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An axial CT scan shows air embolism with air in the pulmonary artery following the withdrawal of a central venous line (arrow).
Source publication
Placements of central venous lines (CVC), percutaneous intrathoracic drains (ITDs), and nasogastric tubes (NGTs) are some of the most common interventional procedures performed on patients that are unconscious and in almost all intensive care/high dependency patients in one form or the other. These are standard procedures within the remit of physic...
Citations
... In oncology, it used for infusion therapy purposes & hemodynamic monitoring. Avoiding complications from CVC, placement is a subject of particular concern and interest in the ongoing era of quality and safety culture [6]. ...
... While the enteral nutrition is devoid of risk of complications associated with central venous catheter insertion for parental nutrition, the hazard of pulmonary complications with feeding tube insertion is comparable to that of central line [2]. ...
Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.
... [28,35] Another major complication is pneumothorax (seen in 0.1-15% of cases). [36] Figure 5 depicts a patient with placement of a TDC via the right SCV (RSV). ...
The role of interventional radiology in the overall management of patients on dialysis continues to expand. In patients with end-stage renal disease (ESRD), the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an integral component of treatment plans. Unfortunately, long-term use of TDCs often leads to infections, acute occlusions, and chronic venous stenosis, depletion of the patient's conventional access routes, and prevention of their recanalization. In such situations, the progressive loss of venous access sites prompts a systematic approach to alternative sites to maximize patient survival and minimize complications. In this review, we discuss the advantages and disadvantages of each vascular access option. We illustrate the procedures with case histories and images from our own experience at a highly active dialysis and transplant center. We rank each vascular access option and classify them into tiers based on their relative degrees of effectiveness. The conventional approaches are the most preferred, followed by alternative approaches and finally the salvage approaches. It is our intent to have this review serve as a concise and informative reference for physicians managing patients who need vascular access for hemodialysis.
... This is not without risk or complication. [1][2][3][4] The American College of Radiology therefore recommends immediate imaging for those undergoing such procedures. 1 We aim to present a pictorial case series of misplaced hardware so as to emphasise the necessity of radiological follow-up, highlight possible adverse outcomes, and demonstrate the salient features. ...
... Bronchial placement may cause atelectasis, bronchial perforation, pneumo/haemo/hydro-thorax, pulmonary contusion, haemorrhage or severe pneumonia, pneumonitis or lung abscess in the case of feeding. [1][2][3][4] ...
... Radiographical features include ETT lateral to the trachea and hyperinflation of the stomach. [1][2][3][4] ...
Procedures such as the placement of central venous catheters, nasogastric tubes, endotracheal tubes and pleural drains are frequently performed within the hospital setting. This is not without risk or complication. The American College of Radiology therefore recommends immediate imaging for those undergoing such procedures. We aim to present a pictorial case series of misplaced hardware so as to emphasise the necessity of radiological follow-up, highlight possible adverse outcomes, and demonstrate the salient features.
Purpose
Enteral access via nasogastric tube (NGT) placement can be essential in the provision of care in pediatric patients. Methods exist to confirm correct placement with success rates between 80% and 85%. Radiographic confirmation remains the “gold‐standard,” however; it exposes patients to ionizing radiation and fails to provide “real‐time” information. In this study, we determined the feasibility of using sonography to assist in the placement of NGT insertions in pediatric patients that have difficulty cooperating.
Methods
Thirty patients requiring NGT placement were stratified into three age groups. Upon NGT insertion, transverse and longitudinal ultrasound images were acquired to visualize tube progression through the esophagus. Subsequently, a focused ultrasonographic exam of the gastric antrum and body were performed. If amenable, an air bolus (1 mL/kg) was injected in the stomach if the NGT was not directly visualized. Following intubation, standard guidelines for NGT position confirmation were performed.
Results
The NGT was visualized in all esophageal views and 52% of gastric views. Subgroup analysis showed that successful visualization of tube placement in the stomach ranged from 40% (7‐18 years) to 70% (3‐6 years). Eighty percentage of air boluses injected were visualized.
Conclusion
The use of ultrasonography may assist NGT placement in pediatric patients and reduce the incidence of suboptimal placement during insertion. We demonstrated successful NGT visualization through the esophagus regardless of age. NGT visualization in the stomach was challenging; however, injection of an air bolus may improve visualization. Further studies are required to improve the success rate of obtaining gastric views of the NGT.
Central venous (CV) catheterization can be lifesaving but is associated with considerable complication rates. Most complications are minor, but some of these can be fatal. In this article, we review various complications related to CV catheterization and access port implantation, and discuss how to avoid and treat the complications.
