New proposed technique developed by scientists for placing a central venous catheter may prevent confused patients from pulling it out or dislodging it easily. Findings from a case report are published in Annals of Internal Medicine.
Physicians from Beth Israel Deaconess Medical Center and Harvard Medical School saw a 77-year-old patient with waxing and waning mental status who required dialysis for chronic kidney failure. The patient became confused and repeatedly pulled out his hemodialysis catheters. Since he was unsuitable for an arteriovenous access and the medical literature offered no solution, the physicians developed a novel technique. They placed a right external jugular vein catheter, tunneling subcutaneously to exit from the patient's upper back, near the midline, just below his neck.
‘Sometimes patients, particularly confused patients, dislodge or pull out central venous catheters inadvertently or intentionally. Although this occurrence is uncommon, it is not rare, and it may have negative consequences.’
It was out of reach to the patient, but not in an area where it would cause pressure on his skin when he was lying on his back. It worked well enough that the authors suggest clinicians consider this placement when caring for patients at risk for central line dislodgement.
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