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 Table of Contents  
LETTER TO THE EDITOR
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 383-384

Sudden occlusion of a central venous catheter port


Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India

Date of Submission10-Jan-2019
Date of Acceptance26-Feb-2019
Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Sarika Katiyar
Department of Anesthesiology and Critical Care, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_78_18

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How to cite this article:
Katiyar S, Dhurwe R. Sudden occlusion of a central venous catheter port. Res Opin Anesth Intensive Care 2019;6:383-4

How to cite this URL:
Katiyar S, Dhurwe R. Sudden occlusion of a central venous catheter port. Res Opin Anesth Intensive Care [serial online] 2019 [cited 2019 Nov 18];6:383-4. Available from: http://www.roaic.eg.net/text.asp?2019/6/3/383/265731



Sir,

Checking for a blood return from a central venous catheter is a significant component of complete catheter patency assessment. Many times, it seems impossible to obtain a blood return, leaving you to think that the catheter has not been properly inserted. We faced a problem after induction of general anesthesia in a 60-year-old woman of ASA grade II who was posted for coronary artery bypass grafting. The patient was properly positioned, and anatomical landmarks were identified for the insertion of a 7 Fr CVC catheter in the right internal jugular vein. Under all aseptic precautions and according to standard protocol, central venous catheterization was carried out successfully at the first attempt using the Seldinger technique, and it was fixed at 13 cm. Blood return was freely observed in the proximal and middle port but not in the distal port. Assuming that the tip of the catheter was getting abutted with the wall of the surrounding structure, we pulled out the catheter slightly, but yet there was no blood return in the distal port.

Finally, we reinserted the guide wire through the catheter to confirm the patency of the distal port. As we railroaded the catheter over the guide wire, we found bits of tissue tangled over it. We removed it over a gauge ([Figure 1]) and railroaded the catheter again over the guide wire and fixed it at 13 cm. Now, all the ports were patent, and blood return was observed. Thereafter, surgery was carried out uneventfully, and postoperative chest radiography was normal. Sudden occlusion of a port could be due to kinking or twisting of the catheter or tubing, resulting in pinching off syndrome [1] and tight sutures, or it could be due to sudden precipitation of the drugs given. Apart from slow obstruction, there can be many causes of port occlusion just after the insertion of a central venous catheter. The absence of a free flow of blood on aspiration from one lumen of a catheter should not be underestimated [2]. In such situations, the catheter should be removed and checked.
Figure 1 Tissue occluding the lumen of the catheter.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and collective review of literature. Am Surg 2004; 70:635–644.  Back to cited text no. 1
    
2.
Pereira S, Preto C, Pinho C, Vasconcelos P. When one port does not return blood: two case reports of rare causes for misplaced central venous catheter. Rev Bras Anestesiol 2016; 66:78–81.  Back to cited text no. 2
    


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