Diseases 58:6, 964-970
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Laure Hermite, Jean-Pierre Quenot, Abdelouaid Nadji, Saber David Barbar, Pierre-Emmanuel Charles, Maël Hamet, Nicolas Jacquiot, François Ghiringhelli, Marc Freysz. (2011) Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial. Intensive Care Medicine
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J. Matthew Fields, Anthony J. Dean, Raleigh W. Todman, Arthur K. Au, Kenton L. Anderson, Bon S. Ku, Jesse M. Pines, Nova L. Panebianco. (2011) The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity. The American Journal of Emergency Medicine
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Richard L. Lambert, John R. Boker, Frank A. Maffei. (2011) National survey of bedside ultrasound use in pediatric critical care*. Pediatric Critical Care Medicine 12:6, 655-659
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Anthony M.-H. Ho, Christopher J. Ricci, Calvin S.H. Ng, Lester A.H. Critchley, Adrienne K. Ho, Manoj K. Karmakar, Chi W. Cheung, Siu K. Ng. (2011) The Medial-Transverse Approach for Internal Jugular Vein Cannulation: An Example of Lateral Thinking. The Journal of Emergency Medicine
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Ramiro Arellano, Aliya Nurmohamed, Amir Rumman, Brian Milne, Robert Tanzola. (2011) Point-of-care transthoracic echocardiography as an alternative to transesophageal echocardiography to confirm internal jugular guidewire position. Canadian Journal of Anesthesia/Journal canadien d'anesthésie
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Gautam V. Shrikhande, Sikandar Z. Khan, Andrew J. Meltzer, Katherine Gallagher, Nicholas J. Morrissey. (2011) Endovascular Management of Type B Aortic Dissection After Attempted Central Venous Catheterization. Annals of Vascular Surgery 25:7, 979.e13-979.e15
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J. Kok, M.V. O’Sullivan, G.L. Gilbert. (2011) Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates. Journal of Hospital Infection 79:2, 108-114
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Jeffrey H. Barsuk, Elaine R. Cohen, Joe Feinglass, William C. McGaghie, Diane B. Wayne. (2011) Unexpected Collateral Effects of Simulation-Based Medical Education. Academic Medicine1
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Gwenhael Colin, Olivier Nardi, Andrea Polito, Jérôme Aboab, Virginie Maxime, Bernard Clair, Diane Friedman, David Orlikowski, Tarek Sharshar, Djillali Annane. (2011) Masseter tissue oxygen saturation predicts normal central venous oxygen saturation during early goal-directed therapy and predicts mortality in patients with severe sepsis. Critical Care Medicine1
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Andrei Ilczyszyn, Hyder Ridha, Amer J. Durrani. (2011) Management of chyle leak post neck dissection: A case report and literature review. Journal of Plastic, Reconstructive & Aesthetic Surgery 64:9, e223-e230
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Irene W. Y. Ma, Mary E. Brindle, Paul E. Ronksley, Diane L. Lorenzetti, Reg S. Sauve, William A. Ghali. (2011) Use of Simulation-Based Education to Improve Outcomes of Central Venous Catheterization: A Systematic Review and Meta-Analysis. Academic Medicine 86:9, 1137-1147
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J.-F. Timsit, C. Minet, M. Lugosi, S. Calvino-Gunther, C. Ara-Somohano, A. Bonadona, R. Hamidfar-Roy, A. Daniel, C. Schwebel. (2011) Prévention des infections de cathéters en réanimation. Journal des Anti-infectieux 13:3, 161-169
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Valerio Mazzei, Domenico Benvenuto, Massimo Gagliardi, Stefano Guarracini, Michele Di Mauro. (2011) Thyrocervical Trunk Pseudoaneurysm Following Central Venous Catheterization. Journal of Cardiac Surgeryno-no
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Evan Alexandrou, Margherita Murgo, Eda Calabria, Timothy R. Spencer, Hailey Carpen, Kathleen Brennan, Steven A. Frost, Patricia M. Davidson, Ken M. Hillman. (2011) Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services. International Journal of Nursing Studies
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Seth Rotz, Madhuri M. Sopirala. (2011) Assessment beyond central line bundle: Audits for line necessity in infected central lines in a surgical intensive care unit. American Journal of Infection Control
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Irene W. Y. Ma, Nadia Zalunardo, George Pachev, Tanya Beran, Melanie Brown, Rose Hatala, Kevin McLaughlin. (2011) Comparing the use of global rating scale with checklists for the assessment of central venous catheterization skills using simulation. Advances in Health Sciences Education
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Martin B. Glaser, Carla Bruchhausen, Wibke Müller-Forell, Klaus U. Klein, Joachim Oertel. (2011) Case report of a cervical intraspinal misplacement of a central venous line. Journal of Anesthesia
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C. Luyet, V. Hartwich, N. Urwyler, P. M. Schumacher, U. Eichenberger, A. Vogt. (2011) Evaluation of a novel needle guide for ultrasound-guided phantom vessel cannulation*. Anaesthesia 66:8, 715-720
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William G. Wood, T. Sloane Guy, Karishma Arora, Reza Firoozabadi, Hubert Kim, Jasleen Kukreja, Paul S. Pagel, Marek Brzezinski. (2011) Posterior Glenohumeral Joint Dislocation: A Rare Complication of Central Venous Cannulation in a Patient Undergoing Coronary Artery Surgery. Journal of Cardiothoracic and Vascular Anesthesia
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Véronique Pottier, Cédric Daubin, Nicolas Lerolle, Cathy Gaillard, Gérald Viquesnel, Benoit Plaud, Jean-Luc Hanouz, Pierre Charbonneau. (2011) Overview of adverse events related to invasive procedures in the intensive care unit. American Journal of Infection Control
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Sander Croes, Ellen E. Stobberingh, Kris N.J. Stevens, Menno L.W. Knetsch, Leo H. Koole. (2011) Antimicrobial and Anti-Thrombogenic Features Combined in Hydrophilic Surface Coatings for Skin-Penetrating Catheters. Synergy of Co-embedded Silver Particles and Heparin. ACS Applied Materials & Interfaces 3:7, 2543-2550
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O. Curtis, M.J. Metcalfe, M.M. Thompson. (2011) Managing Complications of the Misplaced Central Venous catheter. EJVES Extra 22:1, e6-e8
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D. Varona Porres, J. Andreu Soriano, E. Pallisa Núñez, O. Persiva Morenza, A. Roque Pérez. (2011) Patología vascular torácica en pacientes oncológicos. Radiología 53:4, 335-348
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Andrew R. Bodenham. (2011) Ultrasound-guided subclavian vein catheterization: Beyond just the jugular vein*. Critical Care Medicine 39:7, 1819-1820
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D. Varona Porres, J. Andreu Soriano, E. Pallisa Núñez, O. Persiva Morenza, A. Roque Pérez. (2011) Thoracic vascular disease in oncologic patients. Radiología (English Edition) 53:4, 335-348
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Cláudia Sousa, Mariana Henriques, Rosário Oliveira. (2011) Mini-review: Antimicrobial central venous catheters – recent advances and strategies. Biofouling 27:6, 609-620
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Kyung-Jee Lim, Jin-Tae Kim, Hee-Soo Kim, Hyo-Jin Byon, Soo-Kyung Lee, Jung-Man Lee. (2011) The Effect of Lung Deflation on the Position and Size of the Subclavian Vein in Mechanically Ventilated Infants and Children. Anesthesia & Analgesia 112:6, 1448-1451
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Ivo Petrov, Lachezar Grozdinski, Genadi Kaninski, Nikolai Iliev, Marjana Iloska, Angel Radev. (2011) Safety Profile of Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Patients With Multiple Sclerosis. Journal of Endovascular Therapy 18:3, 314-323
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William F. Bond, Arthur E. King. (2011) Modeling for the Decision Process to Implement an Educational Intervention. Journal of Patient Safety 7:2, 85-91
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Jeffrey J. Fletcher, William Stetler, Thomas J. Wilson. (2011) The Clinical Significance of Peripherally Inserted Central Venous Catheter-Related Deep Vein Thrombosis. Neurocritical Care
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Il-Seok Kim, Sang-Soo Kang, Joon-Hee Park, Sung-Jun Hong, Keun-Man Shin, Young-Joon Yoon, Myoung-Sun Kim. (2011) Impact of sex, age and BMI on depth and diameter of the infraclavicular axillary vein when measured by ultrasonography. European Journal of Anaesthesiology 28:5, 346-350
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Piersandro Sette, Romolo M. Dorizzi, Anna Maria Azzini. (2011) First: patient safety, second: patient safety. Journal of Electrocardiology 44:3, 389-390
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James H. Moak, Michael S. Lyons, Stewart W. Wright, Christopher J. Lindsell. (2011) Needle and guidewire visualization in ultrasound-guided internal jugular vein cannulation. The American Journal of Emergency Medicine 29:4, 432-436
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Hyeon Yu, Joseph M. Stavas, Robert G. Dixon, Charles T. Burke, Matthew A. Mauro. (2011) Temporary Balloon Tamponade for Managing Subclavian Arterial Injury by Inadvertent Central Venous Catheter Placement. Journal of Vascular and Interventional Radiology 22:5, 654-659
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Chris Moore. (2011) Ultrasound-Guided Procedures in Emergency Medicine. Ultrasound Clinics 6:2, 277-289
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Angelo Mikrogianakis, April Kam, Shawna Silver, Balisi Bakanisi, Oscar Henao, Allan Okrainec, Georges Azzie. (2011) Telesimulation: An Innovative and Effective Tool for Teaching Novel Intraosseous Insertion Techniques in Developing Countries. Academic Emergency Medicine 18:4, 420-427
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Yvonne K. LENTZ, Michael JOYCE, Xanthe LAM. (2011) In vitro stability and compatibility of tenecteplase in central venous access devices. Hemodialysis International 15:2, 264-272
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Aysu Kocum, Mesut Sener, Esra Calıskan, Nesrin Bozdogan, Hakan Atalay, Anis Aribogan. (2011) An Alternative Central Venous Route for Cardiac Surgery: Supraclavicular Subclavian Vein Catheterization. Journal of Cardiothoracic and Vascular Anesthesia
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M. Kang, H.- G. Ryu, I.- S. Son, J.- H. Bahk. (2011) Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach. British Journal of Anaesthesia 106:3, 344-347
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Ming-Horng Tsai, Shih-Ming Chu, Reyin Lien, Hsuan-Rong Huang, Jiunn-Wei Wang, Chiao-Ching Chiang, Jen-Fu Hsu, Yhu-Chering Huang. (2011) Complications Associated with 2 Different Types of Percutaneously Inserted Central Venous Catheters in Very Low Birth Weight Infants. Infection Control and Hospital Epidemiology 32:3, 258-266
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Kris N.J. Stevens, Sander Croes, Rinske S. Boersma, Ellen E. Stobberingh, Cees van der Marel, Frederik H. van der Veen, Menno L.W. Knetsch, Leo H. Koole. (2011) Hydrophilic surface coatings with embedded biocidal silver nanoparticles and sodium heparin for central venous catheters. Biomaterials 32:5, 1264-1269
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W. SABER, T. MOUA, E. C. WILLIAMS, M. VERSO, G. AGNELLI, S. COUBAN, A. YOUNG, M. DE CICCO, R. BIFFI, C. J. van ROODEN, M. V. HUISMAN, D. FAGNANI, C. CIMMINIELLO, M. MOIA, M. MAGAGNOLI, S. P. POVOSKI, S. F. MALAK, A. Y. LEE. (2011) Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. Journal of Thrombosis and Haemostasis 9:2, 312-319
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Joshua Lenchus, S. Barry Issenberg, Daniel Murphy, Ruth Everett-Thomas, Laura Erben, Kristopher Arheart, David J. Birnbach. (2011) A blended approach to invasive bedside procedural instruction. Medical Teacher 33:2, 116-123
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Hanke E. Marcus, Egfried Bonkat, Oguzhan Dagtekin, Robert Schier, Frank Petzke, Jens Wippermann, Bernd W. Böttiger, Peter Teschendorf. (2011) The Impact of Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Cross-Sectional Area. Survey of Anesthesiology 55:1, 48-49
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Hayato Yamazaki, Kenji Nagasaka. (2011) Successful treatment of steroid-resistant methotrexate-induced interstitial pneumonia with peripherally administered ulinastatin. Modern Rheumatology 21:1, 79-84
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Matthew C. Koopmann, Kenneth A. Kudsk, Molly J. Szotkowski, Susan M. Rees. (2011) A Team-Based Protocol and Electromagnetic Technology Eliminate Feeding Tube Placement Complications. Annals of Surgery 253:2, 297-302
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Hemmelgarn, Brenda R., Moist, Louise M., Lok, Charmaine E., Tonelli, Marcello, Manns, Braden J., Holden, Rachel M., LeBlanc, Martine, Faris, Peter, Barre, Paul, Zhang, Jianguo, Scott-Douglas, Nairne, . (2011) Prevention of Dialysis Catheter Malfunction with Recombinant Tissue Plasminogen Activator. New England Journal of Medicine 364:4, 303-312
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Bongyoung Kim, Sewoo Park, Taehyung Kim, Jieun Kim, Donghwi Rim, Taeyeal Choi, Hyunjoo Pai, Jungoak Kang. (2011) Clinical Efficacy Evaluation of Multi-parameter Real-time Polymerase Chain Reaction for the Central Venous Catheter-related Blood Stream Infection. Infection and Chemotherapy 43:3, 240
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Wassim H. Fares, Katherine R. Birchard, James R. Yankaskas. (2011) Persistent left superior vena cava identified during central line placement: A case report. Respiratory Medicine CME 4:3, 141-143
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Sun Young Park, Min Jung Kim, Mun Gyu Kim, Se Jin Lee, Sang Ho Kim, Si Young Ok, Soon Im Kim. (2011) Changes in the relationship between the right internal jugular vein and an anatomical landmark after head rotation. Korean Journal of Anesthesiology 61:2, 107
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Tianhong Dai, George P. Tegos, Tyler G. St. Denis, Don Anderson, Ed Sinofsky, Michael R. Hamblin. (2011) Ultraviolet-C Irradiation for Prevention of Central Venous Catheter-related Infections: An In Vitro Study. Photochemistry and Photobiology 87:1, 250-255
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Hyun-Seok Han, Young-Tae Jeon, Hyo-Seok Na, Jin-Young Hwang, Eun-Joo Choi, Mi-Hyun Kim. (2011) Successful removal of kinked J-guide wire under fluoroscopic guidance during central venous catheterization -A case report-. Korean Journal of Anesthesiology 60:5, 362
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Andrew Verniquet, Rafid Kakel. (2011) The value of ultrasound in detecting pneumothorax. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 58:1, 118-119
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Radojica V. Stolic, Sanja P. Milojevic. (2011) Laceration of the Iliac Vein in a Patient with a Femoral Catheter for Hemodialysis. International Journal of Nephrology 2011, 1-3
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Radmilo J. Jankovic, Marija S. Pavlovic, Miodrag M. Stojanovic, Biljana S. Stosic, Dragan J. Milic, Nebojsa S. Ignjatovic, Angelina N. Bogicevic, Dragana R. Djordjevic, Nenad N. Savic. (2011) Risk Factors Associated with Carotid Artery Puncture following Landmark-Guided Internal Jugular Vein Cannulation Attempts. Medical Principles and Practice 20:6, 562-566
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Evelyn Lengetti, Anne Marie Monachino, Amy Scholtz. (2011) A Simulation-Based “Just in Time” and “Just in Place” Central Venous Catheter Education Program. Journal for Nurses in Staff Development (JNSD) 27:6, 290-293
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Josh Hanson, Sophia WK Lam, Sanjib Mohanty, Shamshul Alam, Md Mahtab Uddin Hasan, Sue J Lee, Marcus J Schultz, Prakaykaew Charunwatthana, Sophie Cohen, Ashraf Kabir, Saroj Mishra, Nicholas PJ Day, Nicholas J White, Arjen M Dondorp. (2011) Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?. Malaria Journal 10:1, 342
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Rodrigo C. Ribeiro, Simone C. V. Abib, Alexandre S. Aguiar, Sérgio T. Schettini. (2011) Long-term complications in totally implantable venous access devices: Randomized study comparing subclavian and internal jugular vein puncture. Pediatric Blood & Cancern/a-n/a
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Christoph Testori, Fritz Sterz, Wilhelm Behringer, Alexander Spiel, Christa Firbas, Bernd Jilma. (2011) Surface cooling for induction of mild hypothermia in conscious healthy volunteers - a feasibility trial. Critical Care 15:5, R248
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D.J. Dries. (2011) Fever and Leukocytosis in Critically Ill Trauma Patients: It Is Not the Blood. Yearbook of Critical Care Medicine 2011, 125-127
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Akio Akahane, Miyuki Sone, Shigeru Ehara, Kenichi Kato, Ryoichi Tanaka, Tatsuhiko Nakasato. (2010) Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis. CardioVascular and Interventional Radiology
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Jakub T Matera, Diana Egerton-Warburton, Robert Meek. (2010) Ultrasound guidance for central venous catheter placement in Australasian emergency departments: Potential barriers to more widespread use. Emergency Medicine Australasia 22:6, 514-523
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Leonidia Leonidou, Charalambos A. Gogos. (2010) Catheter-related bloodstream infections: catheter management according to pathogen. International Journal of Antimicrobial Agents 36, S26-S32
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Sharon Griswold-Theodorson, Hashibul Hannan, Neal Handly, Brian Pugh, John Fojtik, Mark Saks, Richard J. Hamilton, David Wagner. (2010) Improving Patient Safety With Ultrasonography Guidance During Internal Jugular Central Venous Catheter Placement by Novice Practitioners. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 4:4, 212-216
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Jan P. Goltz, Anne Scholl, Christian O. Ritter, Günther Wittenberg, Dietbert Hahn, Ralph Kickuth. (2010) Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients. CardioVascular and Interventional Radiology 33:6, 1159-1167
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Adriano Peris, Giovanni Zagli, Manuela Bonizzoli, Giovanni Cianchi, Marco Ciapetti, Rosario Spina, Valentina Anichini, Francesco Lapi, Stefano Batacchi. (2010) Implantation of 3951 Long-Term Central Venous Catheters. Anesthesia & Analgesia 111:5, 1194-1201
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Michael Trotter, Jason T. Nomura, Paul R. Sierzenski. (2010) Single-operator Sterile Sheathing of Ultrasound Probes for Ultrasound-guided Procedures. Academic Emergency Medicine 17:11, e153-e153
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Thomas G. Costantino, Jeremy F. Kirtz, Wayne A. Satz. (2010) Ultrasound-Guided Peripheral Venous Access vs. the External Jugular Vein as the Initial Approach to the Patient with Difficult Vascular Access. The Journal of Emergency Medicine 39:4, 462-467
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Daniel Theodoro, Missy Krauss, Marin Kollef, Bradley Evanoff. (2010) Risk Factors for Acute Adverse Events During Ultrasound-guided Central Venous Cannulation in the Emergency Department. Academic Emergency Medicine 17:10, 1055-1061
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Salmaan Kanji, Jason Lam, Christel Johanson, Avinder Singh, Rob Goddard, Jennifer Fairbairn, Tammy Lloyd, Danny Monsour, Juzer Kakal. (2010) Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Critical Care Medicine 38:9, 1890-1898
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Kazuhide Matsushima, Heidi L. Frankel. (2010) Bedside Ultrasound can Safely Eliminate the Need for Chest Radiographs after Central Venous Catheter Placement: CVC Sono in the Surgical ICU (SICU). Journal of Surgical Research 163:1, 155-161
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Hanke E. Marcus, Egfried Bonkat, Oguzhan Dagtekin, Robert Schier, Frank Petzke, Jens Wippermann, Bernd W. Böttiger, Peter Teschendorf. (2010) The Impact of Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Cross-Sectional Area. Anesthesia & Analgesia 111:2, 432-436
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Jacques Bessereau, Nicolas Genotelle, Cendrine Chabbaut, Anne Huon, Alexis Tabah, Jérôme Aboab, Sylvie Chevret, Djillali Annane. (2010) Long-term outcome of iatrogenic gas embolism. Intensive Care Medicine 36:7, 1180-1187
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R.S. Boersma, H.C. Schouten. (2010) Clinical practices concerning central venous catheters in haematological patients. European Journal of Oncology Nursing 14:3, 200-204
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D. Zaccardelli, K. Phares, R. Jeffs, A. Doran, M. Wade. (2010) Stability and antimicrobial effectiveness of treprostinil sodium in Sterile Diluent for Flolan. International Journal of Clinical Practice 64:7, 885-891
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Kerry J. Hollenbeck, Bryan M. Vander Schuur, Matthew R. Tulis, Brian W. Mecklenburg, Cory P. Gaconnet, Scott C. Wallace, Eugenio Lujan, Ivan K. Lesnik. (2010) Effects of Positive End-Expiratory Pressure on Internal Jugular Vein Cross-Sectional Area in Anesthetized Adults. Anesthesia & Analgesia 110:6, 1669-1673
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Barbra S. Miller, Paul G. Gauger, James T. Broome, Richard E. Burney, Gerard M. Doherty. (2010) An International Perspective on Ultrasound Training and Use for Thyroid and Parathyroid Disease. World Journal of Surgery 34:6, 1157-1163
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Christian Ayoub, Catherine Lavallée, André Denault. (2010) Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 57:5, 500-514
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Daniel Theodoro, Brian Bausano, Lawrence Lewis, Bradley Evanoff, Marin Kollef. (2010) A Descriptive Comparison of Ultrasound-guided Central Venous Cannulation of the Internal Jugular Vein to Landmark-based Subclavian Vein Cannulation. Academic Emergency Medicine 17:4, 416-422
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