Thrombosis of the superior vena cava due to a central catheter for total parenteral nutrition

AbstractIntroductionSuperior vena cava syndrome is one of the more serious complications of central venous catheter insertion. Drug interactions of administered drugs used in association with these catheters can lead to formation of precipitations and consequently thrombus formation. These interactions can be either anion-cation or acid-base based and more commonly present in clinical practice than expected.Case presentationThe case of a 31-year old female who was admitted to an intensive care unit with an intracranial haemorrhage, is presented. Occlusion of the superior vena cava was caused by a drug-induced thrombus, formed by the precipitation and clotting of total parenteral nutrition and intravenous drugs. Given the nature of the thrombus and a recent intracranial haemorrhage, the patient was treated with a central thrombectomy supported by a heparin-free extracorporeal membrane oxygenation.ConclusionKnowledge of drug interactions is crucial in order to heighten awareness for the dangers of concomitant drug administration, especially in combination with total parenteral nutrition in critically ill patients.

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Persistent Left Superior Vena Cava

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.04.001 ◽

2014 ◽

Vol 19 (2) ◽

pp. 84-85 ◽

Cited By ~ 2

Author(s):

Vicki L. Mabry ◽

Anne T. Mancino ◽

Sheila Cox Sullivan

Keyword(s):

Superior Vena Cava ◽

Chest Radiograph ◽

Incidental Finding ◽

Superior Vena ◽

Vena Cava ◽

Vascular Anomaly ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena

Abstract This is a case report of an incidental diagnosis of persistent left superior vena cava (PLSVC). The diagnosis was suspected after a peripherally inserted central catheter (PICC) was placed and a postinsertion chest radiograph was conducted. PLSVC is a vascular anomaly that is usually diagnosed as an incidental finding. Here, we discuss the tests performed to confirm the diagnosis and the 3 variants of PLSVC. Nurses who place PICCs are likely to run across this abnormality on postinsertion chest radiograph and knowing the diagnostic test to order to confirm the diagnosis is key in expediting patient care.

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Persistent Left Superior Vena Cava Identified during Peripherally Inserted Central Catheter Line Placement

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0040-1703990 ◽

2019 ◽

Vol 5 (02) ◽

pp. 64-66

Author(s):

Arvind Borde ◽

Vivek Ukirde

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Left Superior Vena Cava ◽

Anatomical Variant ◽

Persistent Left Superior Vena ◽

Line Placement ◽

Picc Line

Abstract Introduction A persistent left superior vena cava (SVC) is found in 0.3 to 0.5% of the general population. It is seen in up to 10% of the patients with a congenital cardiac anomaly, being the most common thoracic venous anomaly, and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during the placement of central lines, Swan-Ganz catheters, peripherally inserted central catheter (PICC) lines, dialysis catheters, defibrillators, and pacemakers. Case Presentation We describe a case of persistent left SVC which was noted after placement of a PICC line. A 5-year-old male child was hospitalized for evaluation and management of leukemia. He required PICC line placement for chemotherapy. He was noted to have a persistent left SVC during the procedure under fluoroscopic guidance and subsequently correct placement of PICC line in right SVC. Discussion This anatomical variant can pose iatrogenic risks if the clinician does not recognize it. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. Conclusion Our case is significant because the patient was diagnosed with double SVC on table only followed by the placement of PICC line into the right SVC. This case strongly demonstrates the importance of knowing the thoracic venous anomalies.

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Complications connected with superior vena cava access in parenteral nutrition

Nutrition ◽

10.1016/s0899-9007(97)90407-x ◽

1997 ◽

Vol 13 (6) ◽

pp. 600

Keyword(s):

Parenteral Nutrition ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava

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The Use of CT Imaging Technology in Peripherally Inserted Central Catheter

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3284 ◽

2021 ◽

Vol 11 (1) ◽

pp. 114-119

Author(s):

Ying Wu ◽

Guohua Huang ◽

Qiufeng Li ◽

Jinai He

Keyword(s):

Superior Vena Cava ◽

Right Atrium ◽

Superior Vena ◽

Vena Cava ◽

Ct Imaging ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Imaging Technology ◽

X Ray ◽

The Right

Objective: The objective is to explore the application of computed X-ray tomography (CT) imaging technology in peripherally inserted central catheter (PICC), and to propose a more effective method for PICC catheterization. Method: In this study, 69 subjects are divided into the observation group (X-ray and CT) and the control group (X-ray). The guiding effect of CT images on PICC tube placement in complex cases is compared. In this study, CT localization of the superior vena cava–caval-atrial junction (CAJ) is used as the gold standard. The position relationship of carina-CAJ and carina-PICC catheter tip is measured and analyzed by CT image and chest radiography (CXR) image, providing scientific basis for PICC tip imaging. Results: After this study, the tip of the catheter should be 1/3 of the middle and lower part of the superior vena cava, about 3 cm above the junction of the right atrium and the superior vena cava, and in the upper part of the diaphragm of the inferior vena cava, so that it cannot enter the right ventricle or the right atrium. The best position of the tip of the catheter is near the junction of the superior vena cava and the right atrium. The average vertical distance between the tracheal carina and CAJ is 4.79 cm. Conclusion: CT and X-ray examination can effectively determine the location of the tip of PICC catheter in cancer chemotherapy patients, but the clarity of X-ray examination is missing. It is suggested to adopt CT examination, and further adopt and promote it.

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Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier

Critical Care Nurse ◽

10.4037/ccn2011966 ◽

2011 ◽

Vol 31 (2) ◽

pp. 64-69 ◽

Cited By ~ 4

Author(s):

Geng Tian ◽

Bin Chen ◽

Li Qi ◽

Yan Zhu

Keyword(s):

Infection Rate ◽

Superior Vena Cava ◽

Chest Radiograph ◽

Superior Vena ◽

Vena Cava ◽

Catheter Placement ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Catheter Tip

Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).

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