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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-08-2011 | Reports of Original Investigations

Frequent malpositions of peripherally inserted central venous catheters in patients undergoing head and neck surgery

Authors: Leonid Minkovich, MD, PhD, George Djaiani, MD, Stuart A. McCluskey, MD, PhD, Nicholas Mitsakakis, MSc, Ralph W. Gilbert, MB, W. Scott Beattie, MD, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2011

Abstract

Purpose

Peripherally inserted central venous catheters (PICCs) do not interfere with surgical access during neck dissection and are used in patients undergoing head and neck surgery. However, severe complications associated with malpositioning of PICCs have been reported in these patients. We conducted a retrospective study to determine the incidence of aberrant positioning of PICCs in patients undergoing free flap reconstructive (FFR) surgery for head and neck malignancies.

Methods

We analyzed a database of 269 patients undergoing FFR surgery. After induction of general anesthesia, a PICC was inserted successfully in 130 patients (48%) at bedside without image guidance. A PICC was not used in 139 patients (52%). A chest x-ray was performed at admission to the postanesthetic care unit, stored digitally, and reviewed retrospectively by two independent observers. Based on the chest x-ray findings, the PICC position was classified as proper, suboptimal, or aberrant and defined according to the position of the PICC tip, i.e., proper, if situated in the ipsilateral innominate vein or in the superior vena cava; suboptimal, if situated in the subclavian vein; and aberrant, if situated in any other location.

Results

Proper, suboptimal, and aberrant PICC positions were found in 68 (52%), 17 (13%), and 45 (35%) patients, respectively. The proper position was confirmed more frequently with a left- than with a right-sided approach: 23/29 (79%) vs 45/101 (44%) patients, respectively (P < 0.001).

Conclusions

There is a high incidence of aberrant positioning when PICCs are inserted without image guidance. The left-sided approach might be preferable due to a lower incidence of malpositions. The risk-benefit ratio should be estimated carefully before using a PICC in patients undergoing FFR procedures.

Hagau N, Longrois D. Anesthesia for free vascularized tissue transfer. Microsurgery 2009; 29: 161-7.PubMedCrossRef

Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008; 134: 172-8.PubMedCrossRef

Kumar M, Amin M. The peripherally inserted central venous catheter; friend or foe? Int J Oral Maxillofac Surg 2004; 33: 201-4.PubMedCrossRef

McGurk M, Thomson PJ. A central venous catheter complicating head and neck surgery. Br J Oral Maxillofac Surg 1991; 29: 388-91.PubMedCrossRef

Orme RM, McSwiney MM, Chamberlain-Webber RF. Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature. Br J Anaesth 2007; 99: 384-8.PubMedCrossRef

Camilleri AE, Davies FW. Aberrant central venous catheter complicating radical neck dissection. J Laryngol Otol 1991; 105: 491-2.PubMed

Clark JR, McCluskey SA, Hall F, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck 2007; 29: 1090-101.PubMedCrossRef

Chasen MH, Charnsangavej C. Venous chest anatomy: clinical implications. Eur J Radiol 1998; 27: 2-14.PubMedCrossRef

Amerasekera SS, Jones CM, Patel R, Cleasby MJ. Imaging of the complications of peripherally inserted central venous catheters. Clin Radiol 2009; 64: 832-40.PubMedCrossRef

10.

Trerotola SO, Thompson S, Chittams J, Vierregger KS. Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team. J Vasc Interv Radiol 2007; 18: 513-8.PubMedCrossRef

11.

Fricke BL, Racadio JM, Duckworth T, Donnelly LF, Tamer RM, Johnson ND. Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position. Radiology 2005; 234: 887-92.PubMedCrossRef

12.

Elsharkawy H, Lewis BS, Steiger E, Farag E. Post placement positional atrial fibrillation and peripherally inserted central catheters. Minerva Anestesiol 2009; 75: 471-4.PubMed

13.

Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth 2000; 85: 188-91.PubMedCrossRef

14.

Brown DH, Mulholland S, Yoo JH, et al. Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction. Head Neck 1998; 20: 169-74.PubMedCrossRef

15.

Schweickert WD, Herlitz J, Pohlman AS, Gehlbach BK, Hall JB, Kress JP. A randomized, controlled trial evaluating postinsertion neck ultrasound in peripherally inserted central catheter procedures. Crit Care Med 2009; 37: 1217-21.PubMedCrossRef

16.

LaFortune S. The use of confirming x-rays to verify tip position for peripherally inserted catheters. J Intraven Nurs 1993; 16: 246-50.PubMed

17.

Yerdel MA, Karayalcin K, Anadol E. Malpositioning of subclavian vein catheters in left and right sided attempts: a prospective study. Neth J Surg 1991; 43: 178-80.PubMed

18.

Unal AE, Bayar S, Arat M, Ilhan O. Malpositioning of Hickman catheters, left versus right sided attempts. Transfus Apher Sci 2003; 28: 9-12.PubMedCrossRef

19.

Ragasa J, Shah N, Watson RC. Where antecubital catheters go: a study under fluoroscopic control. Anesthesiology 1989; 71: 378-80.PubMedCrossRef

20.

Chaturvedi A, Bithal PK, Dash H, Chauhan RS, Mohanty B. Catheter malplacement during central venous cannulation through arm veins in pediatric patients. J Neurosurg Anesthesiol 2003; 15: 170-5.PubMedCrossRef

21.

Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007; 35: 64-8.PubMedCrossRef

22.

Lees N, Hamilton M, Rhodes A. Clinical review: goal-directed therapy in high risk surgical patients. Crit Care 2009; 13: 231.PubMedCrossRef

Title: Frequent malpositions of peripherally inserted central venous catheters in patients undergoing head and neck surgery
Authors: Leonid Minkovich, MD, PhD
George Djaiani, MD
Stuart A. McCluskey, MD, PhD
Nicholas Mitsakakis, MSc
Ralph W. Gilbert, MB
W. Scott Beattie, MD, PhD
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2011
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-011-9512-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Frequent malpositions of peripherally inserted central venous catheters in patients undergoing head and neck surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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