%0 Journal Article %1 ostroff2021tunneled %A Ostroff, Matthew D %A Kushner, Beth %D 2021 %J Emergency Medicine Investigations (ISSN: 2475-5605) %K Central Emergency Jugular Long-term Tunneled access catheter department venous %N 2 %P 5 %T Tunneled Central Venous Catheter Placement in the Emergency Department: Bringing Interventional Radiology Techniques to the Bedside %U https://www.gavinpublishers.com/article/view/tunneled-central-venous-catheter-placement-in-the-emergency-department-bringing-interventional-radiology-techniques-to-the-bedside %V 6 %X Background: Patients with long-term vascular access devices such as a tunneled venous catheter have little recourse for catheter repair or replacement in the emergency department (ED). This often results in a hospital admission awaiting repair or replacement in the interventional radiology suite. This case report describes a patient with congestive heart failure receiving long term inotrope therapy through a right upper extremity peripherally inserted central catheter (PICC), presenting to the emergency department on a Friday night with neck pain, headache, and intermittent chest/clavicular pain. The electrocardiogram demonstrated a prolonged QT interval. The physical exam revealed swelling and pain in the region of the chest and clavicular region. A chest radiograph confirmed the tip of the PICC terminating in the clavicular region at the junction of the subclavian and cephalic veins. A computed tomography (CT) scan of the thorax without contrast revealed diffuse surrounding infiltration or thrombosis in the region of the catheter tip indicating the need for device removal. Replacement of the PICC through a wire exchange was not an option due to the compromised vasculature of the right subclavian vein and placement on the left side was not favorable due to the existence of a left-sided automated implantable cardiac defibrillator. This patient would require placement of a tunneled catheter. Tunneled central line catheters are traditionally placed in interventional radiology which would not re-open for four days (due to a holiday weekend) requiring a five-day patient admission. St Joseph’s Health, Paterson, NJ, expanded the point of care services with an innovative ultrasound-guided multidisciplinary nurse practitioner led vascular access department providing hospital wide bedside- tunneled catheter placement. In this unique case, the patient’s non-cardiac related chest pain was resolved with PICC removal and same-day bedside placement of a tunneled central venous catheter with subsequent discharge to continue home inotrope infusion therapy.

@article{ostroff2021tunneled, abstract = {Background: Patients with long-term vascular access devices such as a tunneled venous catheter have little recourse for catheter repair or replacement in the emergency department (ED). This often results in a hospital admission awaiting repair or replacement in the interventional radiology suite. This case report describes a patient with congestive heart failure receiving long term inotrope therapy through a right upper extremity peripherally inserted central catheter (PICC), presenting to the emergency department on a Friday night with neck pain, headache, and intermittent chest/clavicular pain. The electrocardiogram demonstrated a prolonged QT interval. The physical exam revealed swelling and pain in the region of the chest and clavicular region. A chest radiograph confirmed the tip of the PICC terminating in the clavicular region at the junction of the subclavian and cephalic veins. A computed tomography (CT) scan of the thorax without contrast revealed diffuse surrounding infiltration or thrombosis in the region of the catheter tip indicating the need for device removal. Replacement of the PICC through a wire exchange was not an option due to the compromised vasculature of the right subclavian vein and placement on the left side was not favorable due to the existence of a left-sided automated implantable cardiac defibrillator. This patient would require placement of a tunneled catheter. Tunneled central line catheters are traditionally placed in interventional radiology which would not re-open for four days (due to a holiday weekend) requiring a five-day patient admission. St Joseph’s Health, Paterson, NJ, expanded the point of care services with an innovative ultrasound-guided multidisciplinary nurse practitioner led vascular access department providing hospital wide bedside- tunneled catheter placement. In this unique case, the patient’s non-cardiac related chest pain was resolved with PICC removal and same-day bedside placement of a tunneled central venous catheter with subsequent discharge to continue home inotrope infusion therapy.}, added-at = {2021-11-11T12:09:40.000+0100}, author = {Ostroff, Matthew D and Kushner, Beth}, biburl = {https://www.bibsonomy.org/bibtex/2abd1d52732f84e2cfe160fb6d2560648/alyssacarter}, interhash = {2770f1d102f54a12394be8b9007e7130}, intrahash = {abd1d52732f84e2cfe160fb6d2560648}, issn = {2475-5605}, journal = {Emergency Medicine Investigations (ISSN: 2475-5605)}, keywords = {Central Emergency Jugular Long-term Tunneled access catheter department venous}, language = {ENGLISH}, month = may, number = 2, pages = 5, timestamp = {2021-11-11T12:09:40.000+0100}, title = {Tunneled Central Venous Catheter Placement in the Emergency Department: Bringing Interventional Radiology Techniques to the Bedside}, url = {https://www.gavinpublishers.com/article/view/tunneled-central-venous-catheter-placement-in-the-emergency-department-bringing-interventional-radiology-techniques-to-the-bedside}, volume = 6, year = 2021 }