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Tunneled central venous catheter exchange: techniques to improve prevention of air embolism

Tunneled central venous catheter exchange: techniques to improve prevention of air embolism

forthcoming

Article Type: TECHNIQUES IN VASCULAR ACCESS

Article Subject: Interventional radiology

DOI:10.5301/jva.5000483

Authors

Rossi, Umberto G. Torcia, Pierluca Rigamonti, Paolo Colombo, Francesca Giordano, Antonino Gallieni, Maurizio Cariati, Maurizio

Abstract

Malfunctioning tunneled hemodialysis central venous catheters (CVCs), because of thrombotic or infectious complications, are frequently exchanged. During the CVC exchanging procedure, there are several possible technical complications, as in first insertion, including air embolism. Prevention remains the key to the management of air embolism. Herein, we emphasize the technical tricks capable of reducing the risk of air embolism in long-term CVC exchange. In particular, adoption of a 5 to 10 degrees Trendelenburg position, direct puncture of the previous CVC venous lumen for guide-wire insertion, as opposed to guide-wire introduction after cutting the CVC, a light manual compression of the internal jugular vein venotomy site after catheter removal. The Valsalva maneuvre in collaborating patients, valved introducers, and correction of hypovolemia are also useful precautions. Principles of air embolism diagnosis and treatment are also outlined in the article.

Article History

  • • Accepted on 02/09/2015
  • • Available online on 04/12/2015

Disclosures

Financial support: There was no financial support for the paper.
Conflict of interest: All authors have nothing to disclose.

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Authors

  • Rossi, Umberto G. [PubMed] [Google Scholar] 1, * Corresponding Author (urossi76@hotmail.com)
  • Torcia, Pierluca [PubMed] [Google Scholar] 1
  • Rigamonti, Paolo [PubMed] [Google Scholar] 1
  • Colombo, Francesca [PubMed] [Google Scholar] 2
  • Giordano, Antonino [PubMed] [Google Scholar] 2
  • Gallieni, Maurizio [PubMed] [Google Scholar] 2
  • Cariati, Maurizio [PubMed] [Google Scholar] 1

Affiliations

  • Department of Diagnostic Sciences, Division of Radiology and Interventional Radiology, San Carlo Borromeo Hospital, Milan - Italy
  • Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”, University of Milan, Milan - Italy

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