Kaohsiung Journal of Medical Sciences
Volume 23, Issue 9 , Pages 435-441, September 2007

Transesophageal Echocardiography and Laryngeal Mask Airway for Placement of Permanent Central Venous Catheter in Cancer Patients with Radiographically Unidentifiable SVC-RA Junction: Effectiveness and Safety

  • Jong-Hau Hsu

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Chiayi, Taiwan
    • ,
  • Chien-Kuo Wang

      Affiliations

    • Department of Medical Imaging, Kaohsiung Medical University Hospital, Chiayi, Taiwan
    • ,
  • Chueh-Wen Hung

      Affiliations

    • Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Chiayi, Taiwan
    • ,
  • Shie-Shan Wang

      Affiliations

    • Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
    • ,
  • Kuang-I Cheng

      Affiliations

    • Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Chiayi, Taiwan
    • Deparrment of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Kuang-I Cheng, Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shan-Ming Road, Kaohsiung 812, Taiwan
    • ,
  • Jiunn-Ren Wu

      Affiliations

    • Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, Chiayi, Taiwan
    • Deparrment of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Received 8 March 2007; accepted 13 April 2007.

Article Outline

In patients who require a permanent central venous catheter (PCVC), the usual aim is to put the catheter tip at the superior vena cava and right atrium (SVC-RA) junction. However, there is no study regarding how to guide the positioning of the catheter tip when the SVC-RA junction cannot be identified on chest radiograph. The objectives of this prospective study were: (1) to investigate the incidence and etiologies of radiographically undetermined SVC-RA junctions in cancer patients undergoing PCVC implantation; and (2) to evaluate the feasibility, effectiveness and safety of combined transesophageal echocardiography (TEE) and laryngeal mask airway (LMA) to guide the positioning of catheters during implantations in patients without this radiographic landmark. Over a 1-year study period, 83 consecutive patients with oncologic diseases who required implantation of a PCVC in a tertiary center were screened. Their preoperative chest radiographs were examined by radiologists to identify the presence of the SVC-RA junction. Patients without a radiographically identifiable SVC-RA junction were classified as cancer-related or cancer-unrelated in terms of etiology. For patients without this landmark, we used TEE with a pediatric biplane transducer and a LMA under intravenous general anesthesia during PCVC implantation to guide the positioning of the catheter tip at the SVC-RA junction. We found that in 16% (13/83) of patients, the SVC-RA junction could not be identified on radiograph. Among the 13 patients, only three (23%) had cancer-related etiologies. In all of the 13 patients, the LMA was successfully placed after the TEE transducer was inserted. No episode of air leak from the LMA was found during surgery. All had the catheter tip positioned in the anatomic SVC-RA junction under TEE guidance. In conclusion, 16% of cancer patients requiring PCVC implantation had no identifiable SVC-RA junction on chest radiograph and most causes were cancer-unrelated. In patients without a radiographically identifiable SVC-RA junction, guidance by TEE under LMA general anesthesia is a feasible, safe and effective management to position a PCVC at the SVC-RA junction.

Key Words:  laryngeal mask airway , permanent central venous catheter , SVC-RA junction , transesophageal echocardiography

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References 

  1. Andropoulos DB , Stayer SA , Bent ST , et al.   A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients . Anesth Analg . 1999;89:65–70
  2. Andropoulos DB . Transesophageal echocardiography as a guide to central venous catheter placement in pediatric patients undergoing cardiac surgery . J Cardiothorac Vasc Anesth . 1999;13:320–321
  3. Collier PE , Goodman GB . Cardiac tamponade caused by central venous catheter perforation of the heart: a preventable complication . J Am Coll Surg . 1995;181:459–463
  4. Duntley P , Siever J , Korwes ML , et al.   Vascular erosion by central venous catheters. Clinical features and outcome . Chest . 1992;101:1633–1638
  5. Petersen J , Delaney JH , Brakstad MT , et al.   Silicone venous access devices positioned with their tips high in the superior vena cava are more likely to malfunction . Am J Surg . 1999;178:38–41
  6. Collier PE , Ryan JJ , Diamond DL . Cardiac tamponade from central venous catheters. Report of a case and review of the English literature . Angiology . 1984;35:595–600
  7. Hsu JH , Wang CK , Chu KS , et al.   Comparison of radiographic landmarks and the echocardiographic SVC/RA junction in the positioning of long-term central venous catheters . Acta Anaesthesiol Scand . 2006;50:731–735
  8. Aslamy Z , Dewald CL , Heffner JE . MRI of central venous anatomy: implications for central venous catheter insertion . Chest . 1998;114:820–826
  9. Ferson D , Thakar D , Swafford J , et al.   Use of deep intravenous sedation with propofol and the laryngeal mask airway during transesophageal echocardiography . J Cardiothorac Vasc Anesth . 2003;17:443–446
  10. van Heerden PV , Kirrage D . Large tonsils and the laryngeal mask airway . Anaesthesia . 1989;44:703
  11. Chu KS , Hsu JH , Wang SS , et al.   Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography . Anesth Analg . 2004;98:910–914
  12. Ljung R , van den Berg M , Petrini P , et al.   Port-A-Cath usage in children with haemophilia: experience of 53 cases . Acta Paediatr . 1998;87:1051–1054
  13. McCready CE , Doughty HA , Pearson TC . Experience with the Port-A-Cath in sickle cell disease . Clin Lab Haematol . 1996;18:79–82
  14. Ball AB , Duncan FR , Foster FJ , et al.   Long term venous access using a totally implantable drug delivery system in patients with cystic fibrosis and bronchiectasis . Respir Med . 1989;83:429–431
  15. Naslund E , Wadstrom C , Backman L . Long term home parenteral nutrition using a subcutaneous venous access . Clin Nutr . 1992;11:93–96
  16. Yoon SZ , Shin TJ , Kim HS , et al.   Depth of a central venous catheter tip: length of insertion guideline for pediatric patients . Acta Anaesthesiol Scand . 2006;50:355–357
  17. Fricke BL , Racadio JM , Duckworth T , et al.   Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position . Radiology . 2005;234:887–892

PII: S1607-551X(08)70050-0

doi:10.1016/S1607-551X(08)70050-0

Kaohsiung Journal of Medical Sciences
Volume 23, Issue 9 , Pages 435-441, September 2007

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