mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

Prevention of Unrecognized Arterial Cannulation

The possibility of arterial cannulation during attempted central venous access is well recognized. Classic findings of arterial cannulation such as pulsatile bright red blood are notoriously unrelieable markers of catheter location. When unwanted arterial cannulation is suspected, the catheter should be removed and a new attempt at venous cannulation made. To reduce the possiblity of unrecognized arterial cannulation, the following guidelines must be adhered to:

1. Use ultrasound guidance where possible to minimize the risk of arterial puncture.

2. Confirm placement of internal jugular or subclavian central line placement with chest radiograph. Three key features should be assessed.
a. First, the catheter should lie in the vena cava, outside of the cardiac silhouette.
b. Second, the catheter should be relatively parallel to the walls of the vena cava.
c. Third, the catheter tip should not abut the wall of the vena cava.

3. If obtaining a cxr is not feasible for any reason or there is any doubt regarding location after cxr, the critical care committee recommends confirmation by:
a. Manometry (transduce waveform)
b. Comparative Blood Gas Analysis – draw samples from the catheter and an artery
c. Contrast Dye Study


REFERENCES:

1. Scott WL. Complications associated with central venous catheters. A survey. Chest. 1988; 94:1221-1224.
2. Brandt RL, Foley WJ, Fink GH, et al. Mechanism of perforation of the heart with production of hydropericardium by a venous catheter and its prevention. Am J Surg. 1970; 119:311-316.
3. Sheep RE, Guiney WB. Fatal cardiac tamponade: Occurrence with other complications after left internal jugular vein catheterization. JAMA. 1982; 248:1632-1635.
4. Bar-Joseph G, Galvis AG. Perforation of the heart by central venous catheters in infants: Guidelines to diagnosis and management. J Ped Surg. 1983; 18:284-287.
5. Collier PE, Ryan JJ, Diamond DL. Cardiac tamponade from central venous catheters — A report of a case and review of the English literature. Angiology. 1984; 35:595-600.
6. Maschke SP, Rogove HJ. Cardiac tamponade associated with a multilumen central venous catheter. Crit Care Med. 1984; 12:611-613.
7. Tocino IM, Watanabe A. Impending catheter perforation of superior vena cava: Radiographic recognition. Am J Roentgenol. 1986; 146:487-490.
8. Jiha JG, Weinberg GL, Laurito CE. Intraoperative cardiac tamponade after central venous cannulation. Anesth Analg. 1996; 82:664-665.
9. Bunegin L, Albin MS, Helsel PE, et al. Positioning the right atrial catheter: A model for reappraisal. Anesthesiology. 1981; 55:343-348.
10. Jobes DR, Schwartz AJ, Greenhow DE, et al. Safer jugular vein cannulation: Recognition of arterial puncture and preferential use of the external jugular route. Anesthesiology. 1983; 59:353-355.

Written by phil

June 25th, 2006 at 4:55 pm

Posted in Pearls