A Simple Diagnostic Test to Confirm Correct Placement of Dysfunctional Central Venous Catheters Before Chemotherapy in Children.
BACKGROUND
In children undergoing intravenous chemotherapy, partial dysfunction of the central venous catheter (CVC) is common. Fluids can be infused into the catheter; however, blood cannot be aspirated. In those situations, chemotherapy is withheld and a catheter investigation is performed. Usually, a radiographic study with contrast media or therapy with thrombolytic drugs followed by rechecking for blood return is undertaken.


OBJECTIVE
To evaluate if a previously described method using dilute sodium bicarbonate injection and the resultant rise in measured end-tidal carbon dioxide tracing can confirm correct intravascular placement of a dysfunctional CVC in children at the bedside.


METHODS
Cohort group of 22 children scheduled for chemotherapy with partial dysfunction of a CVC in a tertiary hematology-oncology care facility.


RESULTS
All children with a partial dysfunctional CVC that was proven to be intravascular after venogram or thrombolytic therapy had a distinct and predictable increase in end-tidal carbon dioxide response to injected bicarbonate.


CONCLUSIONS
Injection of 1 mL/kg (maximum 20 mL) of 4.2% dilute sodium bicarbonate is a quick, simple, bedside test allowing confirmation of intravascular location of dysfunctional CVC.
Departments of *Anesthesiology ‡Pediatric Hematology-Oncology, Sheba Medical Center, Tel Hasomer, Israel †Department of Anesthesiology, University of Florida, Gainesville, FL.
Ilan
I
Keidan
Erez
E
Ben-Menachem
Haim
H
Berkenstadt
Amos
A
Toren
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000032:analysis*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D045853:Exhalation; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D000067716:Point-of-Care Testing; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000378:metabolism
D000970:Antineoplastic Agents; D002245:Carbon Dioxide; D017693:Sodium Bicarbonate