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PART 6 — MISCELLANEOUS
Critical Thinking Question
1. While examining the subclavian vein of a patient with a peripherally inserted central vein access device, you notice the bright acoustic reflections of the catheter within the vein. A colleague who is observing the ultrasound asks if that is the catheter tip. What is your answer?
2. You are assisting during the placement of a central venous line via the internal jugular vein. Following the procedure, a hematoma is observed in the area of the puncture. Is this a normal occurrence and what could be done next?
REFERENCES
1. Rothschild JM. Ultrasound guidance of central vein catheterization. http://www.ahrq.gov/ clinic/ ptsafety/chap21.htm. Published 2001. Accessed June 4, 2007.
2. Markowitz JD, ed. Making health care safer: a critical analysis of patient safety practices. http://archive.ahrq.gov/clinic/ptsafety/. Published July 2001. Accessed June 4, 2007.
3. Lameris JS, Post PJ, Zonderland HM. Percutaneous placement of Hickman catheters: comparison of sonographically guided and blind techniques. Am J Roentgenol. 1990; 155(5):1097–1099.
4. Gordon AC, Saliken JC, Johns D, et al. US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol. 1998;9:333–338.
5. National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Clinical practice guidelines and recommendations: vascular access. http://www.kidney.org/professionals/ kdoqi/guideline_uphd_pd_va/index.htm. Published 2006. Accessed June 2011.
6. Seneff MG. Central venous catheters. In: Rippe JM, Irwin RS, Alpert JS, et al., eds. Intensive Care Medicine. 2nd ed. Boston, MA: Little Brown and Co.; 1991:17–37.
7. Sofocleous CT, Schur I, Cooper SG, et al. Sonographically guided placement of periph- erally inserted central venous catheters: review of 355 procedures. Am J Roentgenol. 1998;170:1613–1616.
8. Funaki B. Central venous access: a primer for the diagnostic radiologist. Am J Roentgenol. 2002;179:309–318.
9. Lefrant JY, Muller L, De La Coussaye JE. Risk factors of failure and immediate complica- tion of subclavian vein catheterization in critically ill patients. Intensive Care Med. 2002;28: 1036–1041.
10. Chimochowski GE, Worley E, Rutherford WE, et al. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron. 1990;54:154–161.
11. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348:1123–1133.