DOI QR코드

DOI QR Code

Sternal Retraction and Subclavian Vein Catheter Occlusion during Cardiac Surgery

  • Tarbiat, Masoud (Department of Anesthesiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences) ;
  • Bakhshaei, Mohammad Hossein (Department of Anesthesiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences) ;
  • Derakhshanfar, Amir (Department of Surgery, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences) ;
  • Rezaei, Mahmoud (Department of Anesthesiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences) ;
  • Ghorbanpoor, Manoochehr (Department of Surgery, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences) ;
  • Zolhavarieh, Seyed Mohammad (Department of Anesthesiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences)
  • Received : 2021.05.11
  • Accepted : 2021.07.16
  • Published : 2021.10.05

Abstract

Background: Subclavian vein (SV) catheterization is a method for the delivery of fluids, drugs, and blood products, venous blood sampling, and central vein pressure monitoring in cardiac surgery. Catheter occlusion is a serious complication of SV catheterization during cardiac surgery, especially after sternal retractor expansion. Methods: In this observational study, 303 patients who had successful right infraclavicular SV catheterization from September 2019 to April 2020 were enrolled to determine the incidence of catheter occlusion. After catheterization, the lumens of all catheters were checked for the ability to infuse and withdraw blood from the catheter before and after sternal retractor expansion. The patients' characteristics, cannulation approach, on-pump or off-pump technique, occlusion of the catheter and its lumens, and any associated complications were recorded. The data were analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA). Results: Of the 303 patients studied, 205 were male (67.7%) and 98 were female (32.3%). Catheter occlusion occurred in 11 patients with on-pump cardiopulmonary bypass (CPB) (227 patients) and 4 patients with off-pump CPB (76 patients) (p=0.863). The incidence of catheter occlusion was 4.95% (15 of 303 patients) with no cases of simultaneous 3-lumen occlusion in a catheter. The most commonly occluded lumen was the distal lumen (57.92%). Simultaneous 2-lumen occlusion occurred in 4 patients. Catheter occlusion was found in 3 of 13 malpositioned catheters (23.07%). Conclusion: The current study showed that malpositioning of the catheter tip was a risk factor for catheter occlusion and that the distal lumen of a triple-lumen catheter was the most commonly occluded lumen.

Keywords

Acknowledgement

The authors gratefully acknowledge the Research Vice Chancellor of Hamadan University of Medical Sciences for the material and support for this study and also gratefully thank Dr. Roohi Jamal (Fatemeh) Chakoosari for reviewing and editing this manuscript.

References

  1. Leal MLM, Loyola ABAT, Hueb AC, et al. Fixation of the short-term central venous catheter: a comparison of two techniques. Acta Cir Bras 2017;32:680-90. https://doi.org/10.1590/s0102-865020170080000010
  2. Uemura K, Inoue S, Kawaguchi M. The unnecessary application of central venous catheterization in surgical patients. Braz J Anesthesiol 2018;68:336-43. https://doi.org/10.1016/j.bjan.2018.01.006
  3. Tarbiat M, Davoudi M, Salimbahrami SA. Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery. J Cardiovasc Thorac Res 2018;10:192-6. https://doi.org/10.15171/jcvtr.2018.33
  4. Kocum A, Sener M, Caliskan E, Bozdogan N, Atalay H, Aribogan A. An alternative central venous route for cardiac surgery: supraclavicular subclavian vein catheterization. J Cardiothorac Vasc Anesth 2011;25:1018-23. https://doi.org/10.1053/j.jvca.2011.02.006
  5. Tarbiat M, Farhanchi A, Davoudi M, Farhadian M. Supraclavicular versus infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery. Res Cardiovasc Med 2018;7:5-9. https://doi.org/10.4103/rcm.rcm_26_17
  6. Czarnik T, Gawda R, Perkowski T, Weron R. Supraclavicular approach is an easy and safe method of subclavian vein catheterization even in mechanically ventilated patients: analysis of 370 attempts. Anesthesiology 2009;111:334-9. https://doi.org/10.1097/ALN.0b013e3181ac461f
  7. Tarbiat M, Salimbahrami SA, Khorshidi HR. Influence of cannulation point on infraclavicular subclavian vein catheterization: a clinical trial. Anesth Pain Med 2019;9:e92724.
  8. Tan BK, Hong SW, Huang MH, Lee ST. Anatomic basis of safe percutaneous subclavian venous catheterization. J Trauma 2000;48:82-6. https://doi.org/10.1097/00005373-200001000-00014
  9. Heffner AC, Androes MP. Placement of subclavian venous catheters [Internet]. Waltham (MA): UpToDate; 2019 [cited 2021 May 10]. Available from: https://www.uptodate.com/contents/placement-ofsubclavian-venous-catheters.
  10. Aziz N, Khan A, Iqbal J. Subclavian vein catheterization: supraclavicular versus infraclavicular approach. J Med Sci 2013;21:187-9.
  11. Tarbiat M, Manafi B, Davoudi M, Totonchi Z. Comparison of the complications between left side and right side subclavian vein catheter placement in patients undergoing coronary artery bypass graft surgery. J Cardiovasc Thorac Res 2014;6:147-51. https://doi.org/10.15171/jcvtr.2014.003
  12. Bannon MP, Heller SF, Rivera M. Anatomic considerations for central venous cannulation. Risk Manag Healthc Policy 2011;4:27-39. https://doi.org/10.2147/RMHP.S10383
  13. Cummings-Winfield C, Mushani-Kanji T. Restoring patency to central venous access devices. Clin J Oncol Nurs 2008;12:925-34. https://doi.org/10.1188/08.CJON.925-934
  14. Baskin JL, Reiss U, Wilimas JA, et al. Thrombolytic therapy for central venous catheter occlusion. Haematologica 2012;97:641-50. https://doi.org/10.3324/haematol.2011.050492
  15. Yoon KB, Kim WO, Cha JH, Lee KY. Malfunction due to kinking and banding of a double lumen central venous catheter: a case report. Korean J Crit Care Medicine 2006;21:131-4.
  16. Sofue K, Arai Y, Takeuchi Y, Sugimura K. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: evaluation of suspected system-related mechanical complications. Eur J Radiol 2013;82:e691-6.
  17. Baskin JL, Pui CH, Reiss U, et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet 2009;374:159-69. https://doi.org/10.1016/S0140-6736(09)60220-8
  18. Keum DY, Kim JB, Chae MC. Safety of a totally implantable central venous port system with percutaneous subclavian vein access. Korean J Thorac Cardiovasc Surg 2013;46:202-7. https://doi.org/10.5090/kjtcs.2013.46.3.202
  19. Mantia AM, Robinson JN, Lolley DM, Nieman HL, Berkebile PE, Stullken EH Jr. Sternal retraction and pulmonary artery catheter compromise. J Cardiothorac Anesth 1988;2:430-9. https://doi.org/10.1016/0888-6296(88)90222-0
  20. Hill J, Broadhurst D, Miller K, et al. Occlusion management guideline for central venous access devices (CVADs). Vasc Access 2013;7(Suppl 1):1-36.
  21. Thakur A, Kaur K, Lamba A, et al. Comparative evaluation of subclavian vein catheterisation using supraclavicular versus infraclavicular approach. Indian J Anaesth 2014;58:160-4. https://doi.org/10.4103/0019-5049.130818
  22. Raut MS, Maheshwari A. Undiagnosed kinking of advanced venous access. Glob Anesth Perioper Med 2016;2:178.
  23. Cho HB, Kim SH, Yoo JH, et al. Malfunction of a central venous multilumen access catheter caused by kinking: a case report. Medicine (Baltimore) 2018;97:e11622. https://doi.org/10.1097/MD.0000000000011622
  24. Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol 2011;14:217-24. https://doi.org/10.1053/j.tvir.2011.05.003
  25. Hayaran N, Goyal N, Joy S, Jain A. Coiling of central venous catheter: a rare and preventable complication. Anesth Essays Res 2017;11:773-5. https://doi.org/10.4103/aer.AER_47_17