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: Jeremy Stoller[Show abstract] [Hide abstract]
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
Article: Vascular Access in Oncology Patients[Show abstract] [Hide abstract]
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 · 162.50 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The fracture of an implantable subclavian venous access device and the subsequent embolization of a catheter fragment is a known complication that is usually associated with a set of clinical and radiologic signs of costoclavicular compression. This scenario is also known as pinch-off syndrome. We describe 2 cases of venous port fracture which led us to review the efficacy of follow-up procedures used in our hospital. As a result, we added instructions for radiologic and clinical verification of catheter placement, taking into consideration the dynamic nature of compression. We also established protocols for coordinating the involvement of different services.Revista espanola de anestesiologia y reanimacion 03/2009; 56(2):115-8.