Document Detail


Percutaneous transfemoral repositioning of malpositioned central venous catheters.
MedLine Citation:
PMID:  7726009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Central venous catheters inserted by blind surgical placement may not advance into a satisfactory position and may require repositioning. Malpositioning via surgical insertion is common in patients in whom central venous catheters have previously been placed, as these patients are more likely to have central venous thrombosis and distortion of central venous anatomy. This is less of a problem when catheter placement is guided by imaging; however, even when insertion is satisfactory, central venous catheters may become displaced spontaneously after insertion (Fig. 1). Repositioning can be effected by direct manipulation using guidewires or tip-deflecting wires [1, 2], by manipulation via a transfemoral venous approach [3-5], and by injection of contrast material or saline [6]. Limitations of the direct approach include (1) the number and type of maneuvers that can be performed to effect repositioning when anatomy is distorted, (2) difficulty in accessing the catheter, and (3) the risk of introducing infection. Moreover, these patients are often immunosuppressed, and there is a risk of introducing infection by exposing and directly manipulating the venous catheter. Vigorous injection of contrast material or saline may be unsuccessful for the same reasons: It seldom exerts sufficient force to reposition large-caliber central venous catheters and may cause vessel damage or rupture if injection is made into a small or thrombosed vessel. We illustrate several alternative methods for catheter repositioning via a transfemoral venous approach.
Authors:
G G Hartnell; M Roizental
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  164     ISSN:  0361-803X     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  1995 Apr 
Date Detail:
Created Date:  1995-05-19     Completed Date:  1995-05-19     Revised Date:  2008-02-15    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1003-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Radiological Sciences, Deaconess Hospital, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Catheterization, Central Venous / adverse effects,  methods*
Catheterization, Peripheral
Female
Humans
Male
Middle Aged
Punctures
Radiography, Interventional*
Radiography, Thoracic
Comments/Corrections
Comment In:
AJR Am J Roentgenol. 1996 Jun;166(6):1496   [PMID:  8633476 ]

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