Anatomical basis of central venous catheter fracture
ABSTRACT Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.
- SourceAvailable from: Preetinder Brar
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- "These devices enable long-term chemotherapy in patients with cancer [1–7]. Spontaneous fracture of the catheter and migration of a catheter fragment is a rare complication . The incidence of catheter fracture in recent series varies from 0.4% to 1.8% [3,9]. "
ABSTRACT: Central venous access devices for chemotherapy are being used extensively in patients with cancer. Spontaneous fracture and migration of the catheter is uncommon. We present the uncommon occurrence of a fracture and spontaneous migration of the fragment into the internal jugular vein as a delayed complication of a central venous access catheter implanted for chemotherapy administration. A patient with Ewing's sarcoma of the humerus with metastasis in the lungs underwent placement of a totally implantable venous access device. The port was in place for 1 year. The patient presented with pain in the right side of the neck. A chest X-ray demonstrated complete transection of the catheter and migration of the catheter fragment in the internal jugular vein. Both the migrated catheter fragment and the proximal part of the catheter were retrieved surgically. He had an uneventful recovery. Catheter fracture remains a potential complication, which must be recognized and treated promptly. Periodic chest imaging is recommended for detection and timely removal of the catheter.American Journal of Case Reports 01/2012; 13:14-6. DOI:10.12659/AJCR.882293
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- "Common complications of this procedure include pneumothorax or hemothorax, venous thrombosis and puncture of the subclavian artery, injury to the brachial plexus, phrenic or vagus nerves, and Horner's syndrome (Lechner et al., 1989; Boon et al., 2007). Appreciation of the role of the soft tissue inferior to the medial end of the clavicle (e.g., the subclavius muscle and costoclavicular ligaments) in the entrapment of the catheter or lead is also necessary for understanding the proper placement of these devices as well as their possible dysfunction (Magney et al., 1993; Krutchen et al., 1996; Jensen, 2008). Central venous catheterization has been included as a topic in review courses of human anatomy relevant to emergency medicine (Campanella et al., 2005) and has previously been the focus of the development of a special anatomical preparation by Cahill and his colleagues to review anatomy relevant for medical residents (Buithieu et al., 1996). "
ABSTRACT: The neck is not only one of the more challenging anatomical regions to dissect but also has important application to clinical conditions, diseases, and procedures. In this study, we describe two simple modifications for dissection of the neck that (1) aid in the identification and preservation of the cutaneous branches of the cervical plexus and the accessory nerve, and (2) provide wide exposure of the root of the neck. The cutaneous branches of the cervical plexus can be identified with relative ease at the nerve point of the neck, where they are largest. To accomplish this, the skin and platysma are reflected beginning from the anterior border of trapezius and proceeding anteriorly to the midline of the neck, rather than the conventional approach of reflecting the skin from the anterior midline. The accessory nerve is identified by its relationship to the nerve point and its course to the trapezius muscle. To achieve wide exposure of the root of the neck and its contents, the acromioclavicular and sternoclavicular joints are disarticulated, and then the clavicle removed completely, rather than the more common approach of removing only the middle section of the clavicle. These modified procedures can be readily performed by first-year medical students and integrate well with methods described in widely used anatomy dissection manuals.Anatomical Sciences Education 07/2009; 2(4):186-92. DOI:10.1002/ase.98 · 2.98 Impact Factor
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ABSTRACT: Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date.CA A Cancer Journal for Clinicians 10/2008; 58(6):323-46. DOI:10.3322/CA.2008.0015 · 115.84 Impact Factor