CJEM Articles: central venous catheterization

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  • Identification and correction of guide wire malposition during internal jugular cannulation with ultrasound
    March 2007 9 2
    Michael B. Stone

    Real-time ultrasound guidance for central venous catheterization increases success and reduces procedural complications. I describe a case in which guide wire resistance was encountered and real-time ultrasound visualization of the guide wire facilitated correction of guide wire malposition. No additional passes of the introducer needle were necessary and the chances of inadvertent carotid artery puncture or pneumothorax were therefore reduced. The technique described here may prove valuable when guide wire resistance is encountered while placing a central venous catheter.

  • Right subclavian catheter perforation of the aorta due to an incorrect external landmark-guided insertion technique
    January 2007 9 1
    Nicola Vitale, Peter N. Latto, Rune Haaverstad

    Emergency placement of a right subclavian triple lumen silastic catheter in an obese, unstable postoperative patient caused a perforation of the aorta, resulting in sudden cardiac tamponade. Because this complication was immediately recognized and surgical decompression with suturing of the perforation in the aorta was performed, the patient survived. A standardized approach for all central venous line insertions should be emphasized for all clinicians. Use of ultrasound guidance whenever feasible is encouraged.