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A Third Stitch to Prevent Dislodgment of Pediatric Central Venous Catheters

Hohlrieder, Matthias MD; Margreiter, Josef MD; Keller, Christian MD, MSc

doi: 10.1213/01.ANE.0000156677.31054.0B
Letters to the Editor: Letters & Announcements

Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Innsbruck, Austria, matthias.hohlrieder@uibk.ac.at

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In Response:

We thank Dr. Furman for his interest in our case report describing a life-threatening complication caused by extravascular infusion through a triple-lumen central venous catheter in a child.

In fact, the origin of the complication we described was a partial dislodgment of the central line from its initial position. The additional fixation by a third stitch placed around the catheter as described might actually prevent this problem with the catheter Dr. Furman used but not with ours. Securing the catheter in Dr. Furman’s way is only possible if the catheter is advanced to the full insertion length. Shorter insertion lengths require fastening the catheter with catheter clamps and preclude the suggested fixation. Furthermore, we take into consideration that a stitch placed around the catheter at the insertion site might be able to narrow the lumen of the catheter.

In accordance with Dr. Furman, we believe that the use of fluoroscopy during placement of the catheter helps assess proper placement. In particular, intravascular misplacements with the tip of the catheter in the contralateral subclavian vein, in the internal jugular vein, in the right atrium, or right ventricle can easily be detected.

Matthias Hohlrieder, MD

Josef Margreiter, MD

Christian Keller, MD, MSc

Department of Anesthesiology and Critical Care Medicine

University of Innsbruck

Innsbruck, Austria

matthias.hohlrieder@uibk.ac.at

© 2005 International Anesthesia Research Society