Venous Catheter Line Complications

A 13-year-old with hemolytic uremic syndrome was taken to the OR for a vascular catheter, but there was confusion between the surgical team, primary team, and nephrology about whether a temporary dialysis catheter or peritoneal dialysis catheter was needed

A right internal jugular temporary dialysis catheter was initially placed, then two days later the patient returned to the OR for placement of a peritoneal dialysis catheter

Peritoneal dialysis is usually performed for hemolytic uremic syndrome

At Cleveland Clinic, a separate form must be filled out for any line placement specifying exactly what type of line is wanted and how many lumens

The line request form includes who the responsible attending is and their contact number, and cases are not booked until the form is scanned into the patient's chart

When calling about line placement questions, the team calls the responsible attending (e.g., nephrology attending) rather than the primary pediatric service

An Epic order set exists for line requests that includes contact information for the resident and attending responsible for the patient

The line request form documents every line that was previously present in the patient

A 16-year-old with sickle cell disease on a transfusion protocol had complications and would likely receive a bone marrow transplant today

MRV showed both subclavian veins and both internal jugular veins were clotted off, with reconstitution of the superior vena cava via the azygous vein

A broviac or cuffed central venous catheter can be placed in the femoral vein via saphenous vein cutdown even in active patients

Under thoracoscopic guidance, a needle can be placed in the right neck and tracked along the superior vena cava to access where it reconstitutes with the azygous vein, using a spinal needle which is longer than the needle in standard kits

A patient kept a thoracoscopically-placed superior vena cava line for about one to two years before it required replacement, and the procedure was successfully repeated

Most practitioners would place a single-lumen cuffed central venous line for a 5-year-old with acute lymphoblastic leukemia via right internal jugular using ultrasound guidance

Carolina Milan, a pediatric surgeon from Argentina, taught techniques for performing percutaneous central line placement in younger patients including newborns

Percutaneous central line placement is performed in almost all patients except tiny micropremies, who still receive cutdowns

In micropremies requiring cutdown, the jugular vein is accessed with a needle and a catheter is threaded through rather than ligating the vein, to preserve future access

Micropuncture needles are used as a technique for central line placement

When a subclavian catheter is malpositioned, the decision to reattempt at the same site versus going to the contralateral side depends on whether a large dilator was placed, which could cause a hematoma

Fluoroscopy should be used when troubleshooting malpositioned catheters to avoid ending up with a hemothorax on one side and pneumothorax on the other

Mark Rowe taught external jugular access as a primary approach, but getting to the junction of the external jugular and internal jugular is not as easy as it seems, with catheters potentially getting hung up or going the wrong direction

Facial vein cutdowns can be used for central venous access