3차원 다중 채널 흉부 전산화 단층 촬영술을 이용한 중심정맥관 삽입의 적절한 길이

홍기정,신중호,박현수,김성춘,서길준,이중의 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.5

Purpose: Knowing the optimal length of central venous catheterization is important in order to prevent complications provoked by inappropriate placement of the tip of central venous catheter. We evaluated the optimal lengths of central venous catheterization using 3-Dimensional Multi- Detector Row Computed Tomography (MDCT). Methods: Between May 2005 and September 2005, we prospectively enrolled 122 consecutive patients who underwent elective chest MDCT. We reconstructed 3-dimensional MDCT images of the right internal jugular vein, right subclavian vein, left internal jugular vein, left subclavian vein and the superior vena cava/right atrium (SVC/RA) junction. In 3-dimensional images, we measured the distance from the puncture site of catheterization to the SVC/RA junction. In addition, we analyzed the correlation of the length of central vein to demographic findings, including patients’ height, weight, body mass index, and body surface area (BSA). By regression modeling, we derived formulas to calculate the optimal lengths for central venous catheterization. Results: The optimal lengths of central venous catheterization via the right internal jugular vein, right subclavian vein, left internal jugular vein, and left subclavian vein were 12.9 ±1.5 cm, 14.0±1.5 cm, 15.9±1.9 cm, and 17.9±1.4 cm, respectively. The optimal length of right subclavian catheterization correlated significantly with body weight and BSA (p<0.01). The optimal length of left internal jugular approach correlated well with height (p<0.01), body weight, BMI, and BSA (p<0.005). Conclusion: The optimal lengths of central venous catheter were measured by 3-dimensional MDCT and correlated with demographic findings. By regression modeling, we developed formulas to predict the optimal length of central venous catheterization using based on demographic findings.

한국인에 적절한 우측쇄골하 정맥도관 삽입 길이 및 도관 위치 평가를 위한 심초음파의 유용성

오성범,김현,김호중,김경진,이강현,황성오,안희철 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.4

P u r p o s e: We evaluated the proper length of a central venous catheter (CVC) during subclavian vein catheterization and the usefulness of transthoracic echocardiography in identifying the position of the CVC. M e t h o d s: From August 2002 to September 2002, we studied prospectively 30 consecutive patients who had a CVC inserted. The right subclavian vein was punctured by using the Seldinger method, and the patients were divided into two groups according to the method used to identify the position of the central venous catheter. In the radiology group, after central venous catheterization, we identified the position of the CVC by using a plain chest X-ray; then, we adjusted the length of the catheter. In the echocardiography group, during central venous catheterization, we inserted it deeply enough to observe the tip of the catheter in the right atrium by using echocardiography; then, we withdrew the catheter slowly until it was no longer observed in the right atrium, and we fixed the catheter at that position. We measured the heights, weights, and chest circumferences of the patients. R e s u l t: The maximal lengths of CVCs were 15.9±2.0 cm in the radiology group and 15.9±1.7 cm in the echocardiography group. There was no difference between the two groups (p=0.98). The maximal length of the CVC correlated to the height of the patient (Y=0.154X-9.8: Y=the length of the CVC, X=height, p<0.001, R2=0.394) and to the weight of the patient (Y=0.076X+11.2: Y = the length of the CVC, X=weight, p=0.042, R2=0.140), but not to the chest circumference (p= 0 . 3 7 1 ) . C o n c l u s i o n: Echocardiography was a useful method in identifying the optimal positioning in central venous catheterization. The maximal length of the CVCs was 15.9 ±1.9 cm via the subclavian vein approach in Koreans and correlated to the height of the patients.

중심정맥관의 동맥 내 거치: 증례보고

오승영 ( Seung Young Oh ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger’s method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter. [ J Trauma Inj 2015; 28: 292-294 ]

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients

( Dong Yeon Ryu ),( Sang Bong Lee ),( Gil Whan Kim ),( Jae Hun Kim ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.3

Purpose: To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods: From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results: During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter- days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions: The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

소아에서 말초정맥을 이용한 중심정맥로 확보법

한석주,최승훈,황의호,Han, Seck-Joo,Choi, Seung-Hoon,Hwang, Eui-Ho 대한소아외과학회 1995 소아외과 Vol.1 No.1

Percutaneous infraclavicular subclavian catheterization has been widely used for a total parenteral nutrition, hemodynamic monitoring and for venous access in difficult clinical situations. Many authors have claimed the infraclavicular cannulation of the subclavian vein in the tiniest infants can be performed with safety and ease, but there are always possibility of serious complications in this method. We present our experiences of peripheral venous cutdown with Broviac catheter. Author routinely introduced Broviac catheter into central vein via peripheral venous cutdown. There was no life threatening complications and no catheter related death. The complication rate was very low. The catheter related sepsis was documented in only two patient(4.7%). The average catheter longivity was 19.59 days. In view of the safety and low rate of complication, we think that peripheral venous cutdown with Broviac catheter should be the method of choice when central venous access is necessary in infants. The infraclavicular subclavian catheterization should be reserved in infants with few accessible peripheral vein.

왼쪽 빗장밑정맥을 이용한 중심정맥도관술에서 중심정맥도관의 위치이상의 빈도와 숙련도와의 관계

이동준,김문철 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.1

Background:Malposition of a central venous catheter may cause several complications such as poor function of the catheter or cardiac tamponade. This study was designed to determine the incidence of malposition after subclavian venous catheterization at the university hospital. Methods:We prospectively examined catheter locations from 367 subclavian vein catheterizations by an infraclavicular approach using postoperative chest X-rays to analyze the rate of catheter malposition. Results:Primary misplacement was observed in 29 cases (7.9%). Seventeen cases were located in the right internal jugular vein, 8 cases (2.2%) were located in the left subclavian vein, 2 cases (0.5%) were located inside the right atrium, 1 catheter (0.3%) was kinking in the right subclavian vein and 1 catheter (0.3%) was located in the right brachiocephalic vein. Conclusions:Using the infraclavicular approach for subclavian catheterization, a central venous catheter was most commonly misplaced in the ipsilateral internal jugular vein. Operators must keep in mind that even experienced practitioners may cause a considerable number of malpositions and it is very important to check the chest X-ray to locate the catheter malposition after central venous catheterization. (Anesth Pain Med 2011; 6: 45∼49)

쇄골하정맥을 통하여 중심정맥도관 삽입 실패 후 나타난 혈흉 1예

김대영,김대우,손희원,박상진,이덕희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Central venous catheterization via an internal jugular vein or subclavian vein has become a common procedure in monitonng CVP and managing severely ill patients. However, there have beennumerous reports of complications associated with central venous catheterization. These include vessel injury, pneumothorax, hemothorax, nerve injury, arrhythmias, artriovenous thrombosis, pulmonary embolism, and infection at the insertion site. We report a case of hemothorax after subclavian vein catheterization failure, along with successful treatment.

이달의 X-선 : 중심정맥카테터 삽입의 이상위치로 발생한 편측성 흉수 1례

김재석 ( Jae Seok Kim ),김상하 ( Sang Ha Kim ),이낙원 ( Nak Won Lee ),권우철 ( Woo Cheol Kwon ),최훈 ( Hun Choi ),변종원 ( Jong Won Beon ),홍태원 ( Tae Won Hong ),신계철 ( Kye Chul Shin ),용석중 ( Suk Joong Yong ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.6

중심정맥카테터 삽입 후 생길 수 있는 드문 합병증 중에 하나인 흉수 발생은 카테터와 관련된 혈관벽의 손상을 흉수 발생의 기전으로 설명하고 있다. 저자들은 우측 쇄골하정맥으로 이어지는 이상혈관 내로 카테터가 위치한 후 혈관 파열로 인하여 발생한 흉수 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication. (Tuberc Respir Dis 2006; 60: 690-693)

Central Venous Catheter-Related Hydrothorax

Se Hun Kim,Charles Her 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.4

This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

Central venous catheter-related superior vena cava syndrome following renal transplantation -A case report-

서미숙,신원정,전인구 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.6

A 55-year-old man with end-stage renal disease had severe left ventricular dysfunction and a history of deep vein thrombosis. He underwent renal transplantation, during which a central venous catheter was inserted into the right jugular vein. The central venous pressure (CVP) exceeded 20 mmHg throughout the operation but there was no other adverse event. After surgery, although the left ventricular dysfunction improved, the CVP remained high. On postoperative day 10, the patient presented with cyanosis of the arms and redness of the face and was diagnosed with superior vena cava (SVC) syndrome, for which he underwent emergency thrombectomy and SVC reconstruction. The clinical course of this patient suggests that his end-stage renal disease-associated hypercoagulable state may have promoted thrombus formation. Moreover, placing the central venous catheter tip too deep may have encouraged thrombus formation. Repositioning the tip may have prevented this complication.