Follow-up carotid ultrasound was unremarkable for arteriovenous (AV) fistula or pseudoaneurysm. Despite pressure waveform monitoring, erroneous placement was not noticed until a post-procedure chest was obtained. If there is uncertainty of the punctured vessel, a single lumen catheter can be placed over the guide wire and connected to a pressure transducer to assess for venous waveforms.Ĭhest X-ray demonstrating a pulmonary artery catheter inadvertently placed via the right carotid artery into the thoracic aorta. Use of ultrasound does not eliminate the risk of arterial puncture, and catheters can still be inadvertently placed into the arterial system. Multiple studies have demonstrated the benefit of using ultrasound to reduce vascular complications. Ultrasound is a widely available tool that can aid in proper catheter placement. Arterial injury occurs most commonly in femoral catheter placement and least commonly in subclavian placement. Arterial puncture occurs in 4.2–9.3% of line placements, and is often easily recognized secondary to pulsatile flow, but recognition may be difficult in a hypotensive and critically-ill patient. Ultrasound guidance has been shown to decrease risk of complication at all access sites.Īrterial injury occurs in less than 1% of catheter placements. The use of ultrasound and operator experience greatly influence the incidence of vascular complications. Vascular injuries that can occur during catheter placement include arterial injury, venous injury, bleeding, and hematoma. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice but most complications still center around vascular injury, infection, and misplacement. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Significant morbidity and mortality can result from complications related to central venous access. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Central venous access is a common procedure performed in many clinical settings for a variety of indications.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |