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Importance of securing central venous catheters.

We wish to highlight the problem of dislodgement of central venous catheters (CVC) when they have been inadequately secured. We have noted a number of cases within the preceding few months where CVC lines have been only taped to the skin and have thus fallen out or dislodged on minimal patient movement. Figure 1 highlights such a situation. This patient underwent CVC line insertion prior to a laparoscopic distal pancreatectomy; the line was only secured with tape. This chest X-ray was obtained in the recovery room and the patient transferred to the surgical high dependency unit before anything untoward was noted.

CVC line dislodgement can result in potentially significant complications. If the line moves into the right atrium there is the rare but fatal risk of cardiac tamponade. Higher placed catheters can result in vessel wall trauma, thrombosis or increased line-related sepsis (1). Therefore adequate securement of CVC lines is as important as the initial placement.

CVC lines have been traditionally secured with silk sutures to the skin of the neck. This material is easy to manipulate and ties strong non-slip knots. However silk can cause tissue inflammation (2) and is a potential harbourer of infection (3). Nylon has a lower risk of infection and inflammation but is difficult to tie due to its 'memory'; knots should be tied with multiple throws to prevent slippage but can cause tissue necrosis if sutures are too tight. Sutures risk the potential of incurring needle-stick injury which has led to a number of other securing devices being marketed. These can be as effective as suturing but normally result in higher costs (4). Stapling is yet another alternative, being significantly quicker than suturing but not as efficient at preventing dislodgement (5).

[FIGURE 1 OMITTED]

CVC line insertion is an important way of monitoring sick intensive care patients and as a means of administering life-saving medications. Inappropriately placed or secured CVC lines can result in significant complications. There were no adverse effects as a result of the dislodgement seen in this patient, but the case illustrates the importance of thorough securement of centrally placed venous catheters. By highlighting this issue it is hoped that cases like these will become less frequent in the future.

T. C. BIGGS

A. MOHAMMED

D. MULVIHILL

Southampton, United Kingdom

References

(1.) Raad II, Luna M, Khalil SA, Costerton JW, Lam C, Bodey GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994; 271:1014-1016.

(2.) Postlethwait RW, Dillon ML, Reeves JW. Experimental study of silk suture. Arch Surg 1962; 84:698-702.

(3.) Katz S, Izhar M, Mirelman D. Bacterial adherence to surgical sutures. A possible factor in suture induced infection. Ann Surg 1981; 194:35-41.

(4.) Yamamoto AJ, Solomon JA, Soulen MC, Tang J, Parkinson K, Lin R et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 2002; 13:77-81.

(5.) Vinjirayer A, Jefferson P, Ball DR. Securing central venous catheters: a comparison of sutures with staples. Emerg Med J 2004; 21:582-583.
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Title Annotation:Correspondence
Author:Biggs, T.C.; Mohammed, A.; Mulvihill, D.
Publication:Anaesthesia and Intensive Care
Article Type:Letter to the editor
Geographic Code:4EUUK
Date:Mar 1, 2012
Words:506
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