A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient
Authors: Robert S. Brown, Ducksoo Kim
Journal: Annals of Internal Medicine (2018)

Letters2 April 2019A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused PatientRobert S. Brown, MD and Ducksoo Kim, MDRobert S. Brown, MDBeth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.S.B.)Search for more papers by this author and Ducksoo Kim, MDBoston Veterans Administration Health Care and Boston University School of Medicine, Boston, Massachusetts (D.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0439 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Sometimes patients inadvertently dislodge or pull out central venous catheters; in other cases, they are removed intentionally by patients who are confused. Although this behavior is uncommon, it does occur and may have negative consequences. For example, removing a catheter this way carries the risk for serious bleeding and air embolism (1, 2). In addition, dislodging a central venous catheter may interfere with hemodialysis, administration of fluid calories, and other critical care treatments (3–5). Moreover, repositioning or replacing a catheter involves additional discomfort, risks, and expense and diverts physicians and nurses from caring for other patients. Also, in misguided ...References1. Capozzoli G, Schenk C, Vezzali N. Cerebral air embolism after central dialysis line removal: the role of the fibrin sheath as portal (mechanism) of air entry. J Vasc Access. 2012;13:516-9. [PMID: 22307466] CrossrefMedlineGoogle Scholar2. Nagai H, Maeda H, Kuroda R, Komori M, Nakajima M, Nara A, et al. Lethal pulmonary air embolism caused by the removal of a double-lumen hemodialysis catheter. Am J Forensic Med Pathol. 2014;35:237-8. [PMID: 25376711] CrossrefMedlineGoogle Scholar3. Bream PR. Update on insertion and complications of central venous catheters for hemodialysis. Semin Intervent Radiol. 2016;33:31-8. [PMID: 27011425] CrossrefMedlineGoogle Scholar4. Clark E, Kappel J, MacRae J, Dipchand C, Hiremath S, Kiaii M, et al; Canadian Society of Nephrology Vascular Access Work Group. Practical aspects of nontunneled and tunneled hemodialysis catheters. Can J Kidney Health Dis. 2016;3:2054358116669128. [PMID: 28270920] CrossrefMedlineGoogle Scholar5. Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol. 2013;68:529-44. [PMID: 23415017] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.S.B.)Boston Veterans Administration Health Care and Boston University School of Medicine, Boston, Massachusetts (D.K.)Note: Both authors were the sole contributors to the technical innovation and content of the manuscript.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0439.This article was published at Annals.org on 25 December 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient Robert S. Brown and Ducksoo Kim A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient Bharat Nathoo , Marianne Stroz , and Peter Stroz A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient Anil K. Agarwal Metrics Cited byA Central Venous Catheter That Cannot Be Dislodged Easily by a Confused PatientBharat Nathoo, MD, Marianne Stroz, MD, and Peter Stroz, MDA Central Venous Catheter That Cannot Be Dislodged Easily by a Confused PatientAnil K. Agarwal, MD 2 April 2019Volume 170, Issue 7Page: 503-504KeywordsCathetersJugular veinMedical dialysisPatient advocacyPeripheral vascular diseasePeritoneal dialysisRenal failureStable coronary artery diseaseStrokeType 2 diabetes ePublished: 25 December 2018 Issue Published: 2 April 2019 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...