Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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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
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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.

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