Jpen Parenter Enter
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Jpen Parenter Enter · Nov 1991
Case ReportsBilateral pleural and pericardial effusions because of mediastinal placement of a central venous catheter.
Pneumothorax, hydrothorax, hydromediastinum, and cardiac tamponade are uncommon, although not unusual, complications of central venous catheter placement. We report a case of hydromediastinum with bilateral pleural and pericardial effusions, occurring in a patient after placement of a Silastic double-lumen central venous catheter for hyperalimentation.
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Jpen Parenter Enter · Sep 1991
Case ReportsSpontaneous migration of long-term indwelling venous catheters.
Our institution recently encountered two patients with an unusual complication of indwelling catheters, spontaneous migration of the catheter tip. Both patients had indwelling subcutaneous ports placed via the left subclavian vein into the superior vena cava for the treatment of breast cancer. ⋯ One patient required surgical intervention to properly position the catheter for further chemotherapy. Chest roentgenograms are indicated to confirm the continued appropriate position of indwelling catheters when their position is in doubt to minimize the likelihood of complications associated with delivery of caustic chemotherapeutic agents in low flow vessels.
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Risk factors for superior vena cava perforations following central venous catheterization for total parenteral nutrition were identified in a retrospective study of 1058 catheters in 853 patients; 540 of these catheters were size 16-gauge (51%) and 518 size 14-gauge (49%). Of the size 14-gauge catheters, 274 (53%) were right-sided and 244 (47%) were left-sided subclavian catheters. Four patients (0.4%) had superior vena cava perforation. ⋯ There was no mortality directly related to vascular erosions. Two risk factors were identified for this complication: (1) catheters originating from the left side (p less than 0.05), or (2) large catheters (size 14-gauge or larger) (p less than 0.01). We conclude that large bore or left-sided central venous catheter placement represents an increased risk of superior vena cava perforation.
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Jpen Parenter Enter · Jul 1991
Case ReportsA case of intracerebral air embolism secondary to the insertion of a Hickman line.
Complications following the insertion of intravenous catheters are relatively uncommon. We report a potentially serious, hitherto unrecognized complication of Hickman line insertion, and discuss the condition.
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One hundred forty-four cancer patients harboring a central venous catheter (CVC) were prospectively investigated to assess the relationship between hub culture, clinical assessment of sepsis before removal, and CVC sepsis. In 22 patients, the CVC was removed because of clinical assessment of catheter sepsis expressed by the staff prior to the removal. For each CVC removal, peripheral blood (qualitative method), hub, and CVC tip (quantitative method) cultures were performed. ⋯ Predictive values of clinical assessment were 55% if positive and 97% if negative. Combining hub cultures and clinical assessment, the risk of sepsis varied from 2% with both evaluations negative to 89% in the case of positive clinical assessment associated with positive high-count hub. Inasmuch as the CVCs used have a disposable hub, it is possible to have an accurate diagnosis of CVC sepsis without removing the CVC.