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LETTER TO THE EDITOR

A Third Stitch to Prevent Dislodgment of Pediatric Central Venous Catheters

Pediatric Anesthesia Associates, San Antonio, Texas, jrf8556{at}aol.com

To the Editor:

In reading the case report "Life-Threatening Mediatstinal Hematoma Caused by Extravascular Infusion Through a Triple-Lumen Central Venous Catheter" (1), it seems that the origin of this problem was a partial dislodgment of the central line from its original position. The authors note that although they initially advanced the line a distance of 7 cm from the insertion site, the insertion length of the catheter in question was noted to be only 5.5 cm once the deterioration episode had taken place. In a small child, this degree of change could mean the difference between intravascular and extravascular placement of at least the most proximal of the lumens.

To prevent this from occurring, the catheter can be secured with a third stitch placed around the catheter at the insertion site (Fig. 1). The ends of the suture are subsequently brought between the lumens of the catheter (Fig. 2) and tied in place (Fig. 3). For a triple-lumen catheter, the stitch would need to be brought between any two lumens.

View larger version (156K): [in this window] [in a new window]   Figure 1. Catheter is secured with a third stitch placed around the catheter at the insertion site.

View larger version (137K): [in this window] [in a new window]   Figure 2. The ends of the suture are brought between the lumens of the catheter.

View larger version (135K): [in this window] [in a new window]   Figure 3. The ends of the suture are tied in place.

The authors also note that for central venous catheters, placement is not assessed until the postoperative chest radiograph. The use of fluoroscopy during placement will help assess proper placement before use. Although not useful for ruling out pneumothorax, the C-arm is the best way to prove that the central venous catheter is in the proper position before surgical operation gets underway.

Reference

1. Hohlrieder M, Oberhammer R, Lorenz IH, et al. Life-threatening mediastinal hematoma caused by extravascular infusion through a triple-lumen central venous catheter. Anesth Analg 2004;99:31–5.[Abstract/Free Full Text]

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