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Venous Catheter Line Complications
hosted by Dr. Em Gootee & Dr. Todd Ponsky
Chapter 1 of 4 · Complications
Line request forms
Communication failures in line placement and institutional solutions
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Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
At Cleveland Clinic, a separate form must be filled out for any line placement specifying exactly what type of line and how many lumens are needed
The line request form includes who the attending responsible is and their contact number, allowing direct contact with the nephrology attending rather than the primary pediatric service
Cases will not be booked until the line request form is scanned into the patient's chart with a physical copy available
The line request form includes contact information for the resident and attending responsible for the patient at the bottom of the latest revision
The thoracoscopic SVC access technique can likely be repeated multiple times when needed
Most practitioners would use right internal jugular with ultrasound guidance for a 5-year-old needing a single-lumen cuffed CVL for ALL treatment
In tiny micropremies, cutdown approach is still used, but the jugular vein is punctured with a needle and catheter threaded through rather than ligating the vein, to preserve future access
Micropuncture needles are used as a technique for difficult access
When a subclavian catheter is malpositioned, the decision to retry at the same site depends on whether a large dilator was placed, which could cause hematoma
Fluoroscopy should be used before attempting contralateral access after a failed attempt to avoid having both a hemothorax on one side and pneumothorax on the other
Facial vein cutdowns were used as an access technique in the past
A 13-year-old with hemolytic uremic syndrome had a temporary dialysis catheter placed in the right IJ when nephrology actually wanted a peritoneal dialysis catheter, requiring return to OR 2 days later for the correct catheter
A 16-year-old with sickle cell disease on transfusion protocol had MRV showing both subclavian and both internal jugular veins clotted off with reconstitution of the superior vena cava via the azygous vein
Thoracoscopic-guided needle puncture of the superior vena cava can be performed by tracking along the mediastinum to where the SVC reconstitutes with the azygous vein, using a spinal needle which is longer than the needle in standard kits
A patient maintained thoracoscopic-placed SVC access for about 1-2 years before requiring repeat procedure using the same technique
Marcus Jarbo reported performing similar SVC access using IR with radiographic or ultrasound guidance rather than thoracoscopic guidance
In one case, the clot extended into the upper atrium requiring distal atrial access followed by balloon dilation of the clot to create a channel that would not immediately re-thrombose
Some practitioners are using ultrasound for subclavian access via a supraclavicular approach
The pneumothorax rate with ultrasound-guided supraclavicular subclavian approach is still higher than with internal jugular approach
There is mixed data about whether internal jugular access has a higher infection rate compared to subclavian, with older data suggesting higher IJ infection rates not consistently reproduced
There is not a substantial difference in intravascular complications between subclavian and internal jugular access sites
Sean Saint Peter's paper from Kansas City showed better outcomes using ultrasound guidance for internal jugular access
Percutaneous ultrasound-guided IJ access can be performed safely in newborns, not just older children
External jugular vein can be used as a primary access site when it is present and large
Getting to the junction of the external jugular and internal jugular is not as easy as it appears, with catheters potentially getting hung up, stuck, or going the wrong direction