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Journal of Cardiothoracic Surgery Apr 2024The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right... (Review)
Review
BACKGROUND
The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter.
CASE PRESENTATION
A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications.
CONCLUSIONS
CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.
Topics: Female; Humans; Aged; Azygos Vein; Catheterization, Central Venous; Vena Cava, Superior; Central Venous Catheters; Mediastinum
PubMed: 38643163
DOI: 10.1186/s13019-024-02708-9 -
The Ultrasound Journal May 2024Point-of-care ultrasound (POCUS) has become a mainstay in the evaluation of critically ill patients in the intensive care unit (ICU). ECMO patients are susceptible to...
BACKGROUND
Point-of-care ultrasound (POCUS) has become a mainstay in the evaluation of critically ill patients in the intensive care unit (ICU). ECMO patients are susceptible to complications during prolonged ICU stay, including cannula malposition, which has deleterious consequences. Although the literature surrounding utility of ultrasound on ECMO patients is expansive, direct comparison between radiographic imaging versus ultrasound for identification of cannula malposition is lacking.
CASE PRESENTATION
The authors identified four patients with cannula malposition discovered through POCUS that was missed on routine radiographic imaging. Identification and correction of malposition changed their ECMO course.
CONCLUSION
This case series is the first in literature demonstrating that ultrasound may be superior to radiographic images for ECMO cannula malposition. Further investigation into this subject is warranted.
PubMed: 38717534
DOI: 10.1186/s13089-024-00357-6 -
Plastic and Reconstructive Surgery.... Jan 2019Nipple-sparing mastectomy continues to grow in popularity as oncologic indications for preserving the nipple areolar complex have become less stringent and more patients...
Nipple-sparing mastectomy continues to grow in popularity as oncologic indications for preserving the nipple areolar complex have become less stringent and more patients with genetic predispositions to breast cancer seek aesthetically superior prophylactic mastectomy reconstructions. Nonetheless, nipple malposition remains a common and disturbing complication. This article proposes several anatomic variations that predispose to nipple malposition and a strategy to avoid it through a reliable, easily reproducible method of preoperative marking and intraoperative stabilization.
PubMed: 30859033
DOI: 10.1097/GOX.0000000000002064 -
BMC Pediatrics Jan 2023A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general...
BACKGROUND
A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations.
OBJECTIVES
To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department.
METHODS
A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs.
RESULTS
There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements.
CONCLUSION
The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.
Topics: Humans; Child; Child, Preschool; Catheterization, Central Venous; Cohort Studies; Retrospective Studies; Risk Factors; Catheters; Catheterization, Peripheral; Catheter-Related Infections; Central Venous Catheters
PubMed: 36639748
DOI: 10.1186/s12887-022-03809-x -
Cleveland Clinic Journal of Medicine Jan 2018Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation. Rapid... (Review)
Review
Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation. Rapid identification of lead position is critical during implantation and just after the procedure, with immediate correction required if malpositioning is detected. If lead misplacement is discovered late after implantation, the lead should be surgically removed or chronic anticoagulation with warfarin should be instituted.
Topics: Anticoagulants; Blood Vessel Prosthesis Implantation; Defibrillators, Implantable; Humans; Prosthesis Failure; Reoperation; Ventricular Dysfunction, Left; Warfarin
PubMed: 29328900
DOI: 10.3949/ccjm.85a.17012 -
Turkish Journal of Ophthalmology Oct 2015To evaluate the clinical findings and outcomes of surgical treatment in patients with marginal entropion.
OBJECTIVES
To evaluate the clinical findings and outcomes of surgical treatment in patients with marginal entropion.
MATERIALS AND METHODS
Patients with impairment of the natural square-shaped eyelid margin morphology, anterior migration of mucocutaneous junction and mild lid inversion toward the ocular surface were diagnosed as having marginal entropion. Patients with shortened fornices, cicatricial changes or subconjunctival fibrosis were excluded. Demographic characteristics, ophthalmologic examination findings, surgical procedures and follow-up data were evaluated retrospectively.
RESULTS
Twelve eyes of 11 patients were included in the study. Median age was 73 years (range, 49-84 years). All cases presented with signs of meibomianitis and were treated preoperatively with oral doxycycline and topical corticosteroids. Tarsal fracture procedure was performed for correction of lid malposition. In all patients, lid malposition was corrected and ocular irritation findings had regressed. No recurrences were observed in the follow-up period of mean 10 months (range, 5-16 months).
CONCLUSION
Marginal entropion is a common malposition that is frequently misdiagnosed as trichiasis and is overlooked. Complications secondary to misdiagnosis can be avoided and a normal lid position achieved when the correct diagnosis is made.
PubMed: 27800233
DOI: 10.4274/tjo.20591 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2022Anatomic variations and congenital anomalies involving the gallbladder position, shape, and number are frequently encountered on routine abdominal imagings and at... (Review)
Review
Anatomic variations and congenital anomalies involving the gallbladder position, shape, and number are frequently encountered on routine abdominal imagings and at surgery. However, most have no clinical significance, but their recognition is important because they may predispose to gallbladder diseases, serve as a potential source of confusion and diagnostic pitfalls for radiologists and surgeons, and increase the risk of inadvertent injury during biliary tract surgery or intervention. We observed an intra-mesocolic gallbladder found unexpectedly during the cholecystectomy in a 65-year-old male patient who was being operated on for acute calculous cholecystitis. An abdominal ultrasonography and computed tomography scan reported no anomalous or malpositioned gallbladder pre-operatively. As the location of this organ could not be definitely clarified in his previous operation elsewhere, we performed an explorative lapa-rotomy. There was no gallbladder at the normal position. The organ was found embedded deeply within the proximal portion of the transverse mesocolon, and then it was successfully excised. We established the diagnosis of an ectopic gallbladder in mesocolic position.
Topics: Abdomen; Aged; Cholecystectomy; Cholecystitis, Acute; Humans; Male; Mesocolon
PubMed: 35485503
DOI: 10.14744/tjtes.2020.09274 -
SA Journal of Radiology 2023Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray...
BACKGROUND
Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively.
OBJECTIVES
This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a 'bubble test' to detect malposition and pneumothorax.
METHOD
Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the 'bubble test' and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR.
RESULTS
Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3-6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18-56 min) ( < 0.0001).
CONCLUSION
This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition.
CONTRIBUTION
Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.
PubMed: 37416693
DOI: 10.4102/sajr.v27i1.2587 -
Dermatology Online Journal Feb 2019Eccrine hidrocystoma is a benign cystic tumor. Such benign cystic lesions may be a cosmetic concern, or when large, can cause eyelid malpositions. We report a patient...
Eccrine hidrocystoma is a benign cystic tumor. Such benign cystic lesions may be a cosmetic concern, or when large, can cause eyelid malpositions. We report a patient with a peri-punctal hidrocystoma of the eyelid.
Topics: Adult; Eccrine Glands; Eyelid Neoplasms; Hidrocystoma; Humans; Lacrimal Apparatus; Male; Sweat Gland Neoplasms
PubMed: 30865415
DOI: No ID Found