Central Venous Pressure Estimation by Ultrasound Measurement of Inferior Vena Cava and Aorta Diameters in Pediatric Critical Patients: An Observational Study
Conclusions: Inferior vena cava collapsibility index and ratio of maximal diameter of inferior vena cava/maximum diameter of the abdominal aorta correlate well with central venous pressure measurements in this PICU population, and specific inferior vena cava collapsibility index or ratio of maximal diameter of inferior vena cava/maximum diameter of the abdominal aorta thresholds appear to be able to differentiate children with high or low central venous pressure. However, the actual clinical application of these statistically significant results remains limited, especially by the intrinsic flaws of the procedure.
To decrease the complications related to central catheters there has been an increasing utilization of peripherally inserted central catheters and ultrasound-guided long peripheral intravenous catheters (ie Midlines). While the complications of peripherally inserted central venous catheters are well described, there is less reported data on complications related to midline catheters. Our study aims to compare the incidences of deep venous thrombosis and sepsis related to PICCs and DVTs.
Authors: Gołębiowski T, Konieczny A, Letachowicz K, Krajewska M, Kusztal M Abstract Central venous catheter (CVC) for hemodialysis are frequently implanted to the internal jugular vein. Thyroid cysts are commonly shown in ultrasound examination and their recognition should not pose a problem. Herby we present an uncommon case of the thyroid cyst unintended puncture, during an attempt of CVC insertion. No further clinical consequences were observed. For all practitioners, involved in interventional nephrology, such complication may be of the utmost importance. PMID: 32985345 [PubMed - as supplied by publisher]
CONCLUSIONS: In this critically ill pediatric cohort, all central venous catheters inserted under ultrasound guidance, could have been used with safety prior to acquiring chest x-ray. Overall chest x-ray impacted patient management in only 1% of cases. Our results do not support delaying urgent central venous catheter use pending chest x-ray completion in critically ill children. PMID: 32997852 [PubMed - as supplied by publisher]
Conclusion: This study is the first to tackle the extent of use and the hurdles to PoCUS adoption in Lebanese emergency medicine practice, using ETUDE. The findings from this study can be used in Lebanon to strengthen PoCUS use in the future.
Rationale: Because central venous catheters (CVCs) are placed at the great vessels, mechanical complications can be fatal. Using the landmark method alone can make CVC difficult to access, depending on the skill of the operator and various patient conditions, such as anatomical variations of the vessels, young age, hypovolemic state, obesity, and short neck. Therefore, ultrasound (US)-guided techniques, including visualization of the vein and needle in the lumen of the vessel, are recommended. Nevertheless, our experience demonstrated that CVC malposition or vascular penetration cannot be prevented completely, even with ...
We present a case utilizing contrast-enhanced ultrasound (CEUS) at the bedside to assess catheter integrity in a critically ill infant with a large intra-abdominal fluid collection. CEUS demonstrated extravasation into the collection, confirming catheter fracture and prompting immediate cessation of line use and recommendation for exchange. This case shows the utility of CEUS to evaluate central venous access devices in children who are unable to travel to interventional radiology for a standard contrast injection.
Commercial central line vascular access trainers are available but have significant limitations including cost, size, and limited durability when used for the complete procedure. A unique central venous access trainer was constructed using silicone loaf pan, ballistic gel, copper pipe and aluminum rods as vessels conduits, with varying inserts including latex and silicone to simulate different vascular structures, and the use of camouflage. This trainer is inexpensive, portable, reusable, allows the complete procedure to be simulated, and may be customized to the specific needs of the learner. The assembled simulator demon...
Authors: Wang M, Xu L, Feng Y, Gong S Abstract For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described. PMID: 32787623 [PubMed - as supplied by publisher]
We report a case in which a right internal jugular CVC was inserted under ultrasound guidance and was found to be malpositioned after sternotomy into an anomalous posterior thymic vein. Therefore, we recommend confirming the correct position of CVC with transesophageal echocardiography if such is indicated for the perioperative period and emphasize the importance of a correct J-tip of the guidewire when placing a CVC.
CONCLUSION: The brachio-cephalic vein can be safely catheterized in preterm newborns requiring intensive care after appropriate training. PMID: 32648811 [PubMed - as supplied by publisher]