Acute and Critical Care

Original Articles

Thoracic Surgery
Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a real-time method for eliminating misplacement: Yong Chae Jung, Man-shik Shim, Hee Sun Park, Min-Woong Kang; Acute Crit Care. 2024;39(2):266-274. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00150

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Abstract PDF Supplementary Material: Background
Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement.
Methods
This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications.
Results
Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%–99.36%), 90% CI (55.50%–99.75%), 99%, and 75%, respectively.
Conclusions
TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.

Surgery
Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution: Sukyung Kwon, Soo mi Son, Seul Hee Lee, Joung Hee Kim, Hyangkyoung Kim, Jang Yong Kim, Ji Il Kim, In Sung Moon; Acute Crit Care. 2020;35(1):31-37. Published online February 11, 2020; DOI: https://doi.org/10.4266/acc.2019.00731

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18 Crossref

Background
Bedside insertion of peripherally inserted central catheters (PICCs) has higher rates of malposition than fluoroscopic-guided PICC placement. This study evaluated the success rate of bedside PICC placement, variations in tip location, and risk factors for malposition. Methods: This retrospective study included patients who underwent bedside PICC placement from January 2013 to September 2014 in a single institution. The procedure was conducted under ultrasound guidance or by a blind method. After PICC placement, tip location was determined by chest X-ray. Results: The overall venous access success rate with bedside PICC placement was 98.1% (1,302/ 1,327). There was no significant difference in the venous access success rate between ultrasound-guided placement (868/880, 98.6%) and a blind approach placement (434/447, 97.1%). Optimal tip position was achieved on the first attempt in 1,192 cases (91.6%). Repositioning was attempted in 65 patients; 60 PICCs were repositioned at the bedside, two PICCs were repositioned under fluoroscopic guidance, and three PICCs moved to the desired position without intervention. Final optimal tip position after repositioning was achieved in 1,229 (94.4%). In logistic regression analysis, five factors associated with tip malposition included female sex (Exp(B), 1.687; 95% confidence interval [CI], 1.180 to 2.412; P=0.004), older age (Exp(B), 1.026; 95% CI, 1.012 to 1.039; P<0.001), cancer (Exp(B), 0.650; 95% CI, 0.455 to 0.929; P=0.018), lung disease (Exp(B), 2.416; 95% CI, 1.592 to 3.666; P<0.001), and previous catheter insertions (Exp(B), 1.262; 95% CI, 1.126 to 1.414; P<0.001). Conclusions: Bedside PICC placement without fluoroscopy is effective and safe in central venous catheters. Potential risk factors associated with catheter tip malposition include older age, female sex, cancer, pulmonary disease, and previous central vein catheterizations.

Citations

Citations to this article as recorded by

The Outcomes of Peripherally Inserted Central Catheter (PICC) Insertion in Pediatric Patients at Siriraj Hospital
Niracha Wongchompoo, Khanita Kasikan, Prasert Sawasdiwipachai
Siriraj Medical Journal.2024; 76(3): 135. CrossRef
Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a real-time method for eliminating misplacement
Yong Chae Jung, Man-shik Shim, Hee Sun Park, Min-Woong Kang
Acute and Critical Care.2024; 39(2): 266. CrossRef
Effectiveness of a nurse-led peripherally inserted central catheter service: A retrospective cohort study
Kawthar Alsaleh, Dalyal Alosaimi, Adnan Almousawi, Mohammed Alshaikh, Hisham Omar
The Journal of Vascular Access.2024;[Epub] CrossRef
Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter
Midan Zhang, Xiaofei Chen, Hongqin Zhou, Meifang Xu
Innovative Journal of Pediatrics.2023;[Epub] CrossRef
Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter
Midan Zhang, Xiaofei Chen, Hongqin Zhou, Meifang Xu
Iranian Journal of Pediatrics.2023;[Epub] CrossRef
Feasibility of Ultrasound-Guided, Peripherally Inserted Central Catheter Placement at the Bedside in a Communicable-Disease Isolation Unit
Kyoung Won Yoon, Wongook Wi, Moon Suk Choi, Eunmi Gil, Chi-Min Park, Keesang Yoo
Journal of Personalized Medicine.2023; 13(5): 863. CrossRef
Development and validation of an updated PICC length prediction formula based on anteroposterior chest radiographs for the ultrasound-guided bedside placement
Hyoung Nam Lee, Sangjoon Lee, Sung-Joon Park, Youngjong Cho, Hwan Hoon Chung, Robert Jeenchen Chen
PLOS ONE.2023; 18(11): e0294598. CrossRef
Analysis of tip malposition and correction of peripherally inserted central catheters under ultrasound-guidance: 5-year outcomes from a single center
Eunju Jang, Soo Mi Son, Ki-yoon Moon, Seunghoon Lee, Hong Seok Han, Sun Cheol Park, Jang Yong Kim, Sang Seob Yun
The Journal of Vascular Access.2023;[Epub] CrossRef
Precision at the Bedside: Practical Efficacy of Clockwise Catheter Torque for Accurate Tip Positioning of Peripherally Inserted Central Catheters
Masayuki Akatsuka, Eriko Sugiyama
Cureus.2023;[Epub] CrossRef
Guidewire-Assisted Reduction Technology Combined with Postural Reduction Improves the Success Rate of Internal Vein Catheterisation
Feng-Xian Li, Yan-Ping Li, Hong-Yang Zhang, Mei-Jing Tian, Huan-Huan Gao, Gui-Juan Zhang, Peng Su, Daniel Espino
Journal of Healthcare Engineering.2022; 2022: 1. CrossRef
Therapeutic Effect of Ultrasound-Guided Peripherally Inserted Central Catheter Combined with Predictive Nursing in Patients with Large-Area Severe Burns
Baiyan He, Aiqiong Zhang, Shuting He, Pan Zheng
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Bedside peripherally inserted central catheter placement: focus on the procedure
Dong Hun Kim
Trauma Image and Procedure.2022; 7(1): 21. CrossRef
Validation of the PICC length prediction formula based on anteroposterior chest radiographs for bedside ultrasound-guided placement
Youngjong Cho, Sangjoon Lee, Sung-Joon Park, Hyoung Nam Lee, Hwan Hoon Chung, Robert Jeenchen Chen
PLOS ONE.2022; 17(11): e0277526. CrossRef
Feasibility of Peripherally Inserted Central Catheter Placement in COVID-19 Patients Isolated in the Intensive Care Unit of a Small Volume Center (291-Bed Hospital)
Min Chang Kang, Kyungwon Lee
Journal of Acute Care Surgery.2022; 12(3): 125. CrossRef
Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol
Edienne Rosângela Sarmento Diniz, Kleyton Santos de Medeiros, Richardson Augusto Rosendo da Silva, Ricardo Ney Cobucci, Angelo Giuseppe Roncalli, Raffaele Serra
PLOS ONE.2021; 16(7): e0255090. CrossRef
Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - Thirty cases report-
Sang-Hwan Ji, Sol Ji Yoo, Sung-Ae Cho, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim
Anesthesia and Pain Medicine.2021; 16(3): 273. CrossRef
Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique
Brendan Erskine, Pierre Bradley, Tim Joseph, Sabrina Yeh, Warren Clements
Journal of Medical Radiation Sciences.2021; 68(4): 349. CrossRef
Pneumothorax as a rare complication of peripherally inserted central catheter (PICC) in neonates: A case report study
Rasoul Goli, Sina Zafarmokhtarian, Mahmoodreza Ghalandari, Navid Babakeshi-sheytanabad, Sajjad Rostami, Hossna Farajollahi
International Journal of Surgery Case Reports.2021; 88: 106472. CrossRef

Vascular Surgery
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter: Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho; Korean J Crit Care Med. 2015;30(4):280-285. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.280

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Abstract PDF

Background
We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. Methods: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. Results: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). Conclusions: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Citations

Citations to this article as recorded by

Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report
Parag Gharde, Sourangshu Sarkar, Kalpana Irpachi, Amol Kumar Bhoje, Bhavdeep Kaur, Sandeep Chauhan
A&A Practice.2020; 14(10): e01291. CrossRef

Case Reports

Cardiology
Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization: Hyun Jeong Lee, Namo Kim, Hyelin Lee, Jae Kwang Shim, Jong Wook Song; Korean J Crit Care Med. 2015;30(1):22-26. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.22

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Abstract PDF

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Citations

Citations to this article as recorded by

The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter
Caio Francisco Ternus de Abreu, Bernardo Ternus de Abreu
Biomedical Materials & Devices.2024; 2(2): 968. CrossRef
Transthoracic Echocardiography–Guided Placement of a Pulmonary Artery Catheter in a Patient With a Known Persistent Left but Unknown Absent Right Superior Vena Cava
Jenna L. Leclerc, Raymond Clemes, Cristina Fuss, Conrad J. Macon, Peter M. Schulman
Circulation: Cardiovascular Imaging.2024;[Epub] CrossRef

Thoracic Surgery
A Rare Case of Massive Hemothorax due to Central Venous Catheterization Treated with Angiographic Stent Implantation: Jung-Min Bae; Korean J Crit Care Med. 2015;30(1):18-21. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.18

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Abstract PDF: In critically ill patients, centeral venous catheterization is a widely used procedure for fluid resuscitation, massive transfusion, total parenteral nutrition, central venous pressure monitoring and hemodialysis. However, many complications are associated with central venous catheterization. Among these complications, hemothorax is rare but fatal. We recently experienced a 32-year-old female diagnosed with hemothorax due to subclavian catheterization who was successfully treated with angiographic intervention. There are no absolute indications of surgery or interventional treatment in such cases. Multicenter studies and consensus are necessary to determine the proper treatment for hemothorax due to central venous catheterization. Angiographic treatment is rarely used for this uncommon complication of subclavian catheterization. We describe a rare case with a review of the literature.

Original Articles

Emergency
Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation: Yong Oh Kim, Hyun Soo Park; Korean J Crit Care Med. 2014;29(3):172-176. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.172

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Abstract PDF

BACKGROUND
Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR.
METHODS
This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR.
RESULTS
During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC.
CONCLUSIONS
During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Citations

Citations to this article as recorded by

Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults
Hyun Seok Chai, Young-Min Kim, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Ji Han Lee
SAGE Open Medicine.2023;[Epub] CrossRef
Femoral venous oxygen saturation obtained during CPR predicts successful resuscitation in a pig model
Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
The American Journal of Emergency Medicine.2015; 33(7): 941. CrossRef

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by

Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Case Report

Surgical Management for Pulmonary Artieriole Rupture During Subclavian Vein Catheterization: A Case Report: Jiae Min, Hyun Koo Kim, Ho Kyung Sung, Hyun Joo Lee, Young Ho Choi; Korean J Crit Care Med. 2012;27(1):59-61.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.59

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Abstract PDF: We experienced an extremely unusual case of a 37-year-old woman who suffered from hemothorax soon after subclavian vein catheterization. Many case reports of a hemothorax or hematoma after central vein catheterization through the great vessels, such as the subclavian vein and internal jugular vein, have been published. However, this rare case showed a pinpoint-sized active bleeding site from a pulmonary arteriole rupture. During an emergency operation using thoracoscopy-assisted minithoracotomy, this bleeding site was successfully managed by primary repair.

Original Article

Relationship between Patient Height and Depth of Central Venous Catheter: Dong Jun Lee, Ui Jae Im, Ki Tae Kim; Korean J Crit Care Med. 2011;26(3):145-150.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.145

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Abstract PDF: BACKGROUND
Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC.
METHODS
We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed.
RESULTS
The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups.
CONCLUSIONS
The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.

Case Reports

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report: Deokkyu Kim, Ji Hye Lee, Dong Chan Kim, Hyungsun Lim, Seonghoon Ko, Ji Seon Son; Korean J Crit Care Med. 2011;26(1):38-40.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.38

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Abstract PDF: Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report: Ji Ung Kim, Ji Hyun Cheon, Il Soo Kim, Sun Kwang Kim, Sung Hyun Ko, Sea Won Lee, Sang Hee Kim, Su Hong Kim; Korean J Crit Care Med. 2010;25(3):190-193.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.190

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Abstract PDF: Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

Malfunction due to Kinking and Bending of a Double Lumen Central Venous Catheter : A Case Report: Kyung Bong Yoon, Won Oak Kim, Jae Ho Cha, Ki Young Lee; Korean J Crit Care Med. 2006;21(2):131-134.

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Abstract PDF: Central venous catheters provide an important means of vascular access and are increasingly used. Catheter occlusion refers to the inability to infuse or withdraw fluids from a catheter and could be caused by either thrombotic or nonthrombotic origin. We report an unusual malfunction of double lumen central venous catheter due to kinking and bending of the catheter at the opening site of proximal lumen.

Original Articles

Medicolegal Aspects on Central Venous Catheterization Related Injury: Hyuna Bae, Sungeun Kim, Seokbae Lee, Rack Kyung Chung; Korean J Crit Care Med. 2006;21(1):42-50.

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Abstract PDF: BACKGROUND
We describe the characteristics of malpractice claims related to central venous catheterization and identify causes and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing records at Lawnb and Lx CD-rom. The records on closed malpractice claim related to central venous catheterization were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the factors associated with a successful defense.
RESULTS
Twelve closed claim cases, related to central venous cathetertization were reviewed in the data for malpractice. Catheter-related complications were pneumothorax, hemothorax, cardiac tamponade, pyothorax, hematoma due to arterial puncture, pseudoaneurysm. Almost cases resulted in indemnity payment and verdict for patient. CONCLUSIONS: Although malpractice claims related to central venous catheterization were uncommon, they resulted in high rate and amount of indemnity payments. In pediatric patient, catheterization should be performed with attention. Clinicians should consider the underlying disease of patients and do any pretreatment if needed. Post-procedural radiologic confirmation can improve patient outcome and is also associated with decreased indemnity risk. Informed consent is also important.

The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography: Il Woo Shin, Mi Young Park, Ju Young Choi, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2006;21(1):37-41.

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Abstract PDF: BACKGROUND
The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter.
METHODS
The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed.
RESULTS
The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04).
CONCLUSIONS
The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.

Case Report

Cutting of Guide Wire and Hydrothorax after Subclavian Venous Catheterization for Premature Infant: A case report: Hyun Soo Moon, Sung Hee Han; Korean J Crit Care Med. 1999;14(1):37-41.

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Abstract PDF: Central venous catheterization is one of the common procedures in the care of critically ill patients but numerous major complications have been reported. This report is about a case of sequential complications that were developed after two attempts of subclavian venous catheterization via supraclavicular approach for a critically ill 1.5 kg premature infant in intensive care unit. In the first attempt, the guidewire was cut and remained in the right atrium but fortunately removed without surgery. In the second attempt for the same patient, the catheter positioned out of the vessel. It was in right pleural cavity and caused hydrothorax. After third attempt, successful left subclavian vein catheterization was done.

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