Right vocal fold paralysis as a result of central venous catheterization

1995 ◽  
Vol 109 (11) ◽  
pp. 1107-1108 ◽  
Author(s):  
D. P. Martin-Hirsch ◽  
C. J. R. Newbegin
Keyword(s):  
Vocal Fold ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Central Line ◽  
Vocal Fold Paralysis ◽  
Central Venous ◽  
Central Lines ◽  
Central Line Insertion ◽  
Venous Catheterization ◽  
Bilateral Vocal Fold Paralysis

AbstractInvasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent.Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication.When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis.Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.

Practical procedures

2012 ◽  
Keyword(s):  
Central Venous Catheterization ◽  
Central Line ◽  
Arterial Line ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Central Line Insertion ◽  
Vein Cannulation ◽  
Arterial Blood ◽  
Line Insertion ◽  
Venous Catheterization

Arterial blood sampling 784Arterial line insertion: introduction 786Arterial line insertion: over-the-wire technique 786Arterial line insertion: over-the-needle technique 788Central line insertion 790Internal jugular vein cannulation 792Subclavian vein cannulation 794Ultrasound-guided central venous catheterization (1) 796Ultrasound-guided central venous catheterization (2) ...

Practical procedures

2010 ◽  
pp. 735-812
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir Sam
Keyword(s):  
Central Venous Catheterization ◽  
Central Line ◽  
Arterial Line ◽  
Central Venous ◽  
Internal Jugular Vein Cannulation ◽  
Central Line Insertion ◽  
Vein Cannulation ◽  
Arterial Blood ◽  
Line Insertion ◽  
Venous Catheterization

Arterial blood sampling 736 Arterial line insertion 1 738 Arterial line insertion 2 740 Central line insertion 742 Internal jugular vein cannulation 744 Subclavian vein cannulation 746 Ultrasound (US)-guided central venous catheterization 1 748 US-guided central venous catheterization 2 750 Pulmonary artery catheterization 1 752...

scholarly journals Objective Assessment Metrics for Central Line Simulators: An Exploration of Causal Factors

2020 ◽  
Vol 64 (1) ◽  
pp. 2008-2012
Author(s):  
Jessica M. Gonzalez-Vargas ◽  
Dailen C. Brown ◽  
Jason Z. Moore ◽  
David C. Han ◽  
Elizabeth H. Sinz ◽  
...  
Keyword(s):  
Central Venous Catheterization ◽  
Objective Assessment ◽  
Central Line ◽  
Expert Interviews ◽  
Central Venous ◽  
Patient Case ◽  
Causal Factors ◽  
Venous Catheterization ◽  
Assessment Metrics ◽  
Automated Feedback

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees’ performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

Ipsilateral vocal fold paralysis: An unusual complication of internal jugular tunnelled dialysis catheter insertion

2019 ◽  
Vol 21 (1) ◽  
pp. 116-119 ◽  
Author(s):  
Sreekanth Koduri ◽  
Alvin Kok Heong Ng ◽  
Debajyoti Roy ◽  
Edmund Chiu Kit Wong
Keyword(s):  
Central Venous Catheter ◽  
Vocal Fold ◽  
Venous Catheter ◽  
Vocal Fold Paralysis ◽  
Catheter Insertion ◽  
Unusual Complication ◽  
Complication Rates ◽  
Dialysis Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous

Background: Central venous catheters are extensively used in critical care units and in dialysis centres to gain access to the blood stream for the purpose of invasive monitoring, drug administration, parenteral nutrition and to perform renal replacement therapy. One of the common areas of central venous catheter insertion is right internal jugular vein due to its anatomical continuity with the superior vena cava. The complication rates of central venous catheter insertion can be more than 15%, including early and late complications. Case report: We present an unusual complication of recurrent laryngeal nerve palsy, leading to right vocal fold paralysis, following insertion of a right internal jugular tunnelled dialysis catheter. The vocal fold paralysis improved over next 8 months with conservative management alone. Conclusion: This case illustrates an unusual complication of central venous catheter insertion and the importance of recognizing the possibility of such complications, to prevent them from happening and also to manage them appropriately.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

scholarly journals Ultrasound to Detect Central Venous Catheter Placement Associated Complications

2020 ◽  
Vol 132 (4) ◽  
pp. 781-794 ◽  
Author(s):  
Jasper M. Smit ◽  
Mark E. Haaksma ◽  
Endry H. T. Lim ◽  
Thei S. Steenvoorden ◽  
Michiel J. Blans ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Diagnostic Accuracy ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Reference Standard ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
X Ray ◽  
Venous Catheterization ◽  
Chest X Ray

Abstract Background Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax. Methods This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen’s κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound. Results In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen’s κ-coefficient of 0.50 (95% CI, 0.19 to 0.80). Conclusions This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Vias para Nutrição Artificial na Criança (II): Acessos Parentéricos

2014 ◽  
Vol 27 (6) ◽  
pp. 767
Author(s):  
José Estevão-Costa
Keyword(s):  
Parenteral Nutrition ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Venous Access ◽  
The Body ◽  
Central Catheter ◽  
Maintenance Care ◽  
Central Venous ◽  
Venous Catheterization

Parenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (&lt; 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (&gt; 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral<br />accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols.<br /><strong>Keywords:</strong> Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral.

scholarly journals Identification and correction of guide wire malposition during internal jugular cannulation with ultrasound

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 131-132 ◽  
Author(s):  
Michael B. Stone
Keyword(s):  
Real Time ◽  
Ultrasound Guidance ◽  
Central Venous Catheterization ◽  
Guide Wire ◽  
Venous Catheter ◽  
Central Venous ◽  
Venous Catheterization ◽  
Procedural Complications ◽  
Introducer Needle ◽  
Wire Resistance

ABSTRACT Real-time ultrasound guidance for central venous catheterization increases success and reduces procedural complications. I describe a case in which guide wire resistance was encountered and real-time ultrasound visualization of the guide wire facilitated correction of guide wire malposition. No additional passes of the introducer needle were necessary and the chances of inadvertent carotid artery puncture or pneumothorax were therefore reduced. The technique described here may prove valuable when guide wire resistance is encountered while placing a central venous catheter.

scholarly journals Coiling of shaft of the central venous catheter inside left subclavian vein- a case report

2018 ◽  
Vol 4 (2) ◽  
pp. 87-90
Author(s):  
Lalit Kumar Rajbanshi ◽  
Shambhu Bahadur Karki ◽  
Batsalya Arjyal
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Guide Wire ◽  
Venous Catheter ◽  
Anatomical Landmarks ◽  
Central Venous ◽  
Venous Catheterization ◽  
Left Subclavian Vein ◽  
The Common ◽  
Blood Aspiration

Central venous catheterization is one of the common procedures used for gaining vascular access for various indications. Sometimes, the catheter can take unusual course inside the vein that can lead to erroneous pressure measurement, increase the risk of thrombosis or trauma to the vessel. Any resistance during insertion of the guide wire or catheter and absence of blood aspiration are some alarming signs that help to detect malposition at the earliest moment. We report a case of coiling of the shaft of the central venous catheter inside left sublacvian vein in a patient with head injury. Technical expertise, sound knowledge of anatomical landmarks and use of real time ultrasound can minimize malposition of the catheter. We suggest at any moment if there is resistance during insertion of guide wire or catheter or if there is absence of blood aspiration from any of the lumen, the catheter should be removed immediately suspecting malposition.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 87-90 

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