Examination of the fluid found only a few red blood cells, no significant levels of amylase, and no particulate matter, and it was decided not to perform exploratory laparotomy. Fluid was obtained during diagnostic peritoneal lavage. One femoral artery sustained an iatrogenic intimal injury and required open repair. The aortic injury was repaired using an endograft with access via both femoral arteries. He had no injuries to his central nervous system or vertebral column.įigure 1 - Chest radiograph shows migration of the right IJV catheter into the patient's neck (arrow). He also had minimal bilateral pulmonary contusions moderate hemoperitoneum with no evidence of solid organ injury a closed, comminuted fracture of his right tibia and fibula a fracture of his right elbow and numerous abrasions and contusions. He sustained a contained traumatic tear of his thoracic aorta distal to the origin of the left subclavian artery. Case reportĪ 19-year-old man, weighing approximately 100 kg, was involved in a high-speed motor vehicle collision. When these devices have to be replaced, it may be necessary to perform the exchange using a guidewire. Despite the advent of real-time ultrasound imaging at the bedside, satisfactory peripheral and central venous access sites unfortunately tend to disappear over time in ICU patients. Most are used on a short-term basis, but these catheters have become increasingly necessary adjuncts in the management of long-term intensive care unit (ICU) patients. Although other institutions may use the same or similar approaches to guidewire exchange, the author's literature review did not identify other English-language descriptions of the technique detailed in this article.Ĭonclusion: Clinicians should consider using the technique described in this paper for any patient who requires exchange of a centrally or peripherally inserted catheter.Ĭentral venous catheters are routinely inserted in the acute care setting for a variety of monitoring and therapeutic indications. ![]() ![]() Results and discussion: This paper details a simple technique of catheter preparation and exchange that is designed to minimize the chance of an infectious complication arising from insertion of a replacement catheter. This procedure can be awkward, and great care must be taken to minimize the risk of infection. ![]() Introduction: Sometimes only a limited number of sites are available for central venous catheter insertion, and a malfunctioning or infected catheter must be replaced using an exchange over a guidewire.
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