Acute and Critical Care

Original Articles

Nursing
Minimizing discard volume to 2 ml before blood sampling from a central venous catheter: a prospective observational study in India: Abinaya Pushparaj, Lakshmi Ramamoorthy, Manu Ayyan S, Rajeswari Murugesan, Hmar Thiak Lalthanthuami; Acute Crit Care. 2026;41(1):174-182. Published online February 9, 2026; DOI: https://doi.org/10.4266/acc.000792

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Abstract PDF: Background
Central venous catheters (CVCs) are essential for the treatment of critically ill patients. The practice of discarding varying volumes of blood before sampling from CVCs is widely adopted globally. However, there is no established consensus regarding the appropriate volume of blood to discard before sampling. Therefore, this study aims to compare serum electrolyte levels and hemogram measurements obtained via direct venous puncture with those derived from the proximal lumen of the CVC using a discard volume of 2 ml. Methods: Using a prospective observational study design, 105 patients from intensive care units of a tertiary care center were selected through a convenience sampling method. The parameters analyzed included serum electrolytes (sodium, potassium, and calcium) and complete blood counts (hemograms). Intraclass correlation and Bland-Altman plot analysis were employed to assess agreement between the two sampling methods. Results: The study showed high agreement between the two methods, with a P-value of <0.001, except for white blood cell. The presence of acidosis as a clinical confounder was the primary reason for the differences in agreement for potassium (P=0.018), hematocrit (P=0.006), mean corpuscular volume (P=0.041), mean corpuscular hemoglobin (P=0.034), mean corpuscular hemoglobin concentration (P=0.031), neutrophil (P=0.045), and eosinophil (P=0.553). Conclusions: This study suggests that discarding 2 ml of blood, rather than 3 ml or more, before routine sampling from CVCs is sufficient and may help to reduce iatrogenic blood loss in critically ill patients.

Anesthesiology
Ultrasound-guided supraclavicular internal jugular vein compression to increase internal jugular vein cross-sectional area in hospitalized patients: a prospective observational study in Japan: Masataka Hiruma, Hiroyuki Honda, Shuichiro Kurita, Shunsuke Nukaga, Mitsuhiro Watanabe, Kei Nishiyama; Acute Crit Care. 2025;40(4):574-581. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.002025

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Abstract PDF: Background
Real-time ultrasound-guided catheterization of the internal jugular vein (IJV) is widely used for its safety and high success rate. However, it becomes difficult when the IJV’s cross-sectional area (CSA) is reduced. A reported technique applies manual pressure (with fingers) to the supraclavicular IJV to impede venous return and enlarge the distal CSA. While effective in previous studies, its clinical utility remains unclear, as those studies involved only healthy volunteers and used blind technique. Therefore, this study aimed to evaluate the efficacy of our novel ultrasound-guided compression of the proximal IJV.
Methods
In this prospective observational study, 25 hospitalized patients were included. Two ultrasound machines were used: one to visualize the CSA of the distal IJV, and the other to apply and guide compression of the supraclavicular IJV, ensuring real-time confirmation of venous occlusion. Patients were asked about pain during the compression procedure. The primary outcome was the degree of dilation at the puncture site of the IJV.
Results
All 25 patients (mean Sequential Organ Failure Assessment score: 5.2±3.6) completed the study. Supraclavicular IJV compression resulted in a significant increase in the CSA of the distal IJV by approximately 150%, from 0.4±0.3 cm² to 1.0±0.3 cm² (P<0.001). No patient reported any pain during the procedure.
Conclusions
Ultrasound-guided supraclavicular IJV compression significantly increased the CSA of the distal IJV in hospitalized patients. This method enhances vein visibility by increasing IJV volume, potentially improving the success and safety of central venous catheterization.

Review Article

Surgery
Clinical applications of blood gas analysis: a comparative review of arterial and venous blood gas monitoring in critical care: Gyeo Ra Lee; Acute Crit Care. 2025;40(2):153-159. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000900

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Abstract PDF

Blood gas analysis is an essential diagnostic tool used for assessing acid-base balance, ventilation, and oxygenation in critically ill patients. Arterial blood gas analysis (ABGA) remains the gold standard, primarily due to its accuracy in measuring oxygenation. Venous blood gas analysis (VBGA), in contrast, serves as a less invasive alternative and is particularly useful for evaluating acid-base status and metabolic function. Important parameters such as oxygen saturation of central venous blood (ScvO₂) and venous-to-arterial carbon dioxide pressure difference (∆pv-aCO₂) provide critical insights into hemodynamic status, cardiac output, and tissue perfusion. Although VBGA cannot replace ABGA for the precise assessment of oxygenation, it remains a valuable tool in clinical scenarios involving hemodynamic monitoring, shock management, and critical care decision-making.

Citations

Citations to this article as recorded by

Ultrasound guidance versus conventional technique for radial arterial puncture in patients with shock in the emergency department: a randomized controlled trial
Durmus Ali Ersahin, Ismail Erkan Aydin, Tugce Ersahin, Nalan Kozaci
BMC Emergency Medicine.2026;[Epub] CrossRef
Assessing and Enhancing the Interpretation Quality of Arterial Blood Gas Among Junior Doctors
Abubakr Muhammed, Mohaned Altijani Abdalgadir Hamdnaalla, Fakher Aldeen Raft Fakher Aldeen Noman, Ahmed Altayeb Abbas Fadlallah, Mohammed Ali Mohammed Ali, Hanaa Ahmed Khalifa Elamin, Hala Aamir Abdelraouf Ahmed , Ameer Abdallatif Saeed Elkhazin, Hala Ome
Cureus.2025;[Epub] CrossRef
Using zlog in spider charts for fast diagnosis recognition
Johannes Böhm, Johannes Daubitzer, Thorsten M. Smul, Lisa-Maria Meier, Sven Schneider
Journal of Laboratory Medicine.2025; 49(6): 268. CrossRef
Predictive performance of central venous oxygen saturation, lactate, base excess, and alactic base excess for intradialytic hypotension
Angelica J. Luevanos-Aguilera
BMC Nephrology.2025;[Epub] CrossRef

Original Article

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Abstract PDF Supplementary Material

Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19).
Methods
This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count.
Results
Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002).
Conclusions
In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Citations

Citations to this article as recorded by

Early Driving Pressure Is Associated with Major Adverse Kidney Events at 30 Days in ARDS Patients with SARS-CoV-2
Gustavo Casas-Aparicio, Adrián E. Caballero-Islas, Antonio León-Ortiz, David Escamilla-Illescas, Yovanna Rueda-Escobedo, Carlos Ascención-López, Diana Hernández-Quino, Aimee Flores-Vargas, Jesús Sosa-Chombo, Abraham Tolentino-de La Mora, Ana Saucedo-Prune
Journal of Clinical Medicine.2025; 14(8): 2783. CrossRef
PEEP-AKI-COVID ICU: Effect of positive end-expiratory pressure on acute kidney injury development in patients with COVID-19-associated acute respiratory distress syndrome: an ancillary analysis of the COVID-ICU study
Léo Poirot, Lionel Tchatat Wangueu, Isaure Breteau, Matthieu Petit, Matthieu Schmidt, Florent Bavozet, Alain Mercat, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Arthur Pavot, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dre
Journal of Intensive Care.2025;[Epub] CrossRef
Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef
Renal venous flow in different regions of the kidney are different and reflecting different etiologies of venous reflux disorders in septic acute kidney injury: a prospective cohort study
Rongping Chen, Hui Lian, Hua Zhao, Xiaoting Wang
Intensive Care Medicine Experimental.2024;[Epub] CrossRef

Case Reports

Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?: Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee; Korean J Crit Care Med. 2016;31(1):63-67. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.63

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Abstract PDF: A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Pulmonary
Central Venous Catheter-Related Hydrothorax: Se Hun Kim, Charles Her; Korean J Crit Care Med. 2015;30(4):343-348. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.343

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Abstract PDF

This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

Citations

Citations to this article as recorded by

Successful management of uncommon complication after brachiocephalic vein catheterization: A case report
Namita Mishra, Danish Qutub, Umesh Bhadani
Journal of Pediatric Critical Care.2024; 11(6): 276. CrossRef

Original Article

Vascular surgery
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter: Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho; Korean J Crit Care Med. 2015;30(4):280-285. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.280

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Abstract PDF

Background
We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. Methods: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. Results: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). Conclusions: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Citations

Citations to this article as recorded by

Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report
Parag Gharde, Sourangshu Sarkar, Kalpana Irpachi, Amol Kumar Bhoje, Bhavdeep Kaur, Sandeep Chauhan
A&A Practice.2020; 14(10): e01291. CrossRef

Case Report

Thoracic surgery
A Rare Case of Massive Hemothorax due to Central Venous Catheterization Treated with Angiographic Stent Implantation: Jung-Min Bae; Korean J Crit Care Med. 2015;30(1):18-21. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.18

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Abstract PDF

In critically ill patients, centeral venous catheterization is a widely used procedure for fluid resuscitation, massive transfusion, total parenteral nutrition, central venous pressure monitoring and hemodialysis. However, many complications are associated with central venous catheterization. Among these complications, hemothorax is rare but fatal. We recently experienced a 32-year-old female diagnosed with hemothorax due to subclavian catheterization who was successfully treated with angiographic intervention. There are no absolute indications of surgery or interventional treatment in such cases. Multicenter studies and consensus are necessary to determine the proper treatment for hemothorax due to central venous catheterization. Angiographic treatment is rarely used for this uncommon complication of subclavian catheterization. We describe a rare case with a review of the literature.

Citations

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Report of a Rare Case of Concurrent Pneumothorax and Hemothorax in a 5-Year-old Child with Cardiac Arrest after Induction of Anesthesia
Amirhossein Jalali, Mohammad Mahdavi, Zahra Ansari Aval
Journal of Surgery and Trauma.2025; 13(1): 39. CrossRef

Original Article

Emergency
Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation: Yong Oh Kim, Hyun Soo Park; Korean J Crit Care Med. 2014;29(3):172-176. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.172

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Abstract PDF

BACKGROUND
Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR.
METHODS
This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR.
RESULTS
During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC.
CONCLUSIONS
During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Citations

Citations to this article as recorded by

Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults
Hyun Seok Chai, Young-Min Kim, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Ji Han Lee
SAGE Open Medicine.2023;[Epub] CrossRef
Femoral venous oxygen saturation obtained during CPR predicts successful resuscitation in a pig model
Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
The American Journal of Emergency Medicine.2015; 33(7): 941. CrossRef

Case Reports

Vascular surgery
Guide Wire Entrapment during Central Venous Catheterization: Kyung Woo Kim, Jun Hyun Kim, Se Hyeok Park, Ji Yeon Kim, Sang Il Lee, Kyung Tae Kim, Jang Su Park, Jung Won Kim, Won Joo Choe; Korean J Crit Care Med. 2014;29(2):137-140. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.137

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Abstract PDF: We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.

Air Embolism in the Left Ventricle after the Removal of a Central Venous Catheter: Duk Song Cho, Moo Hyun Kim, Dong Hyun Lee, Hye Won Lee, Eun Bin Kim, Seok Hyun Kim, Hyo Jin Jung, Soo Jin Kim, Hyun Jeong Kim; Korean J Crit Care Med. 2013;28(4):318-322.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.318

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Abstract PDF

Air embolism is a rare, potentially critical complication that can induce death. Central venous catheterization, which is commonly used for critically ill patients, is a possible cause of air embolism. We experienced a severe air embolism with abnormal air in left ventricle after CVC removal in a patient who was treated for eosinophilic pneumonia. Although the neurologic symptoms were severe, the patient was successfully treated with immediate hyperbaric oxygen therapy and the neurologic deficit was minimal.

Citations

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Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report
Sung Ha Mun, Dong Ai An, Hyun Jung Choi, Tae Hee Kim, Jung Woo Pin, Dong Chan Ko
Korean Journal of Anesthesiology.2016; 69(3): 296. CrossRef

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation: Jong Hae Kim, Bo Reum Lim, Jin Yong Jung; Korean J Crit Care Med. 2013;28(4):309-313.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.309

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Abstract PDF

A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.

Citations

Citations to this article as recorded by

Combined liver and kidney transplantation: Our experience and review of literature
KusumaRamachandra Halemani, N Bhadrinath
Indian Journal of Anaesthesia.2017; 61(1): 68. CrossRef

Original Article

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by

Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Case Reports

Surgical Management for Pulmonary Artieriole Rupture During Subclavian Vein Catheterization: A Case Report: Jiae Min, Hyun Koo Kim, Ho Kyung Sung, Hyun Joo Lee, Young Ho Choi; Korean J Crit Care Med. 2012;27(1):59-61.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.59

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Abstract PDF: We experienced an extremely unusual case of a 37-year-old woman who suffered from hemothorax soon after subclavian vein catheterization. Many case reports of a hemothorax or hematoma after central vein catheterization through the great vessels, such as the subclavian vein and internal jugular vein, have been published. However, this rare case showed a pinpoint-sized active bleeding site from a pulmonary arteriole rupture. During an emergency operation using thoracoscopy-assisted minithoracotomy, this bleeding site was successfully managed by primary repair.

Central Venous Catheter Misplaced in the Innominate Vein after Penetrating the Left Subclavian Vein in a Neonate: A Case Report: Sang Wook Shin, Ji Uk Yoon, Hyeon Jeong Lee, O Sun Kwon, Hyun Mok Kim; Korean J Crit Care Med. 2012;27(1):49-51.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.49

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Abstract PDF: In the pediatric ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and serves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.

Original Articles

Relationship between Patient Height and Depth of Central Venous Catheter: Dong Jun Lee, Ui Jae Im, Ki Tae Kim; Korean J Crit Care Med. 2011;26(3):145-150.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.145

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Abstract PDF: BACKGROUND
Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC.
METHODS
We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed.
RESULTS
The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups.
CONCLUSIONS
The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.

Prognostic Factors for Mortality in Emergency Department Patients with Hypotension: Deuk Hyun Park, Young Rock Ha, Young Sik Kim, Tae Yong Shin, Sung Han Oh, Sung Sil Choi, Suk Young No; Korean J Crit Care Med. 2011;26(2):57-63.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.57

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Abstract PDF

BACKGROUND
This study was performed to analyze the effects of differences between initial and follow up amounts of central venous oxygen saturation (Scvo2), lactate, anion gap (AG), and corrected anion gap (CAG).
METHODS
Patients with systolic blood pressure that was lower than 90 mmHg participated in this study. Along with Arterial Blood Gas Analysis (ABGA), the amounts of electrolytes, albumin, and Scvo2 were initially checked and then re-checked four hours later. The patients were divided into two groups, which were survived and expired, and the differences in initial and final values were compared in both groups. RESULTS: Out of a total of 36 patients, 29 patients survived and 7 patients died. The data showed almost no difference in mean age, mean arterial pressure, heart rate, respiratory rate, and body temperature between two groups. Comparing the initial amount, there was a statistically significant variation in lactate. Comparing the final values, lactate, AG, and CAG varied significantly. However, for both groups, the differences between the initial and final values were not significant. The area under curve (AUC) of follow up lactate and follow up CAG was 0.89 and 0.88. AUC of ED-APACHEII and original ICU APACHEII was 0.74 and 0.96.
CONCLUSIONS
There was no prognostic effect of Scvo2, lactate, AG, and CAG in hypotensive patients. The initial and final values of lactate and CAG were good prognostic factors for the expired group.

Citations

Citations to this article as recorded by

Death below 2 g/dL of Hemoglobin Concentrations: As an Independent Predictor of Death
Sun Young Park, Sung Hyun Kang, Sang Hoon Park, Hea Rim Jeon, Mun Gyu Kim, Se Jin Lee
Soonchunhyang Medical Science.2013; 19(1): 45. CrossRef
Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED
Ru-Bi Jeong, Jung-Hwan An, Hyun-Min Jun, Sung-Min Jeong, Tae-Yong Shin, Young-Sik Kim, Young-Rock Ha
Korean Journal of Critical Care Medicine.2012; 27(4): 237. CrossRef

Case Reports

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report: Deokkyu Kim, Ji Hye Lee, Dong Chan Kim, Hyungsun Lim, Seonghoon Ko, Ji Seon Son; Korean J Crit Care Med. 2011;26(1):38-40.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.38

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Abstract PDF: Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report: Ji Ung Kim, Ji Hyun Cheon, Il Soo Kim, Sun Kwang Kim, Sung Hyun Ko, Sea Won Lee, Sang Hee Kim, Su Hong Kim; Korean J Crit Care Med. 2010;25(3):190-193.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.190

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Abstract PDF: Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

Malfunction due to Kinking and Bending of a Double Lumen Central Venous Catheter : A Case Report: Kyung Bong Yoon, Won Oak Kim, Jae Ho Cha, Ki Young Lee; Korean J Crit Care Med. 2006;21(2):131-134.

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Abstract PDF: Central venous catheters provide an important means of vascular access and are increasingly used. Catheter occlusion refers to the inability to infuse or withdraw fluids from a catheter and could be caused by either thrombotic or nonthrombotic origin. We report an unusual malfunction of double lumen central venous catheter due to kinking and bending of the catheter at the opening site of proximal lumen.

Original Articles

Medicolegal Aspects on Central Venous Catheterization Related Injury: Hyuna Bae, Sungeun Kim, Seokbae Lee, Rack Kyung Chung; Korean J Crit Care Med. 2006;21(1):42-50.

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Abstract PDF: BACKGROUND
We describe the characteristics of malpractice claims related to central venous catheterization and identify causes and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing records at Lawnb and Lx CD-rom. The records on closed malpractice claim related to central venous catheterization were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the factors associated with a successful defense.
RESULTS
Twelve closed claim cases, related to central venous cathetertization were reviewed in the data for malpractice. Catheter-related complications were pneumothorax, hemothorax, cardiac tamponade, pyothorax, hematoma due to arterial puncture, pseudoaneurysm. Almost cases resulted in indemnity payment and verdict for patient. CONCLUSIONS: Although malpractice claims related to central venous catheterization were uncommon, they resulted in high rate and amount of indemnity payments. In pediatric patient, catheterization should be performed with attention. Clinicians should consider the underlying disease of patients and do any pretreatment if needed. Post-procedural radiologic confirmation can improve patient outcome and is also associated with decreased indemnity risk. Informed consent is also important.

The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography: Il Woo Shin, Mi Young Park, Ju Young Choi, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2006;21(1):37-41.

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Abstract PDF: BACKGROUND
The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter.
METHODS
The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed.
RESULTS
The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04).
CONCLUSIONS
The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.

Evaluation of the Technique of Central Venous Catheterization via the External Jugular Vein: Seong Hoon Ko, Dong Chan Kim, Sang Kyi Lee, He Sun Song; Korean J Crit Care Med. 1999;14(2):143-147.

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Abstract PDF: BACKGOUND: This study was designed to evaluate the effectiveness and feasibility of central venous catheterization via the external jugular vein (EJV). We compared the success rate of left and right EJV catheterization. The influence of the course of left and right external jugular vein on success rate was investigated also.
METHODS
Eighty anesthetized adult surgical patients were studied consecutively. Patients were allocated to left or right EJV catheterization and measured the angles between EJV and clavicle and transverse shoulder line. Catheterization was performed under sterile conditions by Seldinger technique after angiography of EJV and subclavian vein. We analyzed the relationship between the angles and success rate and time for catheterization. We compared the success rate of left and right EJV catheterization.
RESULTS
The overall rate of intrathoracic placement was 74 from 80 catheterization (92.5%). Analysis of success in left and right EJV catheterization did not reveal statistically significant differences. The success rates did not show any correlation with course of EJV. Complications were few and not serious.
CONCLUSIONS
This study indicated that left and right EJVs were good routes for central venous catheterizationan with acceptably high success rate. However, we could not find the predictor of success for central venous catheterization via EJV.

Case Report

Cutting of Guide Wire and Hydrothorax after Subclavian Venous Catheterization for Premature Infant: A case report: Hyun Soo Moon, Sung Hee Han; Korean J Crit Care Med. 1999;14(1):37-41.

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Abstract PDF: Central venous catheterization is one of the common procedures in the care of critically ill patients but numerous major complications have been reported. This report is about a case of sequential complications that were developed after two attempts of subclavian venous catheterization via supraclavicular approach for a critically ill 1.5 kg premature infant in intensive care unit. In the first attempt, the guidewire was cut and remained in the right atrium but fortunately removed without surgery. In the second attempt for the same patient, the catheter positioned out of the vessel. It was in right pleural cavity and caused hydrothorax. After third attempt, successful left subclavian vein catheterization was done.

Original Article

Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients: Ju Tae Sohn, Heon Young Ahn, Ji Hong Bae, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung; Korean J Crit Care Med. 1997;12(2):151-158.

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Abstract PDF: BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation.
METHODS
Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order.
RESULTS
IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed.
CONCLUSIONS
The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.

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