Central venous catheters are mainly being used for reliable infusion of fluids and
potentially irritant drugs, for haemodialysis, and for assessment of right atrial or
central venous pressure (RAP/CVP). Current guidelines state that central venous
catheterization should be followed-up by immediate anterior-posterior chest X-ray to confirm appropriate positioning and to detect iatrogenic pneumothorax. However,
the appropriate position is still questioned, and pneumothorax requiring therapeutic
intervention may be detectable from clinical signs. A rare but serious complication of central venous cannulation is inadvertent arterial catheterization. Traditional pull and press techniques are associated with considerable risks when applied in noncompressible areas or when large bore catheters have been used. Repair of
intrathoracic arteries may require extensive surgical or sophisticated endovascular
approaches. The RAP/CVP have been reported to correlate with central venous
return of blood and with peripheral venous pressure (PVP). Cuff-occluded rate of rise of peripheral venous pressure (CORRP), reflecting changes in PVP during proximal venous occlusion, has been proposed to predict hyper- or hypovolemia in dogs.
In Study I patients with central venous cannulations were recorded prospectively.
Individual radiographic records of corresponding routine control X-ray procedures
were evaluated retrospectively. There were few complications from malpositioned
catheter tips associated with short-term use.
In Study II echocardiographic, and central and peripheral venous pressure
measurements were made in patients with renal failure before and after haemodialysis.
The changes in CORRP were found to correlate linearly with the volumes of fluid
removed, whereas changes in RAP/CVP and PVP correlated with each other.
In Study III inadvertent arterial catheterization after failed central venous cannulation
was retrospectively found to be associated with obesity, emergency puncture, severe
hypovolemia or lack of ultrasonic guidance, and to be successfully managed by
endovascular therpeutic techniques.
In Study IV records of routine control x-ray procedures after central venous
catheterization were evaluated retrospectively, together with study protocol and
medical charts. All iatrogenic pneumothoraces requiring therapeutic intervention
were associated with clinical signs of respiratory distress or hypoxia.
In conclusion, the results of this thesis indicate that routine post-procedural X-ray
may be replaced by optional X-ray in selected patients, that CORRP (but not
RAP/CVP) may predict changes in fluid balance, and that endovascular management
is a feasible and safe therapeutic option in inadvertent arterial catheterization.
- Anaesthesiology and Intensive Care Medicine
- Åkeson, Jonas, Supervisor
- Acosta, Stefan, Assistant supervisor
- Bååth, Lars, Assistant supervisor
|Award date||2012 Feb 3|
|Publication status||Published - 2012|
Place: Tidskriften, Medicinskt Forskningscentrum, Skånes universitetssjukhus i Malmö, ingång 59, plan 1.
Name: Ricksten, Sven-Erik
Affiliation: University of Gothenburg, Sahlgrenska Academy, Department of Anaesthesiology and Intensive Care.
- Anesthesiology and Intensive Care