The Journal of critical illness
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Review Case Reports
Tips for monitoring the position of a central venous catheter. How placement can go awry--even when the anatomy is normal.
Malpositioning of a central venous catheter can cause potentially life-threatening complications. Knowledge of thoracic anatomy and close attention to proper insertion technique increase the likelihood of, but do not ensure, proper placement. Selection of a right-sided venous entry site reduces the risk of malpositioning. ⋯ Do not assume that venous system valves preclude malpositioning. Use chest films to confirm accurate insertion. When these are equivocal, take simultaneous blood samples from a peripheral artery and the central line; the samples will have markedly different blood gas levels if the catheter is in a vein.
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Major problems facing cardiac transplant recipients include rejection, infection, and transplant coronary artery disease. Commonly used antirejection drugs are high-dose corticosteroids and cytolytic agents. ⋯ Coronary angiography is used to detect transplant coronary artery disease, the only definitive treatment for which is retransplantation. A number of promising new immunosuppressive agents and techniques may prevent some complications and further improve the care cardiac transplant recipients receive.