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Background: After insertion of a central venous catheter (CVC) the catheter position must be controlled and a pneumothorax ruled out.Objective: The aim was to examine whether the use of two standard acoustic windows known from emergency sonography examination techniques is feasible to 1) verify the correct intravenous localization and direction of the guidewire before final CVC insertion and 2) correctly predict the required CVC length for positioning of the catheter tip in the lower third of the superior vena cava.Material and Methods: This single center prospective observational study included adult patients (age ≥18 years) with an indication for CVC insertion after institutional ethics approval was obtained. Puncture sites were restricted to bilateral internal jugular and subclavian veins and except for duplicate examinations no further exclusion criteria were defined. After vessel puncture and insertion of the guidewire, the vena cava was displayed by an additional ultrasound examiner (sector scanner 1.5-3.6 MHz) using the transhepatic or subcostal acoustic window to localize the guidewire. For positioning of the CVC tip, the required catheter length in relation to the cavoatrial junction was measured using the guidewire marks during slow retraction and consecutive disappearance of the J‑shaped guidewire tip from each acoustic window. From the resulting insertion length of the guidewire 4 cm was subtracted for the transhepatic and 2 cm for the subcostal window under the assumption that this length correlates to the distance from the cavoatrial junction. The CVC was finally inserted and a chest radiograph was performed for radiological verification of the CVC position.Results: Of 100 included patients, 94 could finally be analyzed. The guidewire could be identified in the vena cava in 91 patients (97%) within a time period of 2.2 ± 1.9 min. In three patients, the wire could not be visualized, although two catheters had the correct position, while one catheter was incorrectly positioned in the opposite axillary vein. In the second study part, positioning of the CVC was evaluated in 44 of the 94 patients. In 5 of these 44 patients, the correct direction and disappearance of the guidewire from the acoustic window could also be reliably visualized; however, with the left subclavian vein as the puncture site, the respective catheters were up to 6 cm too short for correct positioning. Thus, these 5 patients were excluded from this analysis. In the remaining 39 patients, the position of the CVC tip was optimally located in the lower third of the superior vena cava according to the chest radiograph in 20 patients (51%), while it was relatively too high in 5 patients (13%) and too low (entrance of the right atrium) in 9 patients. In the other 5 patients, disappearance of the guidewire from the acoustic window was not definitely detectable.Conclusion: The presented intraprocedural ultrasound-based method using two standard acoustic windows is reliable for verification of the correct intravenous location and direction of the guidewire even before dilatation of the vessel puncture site for insertion of the catheter. Furthermore, the method allows the clinically acceptable measurement of the required length for catheter positioning. A chest radiograph can be waived provided the ultrasound examination (identification of the guidewire and exclusion of puncture-related complications such as pneumothorax) is unambiguous. [ABSTRACT FROM AUTHOR]

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Background: The ultrasound-guided venipuncture of the internal jugular vein for placement of a central venous catheter is well established. For verification of the catheter tip position mostly intracardiac ECG or chest radiography are used. Previously, we established the right supraclavicular fossa view for ultrasound based verification of the catheter placement in the superior vena cava utilizing a microconvex probe. The microconvex probe has a small footprint. However, not all ultrasound systems used in the operating theater are equipped with a microconvex transducer.Aim: Thus, we systematically compared the visibility of intrathoracic vessels obtained by a linear and a microconvex prone via the right supraclavicular view.Material and Methods: We assessed the visibility of the junction of the brachiocephalic veins, the superior vena cava, the right pulmonary artery, the ascending aorta and the internal jugular vein, comparing a linear with a microconvex probe when using the right supraclavicular view in healthy volunteers. The superior vena cava also was identified using Doppler ultrasound.Results: With the microconvex probe the superior vena cava was visible in all 30 healthy volunteers, but with a linear transducer it was visible in only 53 %. The combined view of the superior vena cava and the right pulmonary artery was possible in all cases when using the microconvex probe, but in only 38 % when using the linear probe. The junction of the brachiocephalic veins was seen in 75 % of the volunteers with the microconvex probe and in 38 % with the linear one. The aorta was visible in 87 % of cases with the microconvex transducer, but only in 30 % with the linear probe. The internal jugular vein was always visible with either probe.Conclusion: The microconvex transducer as compared to the linear probe is superior in visualizing the superior vena cava. Possible reasons are a smaller footprint, a better degree of freedom for angulation and a greater penetration depth of the microconvex probe. [ABSTRACT FROM AUTHOR]

The knowledge of most oncologic emergencies is crucial in daily practice. Treatment options for the superior vena cava syndrome include chemo-therapy, radiation, and intravenous stenting. Hypercalcemia due to malignancy is treated with aggressive rehydration and intravenous bisphosphohates. Febrile neutropenia is a hematologic emergency that usually requires inpatient therapy with broad-spectrum antibiotics. Epidural spinal cord compression must be recognized early and can be treated with dexamethason, radiation, or surgery. [ABSTRACT FROM AUTHOR]

This article presents a case report on the placement of a central venous catheter (CVC) in a patient with an unknown persistent left superior vena cava (PLSVC). Normally, PLSVCs remain asymptomatic but can be associated with disastrous consequences for the patient during placement of a CVC particularly due to vascular perforation and pulmonary injury. A PLSCV is particularly common in association with congenital heart defects; however, otherwise healthy patients can also be affected. As the presence of a PLSCV is normally unknown special attention must be paid in every patient during placement of a CVC. [ABSTRACT FROM AUTHOR]

Copyright of Langenbeck's Archives of Surgery is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)