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: Ahmad Samir AlFaar[Show abstract] [Hide abstract]
ABSTRACT: Reliable central venous access is a crucial part in the treatment of haemato-oncology diseases. Typical central venous catheters (CVCs) for mid and long term therapy in oncology are either external tunneled catheters (ETCs) (e.g. Hickman) or totally implantable devices (TIDs) (port system)  . Catheters are placed by either open cut down on the target vein or by percutaneous puncture using ana-tomical landmarks to guide the site of puncture. Intraop-erative ultrasound (U/S) localization of the target vein and fluoroscopic direction of the guide wire have been used to add to the safety and efficiency of the closed technique [2–9] . Fluoroscopy requires special radiography equipment, technician and in addition it exposes the operating staff to radiation. Other alternatives to flouroscopy include: in-travascular electrocardiography, catheter sensing devices or transeosophageal echocardiography [10, 11] . In our hospital (Children's Cancer Hospital, Cairo, Egypt) we developed a new way to localize the target vein and the guide wire in a rather simple way without the need for radiation exposure. This is done by localizing the guide wire by the same U/S kit that is already used for guiding venipuncture. The aim of this study was first to assess the technical feasibility and efficiency of different techniques of U/S guided puncture, secondly the use of U/S confirmation of the proper position of tunneled cath-eters used for pediatric oncologic patients.The Chinese-German Journal of Clinical Oncology 08/2012; 11(8):484-490.
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ABSTRACT: Fracture and embolization of central venous catheters placed via the subclavian approach is well recognized, but fractured catheters placed via the internal jugular vein are extremely rare. A 65-year-old man presented with a catheter embolus after placement of a central venous port using the internal jugular approach undertaken to administer adjuvant chemotherapy for colon cancer with lung metastases. Goose neck and conformational loop snares were successfully used to percutaneously retrieve the severed catheter, which had migrated to the right ventricle. Catheter fracture may occur even after placement via the internal jugular approach and may be underestimated because it is often asymptomatic. Interventional radiology techniques using goose-neck and conformational loop snares may be useful to retract an intravascular foreign body. Imaging studies such as a chest X-ray are mandatory to check that the catheter tip is in the appropriate position during the entire follow-up period even if it was placed through the internal jugular vein.International journal of surgery case reports. 03/2014; 5(5):219-221.
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ABSTRACT: The jugular venous system constitutes the primary venous drainage of the head and neck. It includes a profundus or subfascial venous system, formed by the two internal jugular veins, and a superficial or subcutaneous one, formed by the two anterior and two external jugular veins. We report one case of unilateral anatomical variations of the external and anterior jugular veins. Particularly, on the right side, three external jugular veins co-existed with two anterior jugular veins. Such a combination of venous anomalies is extremely rare. The awareness of the variability of these veins is essential to anesthesiologists and radiologists, since the external jugular vein constitutes a common route for catheterization. Their knowledge is also important to surgeons performing head and neck surgery.Acta medica (Hradec Kralove) / Universitas Carolina, Facultas Medica Hradec Kralove. 01/2014; 57(1):34-37.