Precautions with right supraclavicular approach and oximetry central venous catheter

Dear Editor,
This letter describes an extravasation problem case of an Edwards PreSep Oximetry Catheter (Edwards Lifesciences Japan Ltd., Tokyo, Japan) inserted via the right supraclavicular approach and discusses the incompa­tibility between an oximetry central venous catheter (CVC) and the right supraclavicular approach. A 37-year-old female patient (height 163 cm; body mass 42 kg) underwent a pulmonary valve replacement due to stenosis and regurgitation of the transannular patch after corrective surgery for tetralogy of Fallot about 30 years ago. While a Swan-Ganz pulmonary artery catheter provides considerable information concerning patients’ circulatory status such as mixed venous saturation (SvO2) [1] and cardiac output (CO) [2] for the perioperative management, the stay time in the intensive care unit (ICU) is extended and medical costs increase because of its use [3]. Moreover, Swan-Ganz pulmonary artery catheters were reported to increase risks of adverse events, including bacteraemia and pulmonary embolism [4, 5]. Therefore, considering the operative procedure of a pulmonary valve replacement, we decided against the use of a Swan-Ganz pulmonary artery catheter. The perioperative anaesthesia management and haemodynamic monitoring were performed using transoesophageal echocardiography (TOE) in combination with a FloTrac Sensor (Edwards Lifesciences Japan Ltd., Tokyo, Japan) to analyse the CO. An Edwards PreSep Oximetry Catheter was used for the measurement of central venous oxygen saturation (ScvO2) in the superior vena cava (SVC) instead of a Swan-Ganz pulmonary artery catheter.
An 8.5 Fr Edwards PreSep Oxime­try Catheter, a widely used oximetry CVC in adult patients in daily clinical practice, was inserted using the real-time ultrasound-guided right supraclavicular approach [6–9] considering patient comfort, and fixed at an insertion depth of 10 cm (6% of the body height) based on the previous study examining the ideal CVC insertion length [10]. The central venous pressure (CVP) line was connected to the proximal lumen as per the standard protocol in our facility so that the changes in the CVP value and curve could be indicated immediately in case CVC became shallower accidentally. Blood was aspirated from the proximal lumen and the CVP value was within the normal range during surgery. Surgery and intraoperative anaesthesia management were uneventful. Postoperative chest X-ray confirmed that the catheter tip was located exactly...


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