Risk of extravasation after power injection of contrast media via the proximal port of multilumen central venous catheters: case report and review of the literature.
OBJECTIVE
Multilumen central venous catheters (CVCs) are not commonly used for power injection. However, in critically ill patients, CVCs-- most of which do not have FDA approval for power injection--may be the only available venous access.


METHODS
The pitfalls of multilumen CVCs are illustrated by a case report of a patient in whom extravasation of intravenously administered contrast medium occurred after power injection in a triple-lumen CVC using the lumen with the port furthest from the catheter tip.


RESULTS
The underlying mechanisms for the displacement of the initially correctly placed right subclavian CVC could include elevation of both arms of the obese patient or the power injection itself. The distances between port openings and catheter tips of various commercially available multilumen CVCs are assessed. We examine the possible caveats of ECG-guided CVC placement for optimal tip position, discuss technical difficulties related to power injection via CVCs, and review commonly used drugs that may cause extravasation injury.


CONCLUSIONS
Knowledge of the distances between CVC port openings and the catheter tip are essential for safe intravasal administration of fluids.
Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität, Albert-Schweitzer-Strasse 2, Suhl. cwsm.schummer@gmx.de
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Schummer
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Sakr
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Steenbeck
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Gugel
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Reinhart
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Schummer
D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000295:instrumentation; D007362:Intensive Care Units; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D008100:Liver Abscess / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008482:Mediastinum / Q000000981:diagnostic imaging; D009333:Neck / Q000000981:diagnostic imaging; D009765:Obesity / Q000150:complications; D011785:Quality Assurance, Health Care; D012772:Shock, Septic / Q000000981:diagnostic imaging*; D012782:Shoulder / Q000000981:diagnostic imaging; D013350:Subclavian Vein; D036542:Tomography, Spiral Computed; D014683:Vena Cava, Superior
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide