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Onan HB, Piskin FC, Sozutok S, Ekinci F, Yildizdas D. An Alternative Central Venous Access Route for Pediatric Patients with Chronic Critical Illness: The Transhepatic Approach. Indian J Pediatr 2024; 91:254-259. [PMID: 35749038 DOI: 10.1007/s12098-022-04219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the safety and functionality of the transhepatic approach as an alternative route for central venous catheterization in pediatric patients with chronic critical illness. METHODS The study included data of 12 chronic critically ill pediatric patients who underwent central venous catheterization with transhepatic approach. The indications, procedure details, mean patency time, and catheter-related complications were retrospectively analyzed. RESULTS A total of 16 central venous catheters were placed through the transhepatic approach. A 5F port catheter was used in eight attempts, a 5F PICC in two attempts, and an 8-14F Hickman-Broviac catheter in six attempts. All procedures were performed with technical success. The mean patency time of the catheters was 132.1 d (range: 12-540 d). In the long-term follow-up, catheter-related sepsis was detected in a patient, and six catheters lost functionality due to malposition. CONCLUSION The transhepatic approach is a safe and functional alternative route for central venous access in chronic critically ill pediatric patients requiring long-term vascular access. The procedure using ultrasonography and fluoroscopy can be performed with high technical success. In the long-term follow-up, Dacron felt cuff tunneled catheters placed in the subcostal space with a transhepatic approach remained functional for a long time.
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Affiliation(s)
- Hasan Bilen Onan
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey
| | - Ferhat Can Piskin
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey.
| | - Sinan Sozutok
- Department of Radiology, Balcali Hospital, Medical Faculty Cukurova University, Adana, 38000, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey
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Dhochak N, Lodha R. Transhepatic Central Venous Catheterization: Unconventional but Effective! Indian J Pediatr 2024; 91:221-222. [PMID: 37945982 DOI: 10.1007/s12098-023-04935-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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3
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Nath S, Naranje P, Kandasamy D, Singh AK. Fluoroscopy-guided transhepatic vena cava cannulation with a peripherally inserted central venous catheter in a pediatric patient with difficult central venous access. J Anaesthesiol Clin Pharmacol 2023; 39:322-323. [PMID: 37564854 PMCID: PMC10410021 DOI: 10.4103/joacp.joacp_329_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 08/12/2023] Open
Affiliation(s)
- Sayan Nath
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Akhil Kant Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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4
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Ziapour B, Iafrati MD, Indes JE, Chin-Bong Choi J, Salehi P. Safety and Efficacy of Percutaneous Translumbar Inferior Vena Cava Catheters: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34:1075-1086.e15. [PMID: 36806563 DOI: 10.1016/j.jvir.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/21/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To examine the reported adverse events associated with inferior vena cava (IVC) catheterization and investigate the reasons for discrepancies between reports. MATERIALS AND METHODS Cochrane Library trials register, PubMed, Embase, and Scopus databases were systematically searched for studies that included any terms of IVC and phrases related to catheters or central access. Of the 5,075 searched studies, 137 were included in the full-text evaluation. Of these, 37 studies were included in the systematic review, and the adverse events reported in 16 of these 37 identified studies were analyzed. An inverse-variance random-effects model was used to conduct the meta-analysis. Outcomes were summarized by the incidence rate (IR) and 95% CI. RESULTS Compared with that of catheters <10 F in size (IR, 0.08; 95% CI, 0.03-0.12), the incidence of catheter-related infections per 100 catheter days was 0.2 more for catheters ≥10 F in size (IR, 0.28; 95% CI, 0.25-0.31). In addition, dual-lumen catheters showed 0.13 more malfunction per 100 catheter days (IR, 0.27; 95% CI, 0.16-0.37) than that shown by single-lumen catheters (IR, 0.14; 95% CI, 0.09-0.19). Both differences were statistically significant. Other adverse events were malposition (IR, 0.04; 95% CI, 0.04-0.05), fracture (IR, 0.01; 95% CI, 0.00-0.02), kinking (IR, 0.01; 95% CI, 0.00-0.01), replaced catheter (IR, 0.2; 95% CI, 0.1-0.31), removal (IR, 0.13; 95% CI, 0.1-0.16), IVC thrombosis (IR, 0.01; 95% CI, 0.00-0.03), and retroperitoneal hematoma (IR, 0.01; 95% CI, 0.00-0.01), all per 100 catheter days. CONCLUSIONS Translumbar IVC access is an option for patients with exhausted central veins. Small-caliber catheters cause fewer catheter-related infections, and single-lumen catheters function longer.
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Affiliation(s)
- Behrad Ziapour
- Department of General Surgery, State University of New York Downstate Health Sciences University, Brooklyn, New York.
| | - Mark D Iafrati
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey E Indes
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Justin Chin-Bong Choi
- Department of Surgery, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Payam Salehi
- Division of Vascular Surgery, Tufts University School of Medicine, Boston, Massachusetts
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5
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Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050688. [PMID: 35626867 PMCID: PMC9139311 DOI: 10.3390/children9050688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 12/19/2022]
Abstract
Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review.
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Mustroph C, Saberian S, Burch K, Parker P, Wrubel D, Sawvel M. Open Retroperitoneal Inferior Vena Cava Cannulation for Distal Ventriculoatrial Shunt Catheter Placement. Cureus 2022; 14:e21555. [PMID: 35228918 PMCID: PMC8865606 DOI: 10.7759/cureus.21555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/05/2022] Open
Abstract
Multiple alternative sites for distal ventriculoperitoneal shunts have been described including pleural, atrial, ureteral, fallopian, and gallbladder placement. In medically complex patients the sites for cerebrospinal fluid (CSF) diversion can be exhausted. We present a case where open retroperitoneal inferior vena cava cannulation was used for successful atrial catheter placement in a 17-month-old female. The patient had a complex abdominal, pulmonary, and vascular history precluding placement of the distal catheter in other sites or atrial placement through more peripheral venous cannulation. The patient underwent uncomplicated open retroperitoneal exposure of her inferior vena cava (IVC) with cannulation and placement of atrial catheter under fluoroscopic guidance. At the follow-up one year after surgery, the patient did not require revision with appropriate placement of the distal atrial catheter.
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Nas OF, Candan S, Oztepe MF, Kandemirli SG, Bilgin C, Inecikli MF, Ozkaya G, Gokalp G, Ongen G, Erdogan C. Right- Versus Left-Sided Approach for Transhepatic Tunneled Catheter Placement: Is There a Difference? Cardiovasc Intervent Radiol 2021; 44:1039-1047. [PMID: 33928408 DOI: 10.1007/s00270-021-02843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. METHODS We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. RESULTS A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. CONCLUSIONS In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.
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Affiliation(s)
- Omer F Nas
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey.
| | - Selman Candan
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Muhammed F Oztepe
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Sedat G Kandemirli
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
| | - Cem Bilgin
- Department of Radiology, University of Health Sciences Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Mehmet F Inecikli
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Guven Ozkaya
- Department of Statistics, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Gokhan Gokalp
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Gokhan Ongen
- Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, Bursa Medicana Hospital, Bursa, Turkey
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8
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Malviya P, Andrews R, Ghodke A, Patel B, Reddy A. Percutaneous transhepatic vein permcath: A case report. Indian J Nephrol 2020; 30:430-432. [PMID: 33840966 PMCID: PMC8023031 DOI: 10.4103/ijn.ijn_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022] Open
Abstract
In patients with end-stage renal disease (ESRD), functional vascular access is like a lifeline. Among the patients undergoing hemodialysis, arteriovenous fistulas are done in most of them. However, in approximately 15% of these patients with multiple access failures, the use of tunneled dialysis catheters (TDC) for hemodialysis has become an integral component of treatment plans. Unfortunately, in many cases of multiple access failure, it is difficult to get proper access especially if problems with peritoneal dialysis also exist. The problems related to tunneled dialysis catheters are infections, thrombosis, hemorrhage, migration, dislodgement, leakage, kinking, and chronic venous stenosis. The progressive loss of venous access sites requires a systematic approach to alternative sites as it is important for patient survival. Herein, we present a case of ESRD with multiple access failures who was effectively managed with the placement of a percutaneous transhepatic vein permcath. Till date, there is very little data onsuch interventions from India.
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Kariya S, Nakatani M, Maruyama T, Ono Y, Ueno Y, Komemushi A, Tanigawa N. Central venous access port placement by translumbar approach using angio-CT unit in patients with superior vena cava syndrome. Jpn J Radiol 2018; 36:450-455. [PMID: 29744732 DOI: 10.1007/s11604-018-0742-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/29/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the clinical results of central venous access port (CV port) placement by translumbar inferior vena cava cannulation using angio-CT unit for cancer patients with superior vena cava syndrome. MATERIALS AND METHODS A CV port was placed by translumbar inferior vena cava cannulation using an angio-CT unit, in 14 consecutive patients. All patients had occlusion or advanced stenosis of the superior vena cava due to cancer progression. RESULTS The technical success rate of the percutaneous translumbar CV port placement was 100%. The only complication related to port placement was bleeding in the right iliopsoas muscle seen on CT in one patient, but it stopped with conservative treatment. The mean initial device service interval was 125 days (range 6-448 days). Complications in the chronic phase occurred in two patients, one with catheter-related infection and the other with catheter breakage, for a rate of 0.44/1000 catheter days. In the patient with the broken catheter, the port chamber placement site was cut and replaced with a new catheter by guidewire exchange. CONCLUSIONS CV port placement with translumbar inferior vena cava cannulation using an angio-CT unit for cancer patients with superior vena cava syndrome was safe and effective.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
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Tavecchio L, Bedini AV, Lanocita R, Patelli GL, Donati I, Ravasi G. Long-Term Infusion in Cancer Chemotherapy with the Groshong Catheter via the Inferior Vena Cava. TUMORI JOURNAL 2018; 82:372-5. [PMID: 8890973 DOI: 10.1177/030089169608200415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Vascular access through a vein draining into the superior vena cava is commonly used for long-term infusion of drugs inr cancer chemotherapy; prolonged cannulation of the inferior vena cava is generally considered as having an excessively high complication rate. Methods Prolonged cisplatin infusion via the inferior vena cava by means of a Groshong catheter was evaluated in 20 consecutive patients with thoracic malignancies showing evidence of superior vena cava infiltration or obstruction. Results We achieved 1,291 catheter days for our survey with a mean duration of vascular access of 64.5 days per patient and a mean duration of infusion time of 40 days. There were 2 complications, a catheter obstruction after a 7-day rest period and an ileo-femoral thrombosis 6 days after catheter placement. Conclusions Our experience compared favourably with the results obtained by long-term central venous access via the supraumbilical route, and demonstrated the reliability and safety of this approach in cases where the superior vena cava cannulation is technically difficult or impossible.
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Affiliation(s)
- L Tavecchio
- Department of Thoracic Surgery, National Cancer Institute, Milan, Italy
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11
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Grözinger G, Grosse U, Syha R, Hoffmann R, Partovi S, Nikolaou K, Stahl S, Königsrainer A, Thiel K, Thiel C. CT-Guided Translumbar Placement of Permanent Catheters in the Inferior Vena Cava: Description of the Technique with Technical Success and Complications Data. Cardiovasc Intervent Radiol 2018; 41:1356-1362. [PMID: 29675773 DOI: 10.1007/s00270-018-1961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/05/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. MATERIALS AND METHODS This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). RESULTS All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4 months (range 3.4-160 months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CONCLUSIONS CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.
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Affiliation(s)
- Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany.
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Sasan Partovi
- Department of Radiology, Section of Interventional Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Stéphane Stahl
- Department for Plastic, Hand and Reconstructive Surgery, Klinikum Lüdenscheid, Paulmannshöher Straße 14, 58515, Lüdenscheid, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Christian Thiel
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
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Fusaro F, Scarpa MG, Lo Piccolo R, Zanon GF. Central Venous Access in Pediatric Patients. J Vasc Access 2018; 2:125-8. [PMID: 17638274 DOI: 10.1177/112972980100200308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occlusion of traditional sites for central venous cannulation is a challenging problem in patients that require a permanent central venous line for chronic administration of nutrients or drugs. In rare cases, extensive central venous thrombosis of the superior and inferior vena cava may preclude catheterization, and uncommon routes should be used. We describe our approach for placement of chronic central venous lines in two pediatric patients with short bowel syndrome and extensive caval occlusion.
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Affiliation(s)
- F Fusaro
- Department of Pediatric Surgery, University of Padua, Padua - Italy
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13
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Dibb M, Lal S. Home Parenteral Nutrition: Vascular Access and Related Complications. Nutr Clin Pract 2017; 32:769-776. [DOI: 10.1177/0884533617734788] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Martyn Dibb
- Royal Liverpool University Hospital, Liverpool, Merseyside, UK
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14
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Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children. Pediatr Crit Care Med 2017; 18:944-948. [PMID: 28746169 DOI: 10.1097/pcc.0000000000001276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children with congenital heart disease may require long-term central venous access for intensive care management; however, central venous access must also be preserved for future surgical and catheterization procedures. Transhepatic venous catheters may be an useful alternative. The objective of this study was to compare transhepatic venous catheters with traditional central venous catheters regarding complication rate and duration of catheter service. DESIGN Retrospective review of 12 congenital heart disease patients from September 2013 to July 2015 who underwent placement of one or more transhepatic venous catheters. SETTING Single freestanding pediatric hospital located in the central United States. PATIENTS Pediatric patients with congenital heart disease who underwent placement of transhepatic venous catheter. INTERVENTIONS Cohort's central venous catheter complication rates and duration of catheter service were compared with transhepatic venous catheter data. MEASUREMENTS AND MAIN RESULTS Twelve patients had a total of 19 transhepatic venous lines. Transhepatic venous lines had a significantly longer duration of service than central venous lines (p = 0.001). No difference between the two groups was found in the number of documented thrombi, thrombolytic burden, or catheter sites requiring wound care consultation. A higher frequency of infection in transhepatic venous lines versus central venous lines was found, isolated to four transhepatic venous lines that had a total of nine infections. All but one was successfully managed without catheter removal. The difference in the proportion of infections to catheters in transhepatic venous lines versus central venous lines was significant (p = 0.0001), but no difference in the rate of infection-related catheter removal was found. CONCLUSIONS Without compromising future central venous access sites, transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines. Transhepatic venous catheters had a higher infection rate, and further investigation into the etiology is warranted.
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15
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Johnson SM, Garnett GM, Woo RK. A technique for re-utilizing catheter insertion sites in children with difficult central venous access. Pediatr Surg Int 2017; 33:113-117. [PMID: 27743023 DOI: 10.1007/s00383-016-3993-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited for patients with difficult and long-term central venous access needs, particularly those with chronic conditions such as intestinal failure. It is specifically useful when tunneled lines are broken, precipitated or clotted and unamenable to wiring.
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Affiliation(s)
- S M Johnson
- Kapiolani Medical Center for Women and Children, Honolulu, USA. .,University of Hawaii School of Medicine, Honolulu, USA.
| | - G M Garnett
- Kapiolani Medical Center for Women and Children, Honolulu, USA.,University of Hawaii School of Medicine, Honolulu, USA
| | - R K Woo
- Kapiolani Medical Center for Women and Children, Honolulu, USA.,University of Hawaii School of Medicine, Honolulu, USA
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16
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Abstract
OBJECTIVES Patients with congenital heart disease may have limited venous access routes as a result of multiple central venous catheters, surgical interventions, and catheterization procedures. Unconventional venous access includes transhepatic central venous catheter. We evaluated transhepatic central venous catheter placed in patients with congenital heart disease and risk factors associated with complications and outcomes. DESIGN Demographic, procedural, and complication data were retrospectively collected on all patients who underwent transhepatic central venous catheter placement at our center over the past 10 years. SETTING This study was completed in a tertiary congenital heart center. PATIENTS A total of 92 transhepatic central venous catheters were placed in 54 patients (63% male patients). The median age and weight of the patient population was 5.7 months and 5.5 kg, respectively. INTERVENTIONS Placement of a transhepatic central venous catheter. MEASUREMENTS AND MAIN RESULTS Successful catheter placement occurred in 96% of cases with median procedure time of 54 minutes with a procedural complication rate of 14%. A total of 86 complications occurred in 54 catheters placed during 2,166 catheter-days (39.7 complications per 1,000 catheter-days). Individual complication rates per 1,000 catheter-days included catheter dysfunction (14.8), dislodgement (8.8), systemic infection (5.1), thrombosis (4.2), local infection (3.7), and bleeding (3.2). Two complications contributed to patient deaths. Factors associated with developing complications included polyurethane central venous catheters (p = 0.03) and catheter duration at least 21 days (p = 0.004). The overall mortality in this population was 50% with median length of hospitalization of 49 days (interquartile range, 33-97). CONCLUSIONS Transhepatic central venous catheters represent a viable option for patients with limited access. Polyurethane catheters and catheter duration at least 21 days are associated with increased transhepatic central venous catheter complications. Although complication rates are higher than more traditional forms of central venous catheters, the long duration of hospitalization and high mortality rates in this patient population attest to their risks for poor outcomes irrespective of venous access.
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Thoracoscopic-guided Azygos vein Catheterization and Port Implantation in a Child with End-stage Central Venous Access. J Vasc Access 2015; 16:e97-8. [DOI: 10.5301/jva.5000435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 11/20/2022] Open
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Liu F, Bennett S, Arrigain S, Schold J, Heyka R, McLennan G, Navaneethan SD. Patency and Complications of Translumbar Dialysis Catheters. Semin Dial 2015; 28:E41-7. [PMID: 25800550 PMCID: PMC4836066 DOI: 10.1111/sdi.12358] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short- and long-term patency and safety of TLDC. We conducted a retrospective analysis of adult patients who received TLDC for hemodialysis access from June 2006 to June 2013. Patient demographics, comorbid conditions, dialysis details, catheter insertion procedures and associated complications, catheter patency, and patient survival data were collected. Catheter patency was studied using Kaplan-Meier curve; catheter functionality was assessed with catheter intervals and catheter-related complications were used to estimate catheter safety. There were 84 TLDCs inserted in 28 patients with 28 primary insertions and 56 exchanges. All TLDC insertions were technically successful with good blood flow during dialysis (>300 ml/minute) and no immediate complications (major bleeding or clotting) were noted. The median number of days in place for initial catheter, secondary catheter, and total catheter were 65, 84, and 244 respectively. The catheter patency rate at 3, 6, and 12 months were 43%, 25%, and 7% respectively. The main complications were poor blood flow (40%) and catheter-related infection (36%), which led to 30.8% and 35.9% catheter removal, respectively. After translumbar catheter, 42.8% of the patients were successfully converted to another vascular access or peritoneal dialysis. This study data suggest that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access.
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Affiliation(s)
- Fanna Liu
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
- Department of Nephrology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jesse Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Robert Heyka
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Sankar D. Navaneethan
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
- Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, OH
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Pereira K, Osiason A, Salsamendi J. Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm. J Clin Imaging Sci 2015; 5:31. [PMID: 26167389 PMCID: PMC4485188 DOI: 10.4103/2156-7514.157858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022] Open
Abstract
The role of interventional radiology in the overall management of patients on dialysis continues to expand. In patients with end-stage renal disease (ESRD), the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an integral component of treatment plans. Unfortunately, long-term use of TDCs often leads to infections, acute occlusions, and chronic venous stenosis, depletion of the patient's conventional access routes, and prevention of their recanalization. In such situations, the progressive loss of venous access sites prompts a systematic approach to alternative sites to maximize patient survival and minimize complications. In this review, we discuss the advantages and disadvantages of each vascular access option. We illustrate the procedures with case histories and images from our own experience at a highly active dialysis and transplant center. We rank each vascular access option and classify them into tiers based on their relative degrees of effectiveness. The conventional approaches are the most preferred, followed by alternative approaches and finally the salvage approaches. It is our intent to have this review serve as a concise and informative reference for physicians managing patients who need vascular access for hemodialysis.
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Affiliation(s)
- Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Adam Osiason
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
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20
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Edwards A, Veldman A, Nitsos I, Chan Y, Brew N, Teoh M, Menahem S, Schranz D, Wong FY. A percutaneous fetal cardiac catheterization technique for pulmonary valvuloplasty and valvulotomy in a mid-gestation lamb model. Prenat Diagn 2014; 35:74-80. [DOI: 10.1002/pd.4486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Andrew Edwards
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Perinatal Services; Monash Medical Centre; Melbourne Australia
- Fetal Cardiac Unit; Monash Medical Centre; Melbourne Australia
| | - Alex Veldman
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
- Pediatric Heart Center; Justus-Liebig University; Giessen Germany
| | - Ilias Nitsos
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
| | - Yuen Chan
- Department of Pathology; Monash Medical Centre; Melbourne Australia
| | - Nadine Brew
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
| | - Mark Teoh
- Perinatal Services; Monash Medical Centre; Melbourne Australia
- Fetal Cardiac Unit; Monash Medical Centre; Melbourne Australia
| | - Samuel Menahem
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
| | - Dietmar Schranz
- Pediatric Heart Center; Justus-Liebig University; Giessen Germany
| | - Flora Y. Wong
- The Ritchie Centre; Monash Institute of Medical Research-Prince Henry Institute; Melbourne Australia
- Department of Paediatrics; Monash University; Melbourne Australia
- Monash Newborn; Monash Medical Centre; Melbourne Australia
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21
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El Gharib M, Niazi G, Hetta W, Makkeyah Y. Transhepatic venous catheters for hemodialysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Butros SR, Walker TG, Salazar GM, Kalva SP, Oklu R, Wicky S, Ganguli S. Direct translumbar inferior vena cava ports for long-term central venous access in patients with cancer. J Vasc Interv Radiol 2014; 25:556-60. [PMID: 24507994 DOI: 10.1016/j.jvir.2013.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the indications, complications, and long-term results of translumbar port placements to the inferior vena cava for long-term central venous access in a single tertiary center. MATERIALS AND METHODS This retrospective study included all patients with cancer who underwent translumbar port placement from January 2000 to July 2012; 31 patients (all women) with an average age of 53.1 years ± 11.1 (range, 30-77 y) were included in the study. Of these patients, 26 (81%) had breast cancer, 3 had lung cancer, 1 had ovarian cancer, and 1 had rectal cancer. Indications included central venous occlusion in 9 patients (29%) and bilateral mastectomy and lymph node dissection in 22 patients (71%). RESULTS All procedures were technically successful. The overall 30-day complication rate was 9.7% (n = 3). Average catheter use was 14.1 months ± 21 (range, 0.75-108 mo). Thirteen (41.9%) ports were removed because they were no longer needed; 4 (12.9%) ports required removal for port malfunction; 12 (38.7%) patients died with their ports still in place; 2 (6.5%) ports remain in use. Three (9.7%) ports required delayed secondary intervention to remain functional. One patient had a systemic infection attributed to the port, resulting in an overall infection rate of 0.08 per 1,000 catheter days. CONCLUSIONS Translumbar inferior vena cava port placement is a technically feasible and safe alternative method for long-term central venous access.
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Affiliation(s)
- Selim R Butros
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114.
| | - T Gregory Walker
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Gloria M Salazar
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Sanjeeva P Kalva
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Rahmi Oklu
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Stephan Wicky
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Suvranu Ganguli
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
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23
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Dibb M, Teubner A, Theis V, Shaffer J, Lal S. Review article: the management of long-term parenteral nutrition. Aliment Pharmacol Ther 2013; 37:587-603. [PMID: 23331163 DOI: 10.1111/apt.12209] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/08/2012] [Accepted: 12/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure. AIM To summarise the major issues in delivering long-term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure. METHODS A literature search using PubMed and MEDLINE databases was performed. RESULTS Safe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter-associated blood stream infection (reported incidence 0.14-0.83 episodes/patient-year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient-year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19-75%) and advanced liver disease (0-50%). Five-year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long-term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults. CONCLUSIONS Home parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter-related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.
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Affiliation(s)
- M Dibb
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK.
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Yang RY, Moineddin R, Filipescu D, Parra D, Amaral J, John P, Temple M, Connolly B. Increased complexity and complications associated with multiple peripherally inserted central catheter insertions in children: the tip of the iceberg. J Vasc Interv Radiol 2012; 23:351-7. [PMID: 22365294 DOI: 10.1016/j.jvir.2011.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/24/2011] [Accepted: 11/28/2011] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the effects of repeated placements of peripherally inserted central catheters (PICCs) on the venous system in children. MATERIALS AND METHODS Children who underwent successful first-time PICC placements between 2005 and 2007 were retrospectively evaluated. Patient demographics, procedural data, and complications were obtained from hospital databases. Data from subsequent PICC insertions were compared with those from previous PICC insertions. A generalized estimating equation was used with appropriate statistical tests for data analysis. RESULTS PICCs were grouped into four groups: first PICCs (n = 1,274), second PICCs (n = 167), third PICCs (n = 52), and fourth to seventh PICCs (n = 32). Successive PICCs were associated with progressively increased difficulty of access compared with earlier PICCs, as demonstrated by significant increases in procedural duration (P = .01) and fluoroscopy time (P = .005). Increased complexity was also evident through significant increases in the percentages of cases that required venography/digital subtraction angiography (P <.0001), multiple attempts to gain venous access (P <.0001), and a switch to another limb for venous access (P <.0001) between subsequent and first PICCs. In addition, rates of procedural complications also increased for subsequent PICCs compared with first PICCs (P <.0001). Furthermore use of the most preferred vein for vascular access significantly decreased in subsequent versus first PICC insertions (P <.0001). CONCLUSIONS Increased procedural complexity and complications were found with successive PICC insertions. These results confirm the need for a prospective study to directly assess the long-term effects of PICCs on venous patency.
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Affiliation(s)
- Roy Y Yang
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
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25
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Abstract
For patients who need long-term central venous access but who have developed obstruction of the usual central veins, "salvage" access techniques offer successful alternatives. These techniques include translumbar inferior vena cava access, transhepatic inferior vena cava access, catheterization of small venous collaterals, and recanalization of occluded veins. Inferior vena cava access techniques allow a range of devices to be placed, including ports, infusion catheters, and hemodialysis catheters. Collateral vessels may be too small to allow for large-caliber devices, such as hemodialysis catheters. Success rates for these access techniques are high and complications are infrequent. These access routes are in general quite durable. Adults and children can be treated. Once placed, devices are managed and used as they would be for any routinely placed venous access device.
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26
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Younes HK, Pettigrew CD, Anaya-Ayala JE, Soltes G, Saad WE, Davies MG, Lumsden AB, Peden EK. Transhepatic hemodialysis catheters: functional outcome and comparison between early and late failure. J Vasc Interv Radiol 2011; 22:183-91. [PMID: 21276914 DOI: 10.1016/j.jvir.2010.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 09/20/2010] [Accepted: 10/18/2010] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To describe the authors' experience with transhepatic placement of catheters, highlighting early and late complications, and to determine if this procedure is a viable option in patients in whom central venous occlusions present a significant challenge. MATERIALS AND METHODS The records of all the patients who underwent placement of transhepatic hemodialysis from January 2003 to October 2008 were retrospectively reviewed. Selected patients were dialysis-dependent, having undergone multiple access procedures and revisions. Kaplan-Meier analysis was used to estimate primary and secondary patency. RESULTS Twenty-two patients (mean age 42 years, range 22-70 years, 59% women) underwent a total of 127 transhepatic catheter placements at 24 transhepatic access sites; technical success was achieved in all cases. There were no hepatic injuries (bleeding or fistula formation). There were 105 exchanges in 14 patients, with a mean of 7.5 exchanges, a median of 5 exchanges (range 1-18 exchanges), and a catheter migration rate of 0.39 per 100 catheter-days. The sepsis rate was 0.22 per 100 catheter-days, and the catheter thrombosis rate was 0.18 per 100 catheter-days. The mean cumulative catheter duration in situ was 506.2 days, and the mean time catheter in situ was 87.7 days. The mean total access site interval was 1,046 catheter-days (range of 423-1,413 catheter-days). CONCLUSIONS Transhepatic hemodialysis catheter placement is associated with low rates of morbidity. In this series, transhepatic catheters provided the possibility of long-term functionality, despite associated high rates of catheter-related maintenance, provides a potentially viable access for patients with exhausted access options.
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Affiliation(s)
- Houssam K Younes
- Dialysis Access Program, Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, 6550 Fannin Street, Houston, TX 77030, USA
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Transhepatic venous approach for balloon-assisted cervical collateral venous access. Cardiovasc Intervent Radiol 2011; 34:1312-5. [PMID: 21331453 DOI: 10.1007/s00270-011-0125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Abstract
Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.
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Motta-Leal-Filho JMD, Carnevale FC, Nasser F, Sousa Junior WDO, Zurstrassen CE, Moreira AM, Affonso BB, Cerri GG. Acesso venoso trans-hepático percutâneo para hemodiálise: uma alternativa para pacientes portadores de insuficiência renal crônica. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000300006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: Acesso venoso trans-hepático percutâneo para hemodiálise é uma opção para pacientes que já exauriram acessos venosos tradicionais. OBJETIVO: Apresentar uma série de casos que demonstram a factibilidade e a funcionalidade da implantação dos cateteres semi-implantáveis por meio de acesso venoso trans-hepático percutâneo em pacientes sem possibilidades de outros acessos. MÉTODOS: Análise observacional retrospectiva dos prontuários de seis pacientes que foram submetidos à implantação de nove cateteres trans-hepáticos percutâneos para hemodiálise. Os cateteres foram implantados na ausência de acessos venosos periféricos disponíveis. No seguimento dos pacientes, procurou-se avaliar: sucesso técnico do procedimento, taxa de complicação, taxa de infecção e patência do acesso. RESULTADOS: Quatro homens e duas mulheres com idades entre 31 e 85 anos (média: 55 anos). Sucesso técnico obtido em 100%. A média de duração dos cateteres foi de 300,5 dias (2 a 814 dias). Médias de patência primária e secundária foram de 179,60 e 328,33 dias, respectivamente. Taxa de trombose dos cateteres foi de 0,05 por 100 cateteres-dias, assim como a taxa de infecção. Houve três complicações precoces (30 primeiros dias de implantação dos cateteres): dois deslocamentos dos cateteres e uma infecção. Duas complicações tardias foram observadas: uma trombose e uma migração. Três pacientes (50%) tiveram que trocar seus cateteres. Taxa de mortalidade em 30 dias foi de 33%, porém não relacionada ao procedimento. CONCLUSÃO: Implantação do cateter para hemodiálise por meio do acesso venoso trans-hepático percutâneo parece ser uma técnica segura, porém a utilização desse acesso deve ser aplicada somente em casos de esgotamento de outros acessos vasculares profundos.
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Affiliation(s)
| | | | - Felipe Nasser
- Sociedade Brasileira de Radiologia Intervencionista e Cirurgia Endovascular, Brasil
| | | | | | - Airton Mota Moreira
- Sociedade Brasileira de Radiologia Intervencionista e Cirurgia Endovascular, Brasil
| | - Breno Boueri Affonso
- Sociedade Brasileira de Radiologia Intervencionista e Cirurgia Endovascular, Brasil
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29
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Quality Improvement Guidelines for Central Venous Access. J Vasc Interv Radiol 2010; 21:976-81. [DOI: 10.1016/j.jvir.2010.03.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/27/2010] [Accepted: 03/03/2010] [Indexed: 11/21/2022] Open
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30
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Krishnamurthy G, Keller MS. Vascular Access in Children. Cardiovasc Intervent Radiol 2010; 34:14-24. [DOI: 10.1007/s00270-010-9865-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 02/18/2010] [Indexed: 11/24/2022]
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Saad WEA, Sahler LG, Westesson KE, Della Pietra PF, Darwish WM, Kitanosono T, Waldman DL. Dual-tract transhepatic U-shaped hemodialysis inferior vena cava catheter: a feasibility study in a swine model. J Vasc Interv Radiol 2009; 20:1625-31. [PMID: 19944987 DOI: 10.1016/j.jvir.2009.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 06/20/2009] [Accepted: 08/26/2009] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the feasibility of establishing a U-shaped inferior vena cava (IVC) catheter entirely from a transhepatic approach and to determine the catheter caliber that would provide adequate flow for hemodialysis. MATERIALS AND METHODS Three pigs (weight, 45-50 kg) were used. A peripheral right hepatic vein was accessed transhepatically by using a 22-gauge needle, and a 0.018-inch wire was passed into the hepatic veins and IVC. An accessory right hepatic vein was accessed from the IVC. A snare was deployed in the accessory vein and used as a target for a second transhepatic 22-gauge needle pass. A wire was snared through the second transhepatic tract, around into the IVC, and through the first transhepatic tract. The 0.018-inch wire was upsized to a 0.035-inch platform. Measurements where made to tailor a U-shaped catheter from simple 10.2- and 12-F tubes by cutting them longitudinally (single long side hole) along the length of the IVC segment. The U-shaped hemodialysis catheter was placed over the wire and positioned so that the catheter opening lay in the IVC. With use of a dialysis machine, pressures and flow tolerance at set flow rates (100, 200, 300, 350, and 400 mL/min) were tested. RESULTS All pigs underwent and survived successful catheter placements. All 10.2- and 12-F catheters tolerated flow rates up to 350 and 400 mL/min, respectively. CONCLUSIONS Establishing a U-shaped hemodialysis catheter with an entirely transhepatic approach is technically feasible. The 10.2-F U-shaped dialysis catheters provided a flow rate (>350 mL/min) that is appropriate for hemodialysis in human clinical settings.
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Affiliation(s)
- Wael E A Saad
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA.
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Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol 2009; 27:176-9. [PMID: 19499308 DOI: 10.1007/s11604-009-0316-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
Abstract
Percutaneous translumbar inferior vena cava (IVC) cannulation is an alternative approach for central venous catheterization, but there have been sporadic reports of puncture-related complications. To avoid complications during IVC puncture, percutaneous translumbar IVC cannulation was performed under computed tomography (CT) guidance in addition to fluoroscopy in two patients. To perform chemotherapy for recurrent breast cancer, we planned subcutaneous port catheter placement for central venous access. Under CT guidance, the direction and insertion distance of a long elastor needle were adjusted, and the IVC was punctured at the level of the third lumbar vertebra while taking care to avoid the right urinary tract. A guidewire was inserted through the long elastor needle, and a catheter was placed over the guidewire. It was possible to perform central venous catheterization by percutaneous translumbar inferior vena cava cannulation under CT guidance.
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Central venous access: techniques and indications in oncology. Eur Radiol 2008; 18:2333-44. [PMID: 18458909 DOI: 10.1007/s00330-008-0981-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.
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Sola JE, Thompson WR. Thoracoscopic-assisted placement of azygos vein central venous catheter in a child. Am J Transplant 2008; 8:715-8. [PMID: 18294169 DOI: 10.1111/j.1600-6143.2007.02121.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Loss of central venous access in intestinal failure patients is a potentially fatal complication, and an indication for intestinal transplantation. Thrombosis of the superior vena cava (SVC) has historically been considered a contraindication to small bowel transplantation; however, unconventional central venous access can facilitate survival and eventual transplant procedure in patients with end-stage central venous access. We describe a technique for azygos vein central catheter insertion utilizing thoracoscopic guidance in a 14-year-old girl with thrombosis of the SVC and chronic idiopathic pseudo-obstruction syndrome awaiting multivisceral transplantation. The technique is simplified by utilizing carbon dioxide (CO(2)) insufflation of the thoracic cavity to collapse the lung instead of double-lumen endotracheal tube placement, and no postoperative chest tube drainage of the pleural space is required. Thoracoscopic-assisted central access can also be used in children requiring chronic hemodialysis with limited venous sites due to thrombosis or small size of vessels.
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Affiliation(s)
- J E Sola
- Division of Pediatric Surgery, Holtz Children's Hospital, University of Miami/Jackson Memorial Medical Center, Miami, FL, USA.
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Mortell A, Said H, Doodnath R, Walsh K, Corbally M. Transhepatic central venous catheter for long-term access in paediatric patients. J Pediatr Surg 2008; 43:344-7. [PMID: 18280287 DOI: 10.1016/j.jpedsurg.2007.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 10/09/2007] [Indexed: 11/17/2022]
Abstract
Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Access is frequently lost in this group because of thrombosis, infection, or displacement, and vascular options can quickly be exhausted. The last resort access procedure is generally a direct atrial catheter inserted via a thoracotomy. A viable alternative is the percutaneous transhepatic Broviac catheter (Bard Access Systems, Salt Lake City, UT). We retrospectively reviewed the charts of 5 patients who underwent percutaneous transhepatic Broviac insertion for long-term access over a 4-year period in a single institution. Four of the patients (80%) had a significant cardiac abnormality, with 1 patient requiring long-term parenteral nutrition after complicated necrotizing enterocolitis. All patients had significant caval thrombosis, which precluded them having placement of a standard percutaneous or openly placed central catheter. Of the 5 patients, 2 (40%) died of cardiac-related illnesses. Of the 3 surviving patients, 2 had functioning catheters electively removed because they were no longer required. One catheter was removed at thoracotomy for right atrial perforation because of catheter erosion. Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Transhepatic central venous catheters are a feasible, reliable, and relatively easily placed form of central access in patients with multiple venous thromboses requiring long-term access. This route should be considered in paediatric patients requiring central access in preference to a thoracotomy.
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Affiliation(s)
- Alan Mortell
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
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Qureshi AM, Rhodes JF, Appachi E, Mumtaz MA, Duncan BW, Asnes J, Radavansky P, Latson LA. Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease. Pediatr Crit Care Med 2007; 8:248-53. [PMID: 17417124 DOI: 10.1097/01.pcc.0000265327.93745.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population. DESIGN A retrospective review. SETTING A tertiary care center. PATIENTS All children with complex congenital heart disease who underwent transhepatic Broviac placement between May 2000 and April 2004. INTERVENTIONS Transhepatic Broviac placement. MEASUREMENTS AND MAIN RESULTS Thirty-two children with a median age of 5 months (20 days-5.3 yrs) and a median weight of 4.2 kg (2.2-24.9 kg) underwent 40 transhepatic Broviac placements. There were three (8.8%) procedural-related complications. One patient suffered an intra-abdominal bleed requiring an urgent laparotomy and removal of the Broviac, one patient required transfusion because of a mild self-contained intra-abdominal bleed, and one patient developed temporary complete heart block. There was one catheter infection. Thrombus was noted by echocardiography on the tip of two Broviacs; however, no intracardiac vegetations or embolic events occurred. There was no mortality related to the procedure. Broviacs remained in place for a median of 36 days (1 day-6 months). Five Broviacs were dislodged inadvertently (two during cardiac massage and three resulting from patient manipulation). The remaining Broviacs were electively removed safely without coil embolization. At a median follow-up of 3.5 months (10 days-3 yrs), there have been no long-term complications related to the Broviacs. CONCLUSIONS Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatric and Congenital Heart Disease, The Children's Hospital at the Cleveland Clinic, Cleveland, OH, USA.
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Sierre S, Lipsich J, Questa H. Bilhemia: a fatal complication following percutaneous placement of a transhepatic inferior vena cava catheter in a child. Pediatr Radiol 2007; 37:498-500. [PMID: 17415603 DOI: 10.1007/s00247-007-0432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Revised: 01/29/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
A transhepatic central venous catheter was implanted in a 2-year-old child with a history of multiple venous access procedures and superior and inferior vena cava thrombosis. After 2 weeks, inadvertent dislodgement of the catheter was complicated by a biloma. The biloma was percutaneously drained, but a biliary-venous fistula led to a rapidly progressive and fatal bilhemia. We report this case as an infrequent complication of transhepatic catheterization.
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Affiliation(s)
- Sergio Sierre
- Department of Interventional Radiology, Hospital de Pediatria Prof JP Garrahan, Pichincha 1850, Buenos Aires, Argentina.
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Rodriguez-Cruz E, Bonilla M, Perez J. Percutaneous translumbar inferior vena cava catheter placement for long-term hemodialysis treatment. Pediatr Nephrol 2007; 22:612-5. [PMID: 17123114 DOI: 10.1007/s00467-006-0373-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 10/22/2006] [Accepted: 10/24/2006] [Indexed: 11/26/2022]
Abstract
Central venous access for long term dialysis has always been a major difficulty, especially in cases where the traditional sites are no longer available. We present a case of a pediatric patient where the usual sites were occluded and he needed a reliable venous access for his dialysis. The inferior vena cava has been used in adult patients, but no reports were found in the pediatric literature. We chose this site as an alternative for this patient. The catheter was placed via a percutaneous translumbar approach, and remained in place for almost 2 years until the patient received a renal transplant.
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Mehta C, De Giovanni J, Sharif K, Gupte GL. Stereotactic Technique of Catheter Placement in the Stump of the Superior Vena Cava in Children with Impaired Venous Access. J Vasc Interv Radiol 2006; 17:2005-9. [PMID: 17185700 DOI: 10.1097/01.rvi.0000252570.10887.fb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The long-term survival of children with irreversible intestinal failure is often dependent on adequate central venous access for the administration of parenteral nutrition. In children with occlusion of major central thoracic veins, innovative techniques to establish venous access have been described in the literature. The present report describes an innovative stereotactic technique of catheter insertion in children with occluded internal jugular and brachiocephalic veins. The catheter is inserted percutaneously from the neck into the distal patent stump of the superior vena cava communicating with the right atrium.
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Affiliation(s)
- Chetan Mehta
- Department of Paediatric Cardiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
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Abstract
A 27-year-old Hispanic man with a history of hypertension and end-stage renal disease for 4 years became unresponsive, apneic, and pulseless during hemodialysis. During his 4 year period on dialysis, vascular access had become increasingly difficult and ultimately a transhepatic catheter had been placed 9 months prior to this event. Resuscitation was unsuccessful. At autopsy, death was determined to be due to cardiac tamponade secondary to perforation of the right atrium by the transhepatic catheter. Cardiac tamponade is a rare cause of sudden death during hemodialysis with a long-standing catheter.
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Affiliation(s)
- Lorenz M Schmiege
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
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Abstract
This review article describes the vascular access devices available for long-term vascular access in children, describes the procedures for implanting them and the sites available for this purpose, discusses the complications associated with catheter placement and how to avoid them, and compares the various catheter systems in terms of their advantages and disadvantages.
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Affiliation(s)
- Walter J Chwals
- Case Western Reserve University, School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
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Abstract
Pediatric interventional radiologists are ideally suited to provide vascular access services to children because of inherent safety advantages and higher success from using image-guided techniques. The performance of vascular access procedures has become routine at many adult interventional radiology practices, but this service is not as widely developed at pediatric institutions. Although interventional radiologists at some children's hospitals offer full-service vascular access, there is little or none at others. Developing and maintaining a pediatric vascular access service is a challenge. Interventionalists skilled in performing such procedures are limited at pediatric institutions, and institutional support from clerical staff, nursing staff, and technologists might not be sufficiently available to fulfill the needs of such a service. There must also be a strong commitment by all members of the team to support such a demanding service. There is a slippery slope of expected services that becomes steeper and steeper as the vascular access service grows. This review is intended primarily as general education for pediatric radiologists learning vascular access techniques. Additionally, the pediatric or adult interventional radiologist seeking to expand services might find helpful tips. The article also provides education for the diagnostic radiologist who routinely interprets radiographs containing vascular access devices.
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Affiliation(s)
- James S Donaldson
- Department of Medical Imaging, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, 2300 Children's Plaza, No. 9, Chicago, IL 60614, USA.
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Rodrigues AF, van Mourik IDM, Sharif K, Barron DJ, de Giovanni JV, Bennett J, Bromley P, Protheroe S, John P, de Ville de Goyet J, Beath SV. Management of end-stage central venous access in children referred for possible small bowel transplantation. J Pediatr Gastroenterol Nutr 2006; 42:427-33. [PMID: 16641582 DOI: 10.1097/01.mpg.0000215311.71040.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED The 3-year survival after small bowel transplantation (SBTx) has improved to between 73% and 88%. Impaired venous access for parenteral nutrition can be an indication for SBTx in children with chronic intestinal failure. AIM To report our experience in management of children with extreme end-stage venous access. SUBJECTS The study consisted of 6 children (all boys), median age of assessment 27 months (range, 13-52 months), diagnosed with total intestinal aganglionosis (1), protracted diarrhea (1), and short bowel syndrome (4), of which gastroschisis (2) and malrotation with midgut volvulus (2) were the causes. All had a documented history of more than 10 central venous catheter insertions previously. All had venograms, and 1 child additionally had a magnetic resonance angiogram to evaluate venous access. Five of 6 presented with thrombosis of the superior vena cava (SVC) and/or inferior vena cava. METHODS Venous access was reestablished as follows: transhepatic venous catheters (5), direct intra-atrial catheter via midline sternotomy (4), azygous venous catheters (2), dilatation of left subclavian vein after passage of a guide wire and then placing a catheter to reach the right atrium (1), radiological recanalization of the SVC and placement of a central venous catheter in situ (1), and direct puncture of SVC stump(1). Complications included serous pleural effusion after direct intra-atrial line insertion, which resolved after chest drain insertion (1), displacement of transhepatic catheter needing repositioning (2), and SVC stent narrowing requiring repeated balloon dilatation. OUTCOME Four children with permanent intestinal failure on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition; the family of 1 child declined the procedure. In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate central venous access as feeds and drug manipulations were undertaken. One of them received liver and SBTx nearly 3 years after presenting with end-stage central venous access, because attempts to achieve independence from parenteral nutrition had failed. The other child died immediately after a transhepatic venous catheter placement, possibly from a nutritional depletion syndrome as no physical cause of death was found. Direct intra-atrial catheters in transplanted children proved to be adequate for the management of uncomplicated transplantation, although the usual infusion protocol had to be modified considerably, and the lack of access would have been critical if massive blood transfusion had been required during the transplant procedure. CONCLUSION It was possible to reestablish central venous access in all cases. However, this was time consuming and difficult to assemble a skilled team consisting of one of more: surgeon, cardiologist, interventional radiologist, and transplant anesthetist. Small bowel transplantation is easier and safer with adequate central venous access, and we advocate liaison with an SBTx center at an early stage.
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Abstract
The dependence of IV hyperalimentation programs on the achievement and maintenance of reliable vascular access in the home infusion patient population has necessitated a review of the current methods used to establish and maintain adequate long-term vascular access. Vascular access device-related complications are significant contributors to the medical course and costs associated with the care of home parenteral nutrition (HPN) patients. The purpose of this manuscript is to review current thoughts on the establishment of long-term vascular access for HPN with regard to techniques used, device selection, and associated complications.
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Affiliation(s)
- Mark J Sands
- Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Stavropoulos SW, Pan JJ, Clark TWI, Soulen MC, Shlansky-Goldberg RD, Itkin M, Trerotola SO. Percutaneous transhepatic venous access for hemodialysis. J Vasc Interv Radiol 2004; 14:1187-90. [PMID: 14514812 DOI: 10.1097/01.rvi.0000085770.63355.f2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Percutaneous transhepatic venous access is an option for hemodialysis patients who have exhausted more traditional sites of venous access. Thirty-six transhepatic dialysis catheters were placed in 12 patients. The mean time of the catheters in situ was 24.3 days. Twenty-one catheters were replaced or removed because of catheter thrombosis, yielding a catheter thrombosis rate of 2.40 per 100 catheter-days. The line sepsis rate was 0.22 per 100 catheter-days. Poor patency rates were seen because of a high rate of late thrombosis. Transhepatic dialysis catheters should only be used as a last resort unless limitations of catheter thrombosis can be overcome.
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Affiliation(s)
- S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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Silberzweig JE, Sacks D, Khorsandi AS, Bakal CW. Reporting Standards for Central Venous Access. J Vasc Interv Radiol 2003; 14:S443-52. [PMID: 14514860 DOI: 10.1097/01.rvi.0000094617.61428.bc] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- James E Silberzweig
- Society of Interventional Radiology, 10201 Lee Highway, Suite 500, Fairfax, VA 22030, USA
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Abstract
The maintenance of long-term venous access is critical to the livelihood of children in a variety of clinical situations, especially those who are dependent on parenteral nutrition. Whereas the traditional routes of either peripheral or central venous access are initially adequate, most of these sites eventually succumb to the pitfalls associated with long-term venous access. This review provides a comprehensive and multidisciplinary approach to the management of reoperative venous access with regard to preoperative planning and imaging and specific techniques in interventional radiology and surgery.
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Affiliation(s)
- Russell J Juno
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
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Chait PG, Temple M, Connolly B, John P, Restrepo R, Amaral JG. Pediatric interventional venous access. Tech Vasc Interv Radiol 2002; 5:95-102. [PMID: 12489048 DOI: 10.1053/tvir.2002.36047] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Venous access for therapy in sick children is very important, but sometimes also extremely challenging. With several advances in imaging modalities, the interventional radiologist can certainly help in these situations. This article reviews the indications, technique, and complications related to short- (peripherally inserted central catheter) and long-term (central venous lines, Port-a-catheters) venous accesses in children. A brief commentary is also made about retrieval of fragmented lines.
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Affiliation(s)
- Peter G Chait
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
Venous access is commonly thought of as the bread and butter of interventional radiologic procedures. However, in those patients who have undergone multiple previous central venous catheter placements, venous access can be a technical challenge for even the most seasoned interventional radiologist. Conventional access sites include the internal jugular veins (IJV) and subclavian veins (SCV). The former should be considered as the primary access site for all patients who will be catheter dependent for whatever reason. Before utilization of the SCV, the external jugular veins (EJV) should be used, especially in the dialysis population. Only after surgical hemodialysis access is no longer an option in the upper extremity should cannulation of the SCV be entertained. Once these usual access sites are no longer available, it may necessary to use an unconventional access method, including catheterization of the common femoral vein, catheterization of enlarged collateral vessels, recanalization of occluded veins, translumbar inferior vena cava (IVC) catheter placement, and transhepatic catheter placement. This chapter serves as a review of these techniques.
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Affiliation(s)
- Susan M Weeks
- Department of Radiology, University of North Carolina at Chapel Hill, USA
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