Journal of Trauma and Injury

Case Report

A Carbon Monoxide Poisoning Case in Which Hyperbaric Oxygen Therapy Was Not Possible Due to Iatrogenic Pneumothorax after Unnecessary Central Catheterization: Hyung Il Kim, Seong Beom Oh; J Trauma Inj. 2019;32(4):252-257. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.040

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Abstract PDF: Hyperbaric oxygen therapy (HBOT) is used to treat carbon monoxide (CO) poisoning. However, untreated pneumothorax is an absolute contraindication for HBOT. More caution is needed with regard to monoplace hyperbaric chambers, as patient monitoring and life-saving procedures are impossible inside these chambers. Central catheterization is frequently used for various conditions, but unnecessary catheterization must be avoided because of the risk of infection and mechanical complications. Herein, we describe a case of CO poisoning in which iatrogenic pneumothorax developed after unnecessary subclavian central catheterization. The patient did not need to be catheterized, and HBOT could not be performed because of the pneumothorax. Hence, this case reminds us of basic—but nonetheless important—principles of catheterization.; Summary

Original Articles

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients: Dong Yeon Ryu, Sang Bong Lee, Gil Whan Kim, Jae Hun Kim; J Trauma Inj. 2019;32(3):150-156. Published online September 30, 2019; DOI: https://doi.org/10.20408/jti.2019.015

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Abstract PDF

Purpose

To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients.

Methods

From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications.

Results

During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05).

Conclusions

The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

Summary

Citations

Citations to this article as recorded by

Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures
Dasom Kim, Jin Woo Park, Sung Bum Cho, Im Joo Rhyu
Journal of Korean Medical Science.2023;[Epub] CrossRef
The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis
Anju Puri, Haiyun Dai, Mohan Giri, Chengfei Wu, Huanhuan Huang, Qinghua Zhao
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Peripherally Inserted Central Catheter lines for Intensive Care Unit and onco-hematologic patients: A systematic review and meta-analysis
Georgios Mavrovounis, Maria Mermiri, Dimitrios G Chatzis, Ioannis Pantazopoulos
Heart & Lung.2020; 49(6): 922. CrossRef

Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making: Ji Hun Kim, Sang Ook Ha, Young Sun Park, Jeong Hyeon Yi, Sun Beom Hur, Ki Ho Lee; J Trauma Inj. 2018;31(3):135-142. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.022

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Abstract PDF: Purpose
When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision.
Methods
This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017.
Results
Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226).
Conclusions
Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.; Summary

Case Reports

Inadvertent Arterial Catheterization of Central Venous Catheter: A Case Report: Seung Young Oh; J Trauma Inj. 2015;28(4):292-294. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.292

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Abstract PDF: Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger's method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter.; Summary

Urgent Endovascular Stent Graft Placement for Iatrogenic Subclavian Artery Rupture: Byung Woo Kang, Jun Ho BAE, Jin Wook Chung, Byeong Joo Jo, Jun Gi Park, Deuk Young Nah; J Trauma Inj. 2015;28(2):83-86. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.83

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Abstract PDF: Central venous cannulation is one of the most commonly performed procedures for critically ill patients in the emergency room. Serious complications like a rupture of subclavian artery may occur during this procedure. We report a case of successful stent graft deployment for iatrogenic ruptured subclavian artery after attempted right subclavian vein catheterization in a 31 year-old female patient with hypovolemic shock due to cervical os laceration during vaginal delivery.; Summary

Accidental Vertebral Artery Cannulation as a Complication of the Central Venous Catherization: Ju Ho Jeong; J Trauma Inj. 2014;27(2):33-37.

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Abstract PDF: Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.; Summary

Original Article

Optimal Insertion Angle between the Skin and Needle in Ultrasound-Guided Internal Jugular Vein Catheterization with Trauma Patients: Hyun Min Jeon, Sung Min Jung, Ru Bi Jung, Jin Jeon, Chong Kun Hong, Tae Yong Shin, Young Rock Ha, Young Sik Kim; J Trauma Inj. 2013;26(3):183-189.

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Abstract PDF: PURPOSE
The aim of this study was to identify the optimal insertion angle between the skin and the needle in ultrasound-guided internal jugular vein (IJV) catheterization with trauma patients.
METHODS
From March 2012 to December 2012, consecutive trauma patients who were planned to receive IJV catheterization were prospectively enrolled. We measured the distances from the skin to IJV's anterior-posterior (AP) vessel wall on the longitudinal scan's midline in supine-positioned patients. We calculated the AP diameter of IJV and the angle between skin and the imaginary line from the puncture site to the IJV's internal center on screen's midline (defined as optimal angle which is considered as the safest approach) on the longitudinal scan. We divided the patients into 3 groups based on the CVP (low CVP <5 cmH2O, 5< or = middle CVP < or =10 cmH2O, and high CVP>10 cmH2O) and compared their mean anterior posterior (AP) diameters and optimal angles.
RESULTS
A total of 56 patients were enrolled. Of these 21 were women(35.4%). The mean AP diameter of low CVP group was significantly lower than middle and high CVP groups(0.68+/-0.30, 1.06+/-0.31, and 1.23+/-0.49 cm respectively, p=0.003 vs. 0.002). There was no significant difference among 3 groups' mean optimal angles (28.1+/-6.1, 30.1+/-4.5, and 28.0+/-5.0 degree respectively).
CONCLUSION
The optimal angle between the skin and the needle in ultrasound-guided IJV catheterization with trauma patients is not changed as about 30 degrees regardless of CVP even though IJV's diameter is altered in proportion to the CVP.; Summary

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