• Journal of Yeungnam Medical Science
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• 제25권2호
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• pp.175-181
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• 2008

Central venous catheterization via an internal jugular vein or subclavian vein has become a common procedure in monitoring 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, arteriovenous thrombosis, pulmonary embolism, and infection at the insertion site. We report a case of hemothorax after subclavian vein catheterization failure, along with successful treatment.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.183-186
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• 2013

Septic internal jugular vein-sigmoid sinus thrombosis (IJV-SST) associated with a malpositioned central venous catheter is a rare condition. It is potentially life-threatening and necessitates early diagnosis and rapid administration of appropriate medications. Unfortunately, it is difficult to diagnose due to vague clinical presentations. Several studies such as CT, MRI, and cerebral angiography should be performed and carefully examined to help make the diagnosis. We report a case of septic IJV-SST due to a malpositioned central venous catheter.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.276-280
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• 2023

Fungal thrombophlebitis of the central vein is a rare, life-threatening disease associated with significant morbidity and mortality. It requires immediate central venous catheter removal and intravenous antifungal therapy, combined in some cases with either anticoagulation or aggressive surgical debridement. A 70-year-old male patient injured by a falling object weighing 1,000 kg was transferred to our hospital. A contained rupture of the abdominal aorta with retroperitoneal hematoma was treated with primary aortic repair, and a small bowel perforation with mesenteric laceration was treated with resection and anastomosis. After a computed tomography scan, the patient was diagnosed with thrombophlebitis of the left internal jugular vein and brachiocephalic vein. Despite antifungal treatment, fever and candidemia persisted. Therefore, emergency debridement and thrombectomy were performed. After the operation, the patient was treated with an oral antifungal agent and direct oral anticoagulants. During a 1-year follow-up, no signs of candidemia relapse were observed. There is no optimal timing of surgical treatment for relapsed fungal central thrombophlebitis. Surgical treatment should be considered for early recovery.

• Clinical and Experimental Pediatrics
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• 제45권9호
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• pp.1120-1125
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• 2002

목 적: 소아에서 장기간의 정맥유지, 고단위 영양 수액투여, 혈액채취, 중심정맥압 측정 등을 위해 중심 정맥 도관 삽입술을 시행하고 있다. 그런데 소아는 경부의 해부학적 구조의 구별이 어려워 중심정맥에 도관 삽입이 상당히 어렵고, 여러 가지 심각한 합병증을 초래할 수가 있다. 저자들은 소아에서 audible Doppler ultrasound(8 MHz)를 이용하여 쉽게 중심정맥을 확인하여 카테타를 삽입할 수 있는지 알아보고자 하였다. 방 법: 2001년 4월에서 7월까지 서울아산병원 소아과에 입원한 환아 중 중심정맥 삽입술을 시행한 46명을 대상으로 하였다. 휴대용, 8 MHz Doppler ultrasound device(Pocket-Dop II, iMex, USA)를 이용하여 중심정맥 삽입술을 시행하였고, 이들 환아에서 삽입술의 성공률과 천자시간, 천자횟수, 합병증 등을 조사하였다. 결 과 : 1) 대상 환아는 46례로 남아 20례, 여아 26례였고 평균연령은 3세(범위 1-156개월)였으며, 특히 영아는 18명이었으며 평균연령은 6.3개월이었다. 2) 중심정맥에 도관을 삽입한 가장 흔한 부위는 우측내경정맥(63%)이며, 다음으로 좌측내경정맥, 대퇴정맥, 쇄골하정맥 순이었다. 3) 중심정맥 도관 삽입술의 성공률은 96%(46례 중 44례)였으며, 소아는 96%였고, 영아는 94%였다. 4) 평균 천자시간은 5.2분이었고, 소아는 3.7분, 영아는 7.5분 소요되었다. 5) 46례 중 6례에서 합병증이 발생했으며, 혈종 4례, 동맥천자 1례, 기흉 1례 등이었다. 6) 1회 시도 성공률은 전체 환아는 59%였으며, 소아는 71%, 영아는 39%였다. 중심정맥 삽입 과거력이 없을 경우 전체 환아의 1회 시도 성공률은 70%였고, 있을 경우는 48%였다. 결 론 : 소아나 영아에서 휴대용, 8 MHz Doppler ultrasound device를 이용하여 쉽게 중심정맥의 위치를 확인하여 중심정맥 도관 삽입술의 성공률을 높이고, 심각한 합병증을 줄일 수 있어서, audible Doppler ultrasound를 이용하여 중심정맥 도관 삽입술을 시행하는 것이 유용할 것으로 생각한다.

• Advances in pediatric surgery
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• 제14권1호
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• pp.67-74
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• 2008

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

• Advances in pediatric surgery
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• 제4권1호
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• pp.1-15
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• 1998

To evaluate the effectiveness of central venous catheters(CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was placed by one pediatric surgeon for a total of 6, 116 patients days. Catheters were placed preoperatively for TPN or chemo in 223 cases. CVC was solely for TPN in 57 cases and for chemotherapy in 40. Local anesthesia was utilized in 71 cases, and the general anesthesia was administered in the remainder of the patients. The subclavian vein was catheterized(SCV) in 202 cases(82 infants and neonates), tunneled external jugular venotomy(EJV) was utilized in 38, tunneled internal jugular venotomy(UV) in 2, the facial venotomy(FV) was used in 3, and the umbilical vein was catheterized UVC) with vein transposition in 74 infants. In neonates, 72 UVCs were placed during laparotomy. SCV was increased with ages, from 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture(6), puncture failure(5) and abnormal location(12) in SCV; insertion failure(3) in EJV; abnormal location in the portal vein(4) and the liver parenchyma(2) cystic fluid accumulations in UVC. Twelve migrations(3.8 %) out of position occurred; SCV(2), EJV(1) and UVC(9). There were 4 cases(1.2 %) of catheter obstruction and 11(3.4 %) of catheter infection(3 SCV, 2 EJV and 6 UVC). Rescue procedures were utilized with some success. There was one mortality(0.3 %) due to deep sedation in a 1.06 kg baby during placement of an EJV. The surgeon's experience, proper catheter selection and following safety rules are the most important factors for successful CVCs.

• Advances in pediatric surgery
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• 제1권1호
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• pp.46-52
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• 1995

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.

• Journal of Chest Surgery
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• 제31권6호
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• pp.619-623
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• 1998

우측 팔의 부종과 압통을 주소로 내원한 51세 만성 신부전증 환자에서 정맥 촬영술의 결과 반복된 쇄골하정맥 도관삽관술후에 생긴 중심정맥(우쇄골하정맥, 우내경정맥, 우상완두정맥과 좌무명정맥)의 폐쇄증을 Goretex 인조혈관을 이용하여 우쇄골하정맥-상공정맥에 10 mm Goretex 인조혈관 우회로 조성술과 좌쇄골하정맥-10 mm Goretex 인조혈관사이에 8 mm Goretex 인조혈관 우회로 조성술을 실시하여 좋은 결과를 얻었다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.81-85
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• 2021

Central venous catheter (CVC) insertion is commonly used in the operating room and intensive care unit to monitor central venous pressure and secure an intravenous route to deliver medications and nutritional support that cannot be safely infused into peripheral veins. However, CVC insertion may be associated with serious complications such as arterial puncture, hematoma, pneumothorax, hemothorax, catheter infections, and thrombosis. Several methods have been recommended to prevent these complications. Here we report a case of massive hemothorax caused by attempts of CVC insertion into the internal jugular vein and subclavian vein in a patient with multiple trauma. CVC placement should be performed or supervised by an experienced physician to decrease the incidence of CVC-related complications. CVC insertion under ultrasound guidance is recommended.

• 한국광물학회지
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• 제31권2호
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• pp.87-101
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• 2018

만장광상은 옥천변성대 화전리층 내에 발달되었으며 열극충전형 동광체인 중앙 및 본광체와 철 스카른형 서부광체로 대분된다. 본 연구에서는 중앙 및 본광체에 대한 광상학적 연구를 수행하여 기존 서부광체 광화작용 특성과 비교하고자 한다. 중앙광체는 맥상조직이 두드러지며 자류철석과 황동석이 주를 이루는 반면, 본광체는 맥상, 괴상, 각력상 조직과 더불어 황철석, 유비철석, 황동석이 주로 산출된다. 이 밖에 섬아연석, 방연석, 자철석, 티탄철석, 금홍석, 석석, 철망간중석, 황석석 등이 수반된다. 스카른이 부분적으로 발달하며 석류석은 그로슐라 계열, 휘석은 헤덴버자이트 계열이 우세한 것으로 보아 대체로 환원환경에서 정출된 것으로 보인다. 중앙광체의 섬아연석-황석석과 본광체의 황철석-유비철석 광물공생군을 이용한 생성온도는 각각 $204-263^{\circ}C$, $383-415^{\circ}C$로서 중앙광체가 상대적으로 낮고, 황분압도 본광체에서 $10^{-6}-10^{-7}atm$로서 비교적 높고 중앙광체로 가면서 점차 감소한 것으로 보인다. 황화광물의 황동위원소조성은 중앙광체 4.6-7.9‰, 본광체 4.3-7.0‰로 상호 유사하며 주로 화성기원이지만 모암의 영향으로 약간 높게 나타난다. 광석광물의 종류와 조직 그리고 광화작용의 물리화학적 조건을 고려할 때 동광화작용이 발달한 본광체와 중앙광체는 잠두화성암에 대하여 각각 근지성과 원지성 광화작용의 특성을 나타낸 것으로 보이며, 스카른 철광상이 발달한 서부광체와는 서로 다른 열수계의 영향을 받아 생성된 것으로 여겨진다.