Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Mar 2019

Subclavian Vein Catheter Extravasation—Insufficient Catheter Length as a Probable Causal Factor

DipAppSc, BHSc, ICCert, RN, APRN, VA-BC™ (ORCID 0000-0002-3128-2034)
Page Range: 46 – 51
DOI: 10.1016/j.java.2018.31.006
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Abstract

Central venous catheters are used extensively throughout critical care, anesthesia, and emergency medicine, and are now growing increasingly in their use outside of the critical care arena. With the mounting need to preserve patients' vessel health for future therapies, central venous catheterization is often an essential therapeutic intervention for many patients and is not without risk. There is an ever-growing volume of published extravasation injuries associated with peripheral intravenous devices and the power injection of contrast media in both adult and child health. Compared with the pediatric and neonatal populations, there is almost no evidence related specifically to inappropriate central venous catheter length and extravasation within the adult domain. Any type of extravasation poses a serious risk for the patient, and significant tissue-related consequences require immediate attention to restrict further injury. The accurate length for any central venous catheter is considered a vital patient factor when a device is selected for parenterally administered therapies; and while this is not the sole contributory indicator, it is a consideration that should not be overlooked by the inserting clinician. This paper explores the singularity of inappropriate catheter length, through corroborating evidence and a case study, as a plausible cause for central venous catheter extravasation-related injuries, and seeks to provide a clearer understanding for all clinicians with regard to recognizing correct catheter length when inserting or when providing safe central venous catheter practices and management.

Copyright: © 2019 Association for Vascular Access
Figure 1
Figure 1

Pythagoras' theorem relating to ultrasound beam and needle insertion angle to calculate appropriate subcutaneous catheter length. Reprinted with permission from Pandurangadu AV, Tucker J, Brackney AR, Bahl A. Ultrasound-guided intravenous catheter survival impacted by amount of catheter residing in the vein. Emerg Med J. 2018;35:550–555. © Author(s) (or their employer(s)) 2018.


Figure 2
Figure 2

(a) The intercostal spaces and potential catheter tip position to SVC and CAJ. (b) Non-ideal positioning for catheter tip locations high in the proximal SVC. ICS = intercostal space; RIV = right innominate vein; SVC = superior vena cava; CPA = cardiophrenic angle; RA = right atrium; RV = right ventricle. Reprinted with permission from Symington KE, http://www.sweetspot-venouscatheter.com/. Accessed on December 5, 2018.


Figure 3
Figure 3

Extravasation injury area around right infraclavicular central venous catheter site. Skin puncture point of the catheter at lateral border of extravasation marking (black arrowhead). Reprinted with permission from Bronshteyn YS, Bittner EA. Images in Anesthesiology: Examining the Edges of Extravasation. Anesthesiology. 2017 Apr 1;126:716 © Author(s) (or their employer(s)) 2018.


Figure 4
Figure 4

Clear delineation of tissue injury around right infra-clavicular area. Needle puncture point (black arrowhead) is clearly seen after device/dressing removal (day 4). Reprinted with permission from Bronshteyn YS, Bittner EA. Images in Anesthesiology: Examining the Edges of Extravasation. Anesthesiology. 2017 Apr 1;126:716. © Author(s) (or their employer(s)) 2018.


Contributor Notes

Correspondence concerning this article should be addressed to tim.spencer68@icloud.com
Received: 19 Oct 2018
Accepted: 21 Jan 2019
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