Comments on Clinical Cases and Images: Complications of Central Line Placement: Pneumotho...

What are the long term adverse effects(real or pot...

2010-02-11T16:36:12.380-05:00

What are the long term adverse effects(real or potential) of a retained guide wire following the placement of a central IV line in the right internal jugular -- i.e., assume a fully intact guide wire (approx. 24 inches in length) was lost down the internal jugular vein such that today it resides fully intact inside the inferior venacava down into the right bifurcation of the femoral vein. Also, that the guide wire has been lodged inside the inferior vena cava (from heart to bifurcation level) for almost 9 years, and, presumed to be fibrosed along the intima of the vena cava.

Is there a chance(s)(i.e., any risk or level of adversity)that after 9 years the retained guide wire can (nevertheless) still puncture the vena cava, breakdown and small physical parts migrate into the heart, or cause a stroke from pieces of fibrin surrounding the guide wire breaking free and migrating up into the vascular of the brain, etc., etc.

Any comments or suggestions regarding potential and/or future complications or risks directly associated from a retained intravenous central line guide wire appreciated.

"what exactly is the damage that will happen placi...

2009-11-23T22:25:02.128-05:00

"what exactly is the damage that will happen placing this arterially and infusing meds?"

It depends on the medications. See a few examples:

http://www.ncbi.nlm.nih.gov/pubmed/9350405

http://www.ncbi.nlm.nih.gov/pubmed/10726331

http://www.mayoclinicproceedings.com/content/80/6/783.refs

Re: "what exactly is the damage that will happen p...

2009-11-23T22:23:32.399-05:00

Re: "what exactly is the damage that will happen placing this arterially and infusing meds?"

It depends on the medications. See a few examples:

http://www.ncbi.nlm.nih.gov/pubmed/10726331

http://www.ncbi.nlm.nih.gov/pubmed/9350405

http://www.mayoclinicproceedings.com/content/80/6/783.refs

We had a MD place a central line on my patient and...

2009-11-23T22:18:07.785-05:00

We had a MD place a central line on my patient and it was arterial. The nurse had medications running for several hours until she realized it was arterial. Of course I understand this is the wrong placement, but what exactly is the damage that will happen placing this arterially and infusing meds?

"IF a patient is to receive a central line and the...

2009-11-16T15:08:16.576-05:00

"IF a patient is to receive a central line and they are on either LOvenox or blood thinners, and are at any risks of having bleeding problems, which would be the better optimal placement, subclavian, internal jugular or femoral?"

Femoral placement is preferred because one can compress the vein and stop the bleeding. You cannot compress the subclavian vein. Compression of the IJ is impractical and dangerous because of the juxtaposition to carotid artery.

"Especially with there being more infection risks with the IJ or femoral."

The IJ infection risk should not be much higher than subclavian.

If someone can answer this question for me. IF a p...

2009-11-16T14:21:44.313-05:00

If someone can answer this question for me. IF a patient is to receive a central line and they are on either LOvenox or blood thinners, and are at any risks of having bleeding problems, which would be the better optimal placement, subclavian, internal jugular or femoral?
Especially with there being more infection risks with the IJ or femoral.
Thanks

Thank you. I agree that significant complications ...

2009-11-03T13:03:39.838-05:00

Thank you.
I agree that significant complications (PTX) of the central line placement are quite rare. I am using US guidance in my practice. Interesting paper in the August issue of Critical Care Medicine - "An unseen danger: Frequency of posterior wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance." indicates that even using US you are still not "immune" from complications.

Ralph, Complications with central line placement ...

2009-11-02T15:24:21.245-05:00

Ralph,

Complications with central line placement are not uncommon. Placement with U/S guidance is one approach to decrease them:

http://clinicalcases.org/2009/03/central-line-placement-with-ultrasound.html

There was an interesting paper published in Critic...

2009-11-02T15:15:24.641-05:00

There was an interesting paper published in Critical Care just month or two ago about central lines. Apparently, the complications happen more often than we think.
I have a blog post dedicated to this issue, if you are interested:
http://realicu.com/content/complications-central-venous-line-placement-%E2%80%93-happens-more-often-we-think

"what's the best & inital step to do if during cen...

2009-04-11T11:57:00.000-04:00

"what's the best & inital step to do if during central line placement, there is a obvious subcutneous emphysema"

A: Remove the line.

"How about if subcutaneous emphysema occurs post placement?"

A: Examine the line on CXR, physically, and flush it. If operating properly, you can leave it in place. Monitor the size of the subcut. emphysema several times a day until resolution.

what's the best & inital step to do if during cent...

2009-04-11T11:51:00.000-04:00

what's the best & inital step to do if during central line placement, there is a obvious subcutneous emphysema.How about if subcutaneous emphysema occurs post placement?

"Damage to the ulnar and radial nerves" are unlike...

2009-03-09T16:03:00.000-04:00

"Damage to the ulnar and radial nerves" are unlikely to happen due to placement of a central line because the anatomical location is totally different. A damage to the brachial plexus (which contains the roots for the ulnar and radial nerves) can occur but it is very rare. I hope this answers your question.

Anyone know of damage to the ulnar and radial nerv...

2009-03-09T12:09:00.000-04:00

Anyone know of damage to the ulnar and radial nerves in addition to pnemohemothorax.

My sister had a central line inserted last week an...

2009-02-03T02:22:00.000-05:00

My sister had a central line inserted last week and they punctured her lung (they went in blind), her lung collapsed and now they have a tube to inflate it. The first time they put it in, it collapsed again, when they did any xray, they found the tube had fallen out, so they reinserted the tube and inflated the lung again. It's been 3 days now and they say the puncture is not healing and she may have gotten pneumonia now. She originally went in for a blocked intestine, which ended up clearing with the liquid they gave her during the cat scan. They put the central line in, because they were going to do surgery.

what do we do for a hematoma in femoral central li...

2008-11-23T23:24:00.000-05:00

what do we do for a hematoma in femoral central line, do we have to remove the line and start another one , though this line was patent.patient's pt was 3 min and inr 15 .when do we remove the faulty line.

Last month I unfortunetely experienced a left pnem...

2008-09-21T10:57:00.000-04:00

Last month I unfortunetely experienced a left pnemohemothorax after an ER physician was placing a subclavian central line and the guidewire accidently punctured my left mammary artery. I immediately knew something was wrong with severe chest pain and shortness of breath. I was on anticoagulants at the time and bled profusely into my mediastinum and then into my left pleural cavity. My systolic pressure was down into the 60's and I was life flighted to the closest trauma center 200 miles away. I ended up losing 4 liters of blood through the chest tube and was very lucky to survive. I was doing research on the internet about this complication and was surprised to see it does happen quite often. The ER physician was doing a blind approach instead of using ultrasound. I think it would of been prevented if he was using ultrasound or fluoro. But nothing I can do know. I guess just lucky to be alive. Thanks.

i have personally seen two cases of delayed pneumo...

2007-11-24T21:59:00.000-05:00

i have personally seen two cases of delayed pneumothorax from subclavian central line placement. Even though CDC recommends subclavian as the site of choice, I find that with the new ultrasound equipment, sonosite and such... its much easier to go to IJ and avoid complications.

Amazing examples of complications of central lines...

2005-12-29T01:18:00.000-05:00

Amazing examples of complications of central lines placement.
Nice job.