Anatomical variation in the internal jugular vein:potential risk factors for central venous catheterization-a case report

Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.

How to manage the malposition of deep vein catheterization into the artery?

Central venous catheterization establishes temporary,efficient,and rapid use of deep venous access in patients,which provides high flow rate fluid perfusion,enables measurement of central venous pressure,and acts as an important reference for clinical decision-making.However,various complications such as pneumothorax,hemothorax,hematoma,and puncture failure can easily occur during the puncture and catheterization process.

Analysis of the Nursing Effect of Hierarchical Extended Nursing Based on The Guidance of Orem’s Theory in Patients with PICC Catheterization

Objective:To analyze the nursing effect of hierarchical extended nursing based on the guidance of Orem’s theory in patients with peripherally inserted central(PICC)catheterization.Methods:Ninety-one patients with PICC catheterization admitted to the hospital from May 2021 to May 2023 were selected and divided into a control group and an observation group,with 45 and 46 cases,respectively.The control group received routine nursing care,while the observation group received routine nursing care combined with hierarchical extended nursing based on the guidance of Orem’s theory for 3 months.Relevant indicators between the two groups were compared.Results:The improvement degree of various indicators in the observation group after nursing was better than that of the control group(P<0.05).Conclusion:Graded extended nursing based on the guidance of Orem’s theory improved the knowledge,belief,behavior,and self-efficacy of patients with PICC catheterization,and relieved their anxiety,depression,and other negative emotions.The nursing effect was deemed to be significant.

The Impact of Patient Education on the Nursing Care of Perioperative Patients in the Interventional Catheterization Room

Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified;62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.

Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Median neuropathy after multiple punctures of the forearm for catheterization:A case report

BACKGROUND Neuropathy may occur at some sites after catheterization for close examination of cardiac disease.Although the radial artery is considered a relatively uncomplicated site for catheterization,the radial artery and median nerve are in relatively close proximity,with the risk of median nerve injury depending on the angle of puncture.The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.CASE SUMMARY A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm.Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site.Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials.Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers.Median nerve injury and associated flexor tendon adhesion was diagnosed,and the patient was referred for surgery at 3 mo after injury.When the same area was opened,no injury to the median nerve epithelium was obvious,but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers.The surgery was terminated with adequate adhesion release.Rehabilitation was initiated postoperatively,improving neurological symptoms and range of motion of the fingers.Six months after surgery,the patient returned to daily activities without discomfort.CONCLUSION This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Iatrogenic bladder neck rupture due to traumatic urethral catheterization: A case report

BACKGROUND In this article,we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient.CASE SUMMARY The patient,who had a urethral catheter inserted in the palliative service 3 d ago,was consulted because the catheter did not work.Because the fluid given to the bladder could not be recovered,computed tomography was performed,which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area.The appearance of the anterior urethra and verumontanum was normal at cystoscopy.However,extremely severe stenosis of the bladder neck,and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed.Internal urethrotomy was applied to the bladder neck with a urethrotome.An urethral catheter was sent over the guide wire into the bladder.The patient was followed in the palliative care service and the catheter was removed 7 d later.No extravasation was observed in the control urethrography.CONCLUSION Although catheter insertion is a simple and frequently performed procedure in hospitalized patients,it is necessary to avoid unnecessary extra-indication catheter insertion.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

Development and validation of a risk prediction model for repeated indwelling urinary catheterization in patients with cervical cancer after surgery

Objective:To study the factors influencing secondary indwelling catheterisation after cervical cancer surgery and to develop a predictive risk model.Methods:A total of 260 patients in a tertiary hospital in Chongqing were selected from January 2020 to December 2021 via convenience sampling.Relevant information of patients was recorded,including age;body mass index;history of hypertension and diabetes,bladder dysfunction,postoperative urinary retention,and postoperative urinary tract infection;Histology;staging;surgical approach;Operation time;Time of first remove of catheter;indwelling catheter days;Hospitalization days.Least absolute shrinkage and selection operator was used to reduce dimensionality and select patient characteristics,and multivariate analysis was performed based on the selected variables.Based on the outcome of analysis,a line chart model was developed for predicting the risk of secondary catheterization in patients with indwelling catheterization after radical cervical cancer surgery.The coefficient of conformity index(C-index)and calibration curves were used to evaluate the accuracy and fit.The model was internally validated via bootstrapping(1000 random samples),and the clinical utility of the model was assessed via decision curve analysis(DCA).Results:Four characteristic variables were selected,including preoperative bladder function,postoperative urinary tract infection,surgical approach,and Time of first remove of catheter.They are independent risk factors affecting urinary tract.The risk prediction model exhibited good discrimination performance with a C-index of 0.722(95%CI,0.661-0.783)and was well calibrated.The C-index was 0.708 in internal validation analysis.DCA showed that the risk model was clinically useful for predicting secondary catheterization,and clinical benefits were observed at the decision threshold of≥11%.Conclusion:A novel model was developed to predict the risk of secondary catheterization.The model was based on preoperative bladder dysfunction,postoperative urinary tract infection,surgical approach,and number of days since the removal of the primary catheter.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

The Application Value of Swan-Neck Microcatheter in Peripheral Vascular Interventional Therapy

Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intubation can not only significantly improve the efficacy of peripheral intervention treatment, but also greatly reduce surgical complications. However, during the treatment of peripheral vascular intervention (such as liver tumor arterial chemotherapy embolism, hemoptysis bronchial arterial embolism, gastrointestinal hemorrhagic gastrointestinal arterial embolism, etc.), vascular mutation is often large, and there are many branches, and the direction of blood flow is into the direction of blood flow, the horns are even reverse, and even the use of straight-headed microstructures will have difficulty interpolation difficulties or even failure, which increases the risk of surgery and affects safety treatment. To overcome this, pre-plasticized microcatheters have emerged, among which the InstantPass Swan-Neck Microstructure is a catheter with a head-end morphology similar to Cobra. Our research aims to explore the feasibility, safety, and technical advantages of the use of swan-neck microcatheter in peripheral vascular hyperboloid intubation. Materials and Methods: From January 2023 to March 2024, 31 patients with swan-neck microstructure were used in the peripheral vascular intervention therapy outside the hospital. Among them, there were 23 men and 8 women, aged 32 - 81 years old, an average (55 ± 13) years, and the average irradiation time was 35.1 ± 24.7 minutes. 10 cases of iodide oil arterial chemotherapy embolism, 7 cases of microspheres of hepatic arteries, 3 cases of gastric duodenal artery selective embolism, 3 cases of vein embolism with esophageal stomach, and 2 cases of sperm varicose vein embolism, 2 cases of selective embolism of the intestinal membrane, 2 cases of uterine arteries embolism, and 2 cases of renal arterial embolism. 11 of these patients switched to the swan-neck microstructure after using the straight-headed microstructure super-selective intubation. To analyze whether the swan-neck microcatheter is successfully transported to the target location, whether it can provide a satisfactory path for subsequent intravascular treatment, evaluate the surgery instant image results and complications related to the microstructure during the surgery period, analyze the angle of the target blood vessels and the main blood vessels, the target blood vessels, the target blood vessels, the relationship between the degree of pedestrian and the success rate of ultra-selective intubation, and summarize the indication of the application of the swan-neck microstructure in peripheral intervention therapy. Results: In this study, 31 patients used 31 swan-neck microcatheters, of which 22 (70.9%) target vascular and main blood vessels were ≤90˚;17 patients (54.8%) patients were curved and angulated;11 cases (35.5%) were after the failure of the superselective intubation of the straight-headed microstructure, the swan-neck microcatheter was successful after the failure;1 case (3.2%) patients with microstructure-related mezzanine occurred during surgery, and the complication rate of the perioperative ductation was 3.2%. All target lesions are finally successfully completed, and the success rate of surgical technology is 100%. Conclusion: Swan-neck microcatheters have a high success rate in superselective cannulation of peripheral blood vessels and perform well in vascular tortuosity and angulated lesions.

Unique method for removal of knotted lumbar epidural catheter: A case report

BACKGROUND Combined spinal-epidural(CSE)anesthesia is the preferred anesthesia method for cesarean delivery.The use of an epidural catheter is essential for administering additional drugs intraoperatively and managing postoperative pain.However,the insertion of epidural catheters is associated with various complications,such as total spinal anesthesia,symptoms indicative of spinal nerve root irritation,and challenges in epidural catheter removal.CASE SUMMARY We present a case report of a challenging epidural catheter removal due to knotting.The lumbar computed tomography scan results revealed that the catheter formed a tight knot in the epidural space.We used a novel extubation method and successfully removed the catheter.CONCLUSION The operator can use opposite forces to"spiral"apart the spinal joints by positioning the patient's body in a specific position.The findings indicate that,when combined with imaging examination results,this method is effective for the removal of epidural catheters.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Assessment of Physicians’ Knowledge of Clean Intermittent Urinary Self-Catheterization in an African Country: The Case of Senegal

Introduction: Clean intermittent self-catheterization is the gold standard for the management of urinary retention. But its use remains limited in our practice. Objective: We are conducting this study to assess physicians’ knowledge of its practice in order to promote its promotion. Material and Methods: We conducted a cross-sectional, prospective, descriptive and analytical study in two hospitals in Dakar for two months. The resident doctors were interviewed on the basis of a questionnaire developed based on the recommendations of the French Society of Physical Medicine and Rehabilitation (SOFMER). Results: 54 medical residents returned the questionnaire. 63% of physicians surveyed defined the clean intermittent self-catheterization as a sterile intermittent self-catheterization. 70.9% of the doctors surveyed had cited urinary retention as an indication for the clean intermittent self-catheterization;53.7% advocated sterile gloves for the catheterization;29.6% proposed a frequency of one to two times and 2 to 4 catheterizations per day. 70.4% of doctors recommended indicating Cytobacteriological examination of urine in case of symptoms of urinary tract infection. Antibiotic therapy from the outset was offered by 83.3% of doctors in case of symptoms of urinary tract infection under intermittent self-sounding. 59.3% were unaware of clean intermittent self-catheterization. Discussion and Conclusion: Apart from the indica-tions, the clean intermittent self-catheterization remains unknown by res-ident doctors and its practice remains to be mastered, hence the need to establish a course on its practice at the faculty of medicine.

Knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter

Objectives:The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter.Materials and Methods:This cross-sectional study was conducted from June 1,2021,to September 11,2021,in a tertiary hospital in north India.Purposive sampling was used to select 50 participants.Three instruments were employed for data collection after fulfilling sample criteria;for baseline information demographic tool,knowledge questionnaires,and a practice checklist.Data were analyzed using descriptive and inferential statistics.Results:On assessment of 50 participants,the majority of parents aged above 30 years(74%).Most of the participants were male(82%),graduated(38%),and working in the private sector(58%).Similarly,two-thirds of participants were residing in a nuclear family(64%)with a single child 32(64%)and family income<5000 rupees per month(60%).The mean score of knowledge was 1.94±0.81 and that of practice skills was 1.98±0.85 on home-based care.Regression analysis showed that knowledge of parents was significantly associated with qualification(β:1.821,P=0.002).Similarly,association of practice skills of parents with gender(β:1.235,P=0.050)and qualification(β:1.889,P=0.00)was significant.Conclusion:The general findings of our study showed that parents’education and occupation played a significant role in a child’s care.Parental education and catheter care skills positively affect the child and reduce readmission rates.

New application of intestinal obstruction catheter in enterocutaneous fistula:A case report

BACKGROUND Enterocutaneous fistula(ECF)is an abnormal connection between the gastrointestinal tract and the skin.ECF can lead to massive body fluid loss,hypercatabolism,and malnutrition.Therefore,nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas.For nutritional support,enteral nutrition(EN)is the preferred method when gastrointestinal function is recovering.Currently,various EN approaches have been applied for different anatomical positions of the ECF.However,the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement.CASE SUMMARY We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection.Six days after the surgery,the patient presented with fever,fatigue,severe upper abdominal pain,and septic shock.Subsequently,lower ECFs were diagnosed through laboratory and imaging examinations.In addition to symptomatic treatment for homeostasis,total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine.After that,we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube.Ultimately,the patient could receive optimal EN support via the catheter,and no complications were found during the treatment.CONCLUSION Nutritional support is a crucial element in ECF management,and intestinal obstruction catheters could be used for early EN administration.