OBJECTIVE: The work presents an alternative approach of central venous catheter (CVC) introduction in patients with congenital or acquired coagulation disorders, in which the introduction by classical Seldinger‘s method would be particularly dangerous or fatal for the development of bleeding complications. These are mainly patients with a disorder of hemocoagulation in whom it is not possible to use a peripheral venous approach to correct the hypocoagulation state. In these cases, and in cases of puncture failure, it is safe to use an alternative approach to the introduction of CVC by open surgery via the extrathoracic veins – cephalic and external jugular vein.
METHODS: In patients with hemocoagulation disorder with high risk of hemorrhagic complications during the classic introduction of CVC by the puncture method, an alternative approach of surgically accessible (prepared) extrathoracal veins – proximal section of the cephalic vein, if this failed – external jugular vein, were used.
RESULTS: From January 2016 to December 2020, surgical approach through cephalic vein was used to introduce CVC in 10 patients for whom it was not possible to use the puncture CVC method for hypocoagulable status: 5 patients on anticoagulant therapy (2 males, 3 females), in 3 patients with metabolic and vascular decompensation of liver cirrhosis (3 males); in 2 patients we used this method in case of failure of the attempt to introduce CVC by the puncture method. Patients were in hemorrhagic shock, and an attempt to introduce a peripheral venous approach was unsuccessful. We achieved full functionality of CVC without bleeding complications. Access via external jugular vein we were not forced to use.
CONCLUSION: Although the group of patients is small, we have shown that for patients at high risk of bleeding (anticoagulated, with liver cirrhosis, intoxicated, septic, etc.), surgically prepared cephalic vein (alternatively external jugular vein) is a useful approach to introduce CVC. The mentioned veins have a constant course and are easily accessible by surgical preparation. This procedure is fast, short-termed, safe, without the risk of severe bleeding, pneumo- and hemothorax, without risk of venous drainage, does not require a control contrast X-ray examination to verify the intravascular position of CVC, any local bleeding can be solved by compression. The position of the CVC thus introduced does not need to be checked by contrast X-ray examination (Ref. 32). Text in PDF www.lekarsky.herba.sk.
KEY WORDS: central venous catheter, Seldinger‘s method, alternative approach, surgical preparation of cephalic vein.
Lek obz 2022, 71 (8): 288-292
Jaroslav ŠIMO 1, Pavel BABÁL 2, Timea ZÁCSIKOVÁ 3
1 I. chirurgická klinika LF UK a UNB Staré Mesto, Bratislava, prednosta prof. MUDr. P. Labaš, CSc.
2 Ústav patologickej anatómie LF UK a UNB, Bratislava, prednosta: prof. MUDr. Ľ. Danihel, PhD.
3 Oddelenie anestéziológie a intenzívnej medicíny LF UK a UNB Staré Mesto, Bratislava, prednosta: MUDr. T. Grgačová
ŠIMO J., BABÁL P., ZÁCSIKOVÁ T.: Surgical method of introducing a central venous catheter as an alternative to the puncture Seldinger‘s method in patients with coagulation disorders. Lek obz 2022, 71 (8): 288-292