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Are we underestimating the frequency of malpositioned central venous catheters inserted via the left internal jugular vein? A case report and short review of literature

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Ikonić N. , Uvelin A. , Hajduković D. , Kolak R. , Jokić-Divljak D.

Open Medicine

2011

tom 6

nr 1

45-48

Central venous cannulation is a widely used procedure in clinical medicine. Central venous catheters are inserted most often via the internal jugular and subclavian veins. One of the complications is malpositioning of the catheter, and some insertion sites carry a higher risk for that occurrence. We report a case of a malpositioned central venous catheter inserted via the left internal jugular vein in a patient with a ruptured diaphragm. Our objectives were to review the venous anatomy of the chest and the literature reporting malpositioned central venous catheters and to discuss the approach through the left internal jugular vein. Left internal jugular cannulation could carry a higher rate of malposition than reported, and anatomy gives a possible, simple answer. Contrast enhancement, although central venous catheters are radiopaque, is helpful when an approach through the left internal jugular vein is used and difficulties are encountered during insertion.

Reducing central catheter-associated infections in pediatric surgery clinic: Implementation of a care bundle

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Dolgun E. , Aliye O. A. , Islamoğlu A. , Eroğlu B. , Polat M. , Yavuz van Gıersbergen, Meryem , Erdener A.

Progress in Health Sciences

2021

tom 11(1)

57-65

Purpose: Central line care bundle comprises a few evidence-based interventions for improving patients' outcomes and recovery process. This semi-experimental study aimed to determine the effect of pediatric central line care bundle implementation on central line-associated bloodstream infections (CLABSI) rates. Materials and methods: A central line care bundle was implemented for pediatric surgery patients (n=70). Baseline observations were made to determine the central line care bundle compliance of healthcare professionals for 435 catheter days. Subsequently, physicians and nurses were educated about the central line care bundle. After the implementation period, 722 catheter days were observed to determine post-implementation compliance. Baseline CLABSI rates were compared with post-implementation CLABSI rates. Results: It was found that the entire central line care bundle compliance was 32.4% pre-implementation and 86.3% post-implementation. After education, the physicians' and nurses' central line care bundle compliance showed statistically significant improvement (p= 0.0001). There were five CLABSI events in the pre-implementation period and three CLABSI events in the post-implementation period. It was determined that the number of CLABSI decreased in the post-implementation period compared to the pre-implementation period, but this difference was not statistically significant (p= 0.207). Conclusions: Central line care bundle implementation decreased the CLABSI rates. It is recommended the Implementation of a central line care bundle on the care of pediatric surgery patients with the central venous catheter.