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Kato K, Gan C, Rhodes A. Necessity of performing a routine chest radiograph following the insertion of tunnelled Hickman catheter under imaging guidance: A single centre experience. J Med Imaging Radiat Oncol 2023; 67:482-486. [PMID: 36161771 DOI: 10.1111/1754-9485.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A chest radiograph has traditionally been performed following the insertion of a tunnelled Hickman catheter to immediately exclude rare but potentially serious complications such as pneumothorax and haemothorax and confirm appropriate positioning of the catheter tip. The value of completing the routine chest radiograph has been questioned when fluoroscopic image may be easily obtained in the angiography suite for the same purpose, and the rate of iatrogenic pneumothorax remains extremely low in the Medical literature. We describe our experience of performing Hickman catheter insertion under ultrasound and fluoroscopic guidance and whether routinely performing the chest radiograph is justifiable. METHODS A single centre retrospective review was performed of patients who received a tunnelled Hickman catheter and underwent postprocedural chest radiograph in the Interventional Radiology Department during a fifteen-year period from August 2007 to April 2021. Patient demographics and complications were documented. RESULTS Delayed iatrogenic pneumothorax was diagnosed in one asymptomatic patient (0.06%) on a chest radiograph out of 1735 patients, and they required chest tube insertion. Other complications included two cases of right common carotid artery puncture, one case of right internal jugular vein dissection and one case of left internal jugular perforation. Two patients required a repeat procedure within 24 h due to superior migration of the Hickman catheter on chest radiograph. CONCLUSION Given the extremely low rate of iatrogenic pneumothorax, chest radiograph following the insertion of a tunnelled Hickman catheter under ultrasound and fluoroscopic guidance may be an unnecessary investigation unless the patient is symptomatic, or there is sufficient clinical concern.
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Affiliation(s)
| | - Calvin Gan
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexander Rhodes
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
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2
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Sugawara S, Sone M, Sakamoto N, Sofue K, Hashimoto K, Arai Y, Tokue H, Takigawa M, Mimura H, Yamanishi T, Yamagami T. Guidelines for Central Venous Port Placement and Management (Abridged Translation of the Japanese Version). INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:105-117. [PMID: 37485481 PMCID: PMC10359169 DOI: 10.22575/interventionalradiology.2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/22/2022] [Indexed: 07/25/2023]
Abstract
The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review.
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Affiliation(s)
- Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | | | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Kazuki Hashimoto
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Japan
| | | | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Japan
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3
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Chen Y, Li W, Bai H, Zhang Y, Lu C. Characteristic CT angiography findings and clinical value of catheter-related central venous thrombosis in hemodialysis patients with end-stage renal disease. Acta Radiol 2023; 64:2211-2216. [PMID: 37128160 DOI: 10.1177/02841851231170362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Central catheter-related thrombosis (CRT) is the most common catheter-related complication in patients with end-stage renal disease (ESRD) but is often underappreciated and misdiagnosed by radiologist. PURPOSE To find the computed tomography angiography (CTA) characteristics of central CRT, then raise the diagnosis of this disorder. MATERIAL AND METHODS A total of 301 eligible patients with ESRD who experienced both chest multi-phase multidetector CTA (MDCTA) and digital subtraction angiography were enrolled in the final analysis. The location, shape, and related signs of the central CRT in MDCTA images were evaluated. Independent-samples T test, chi-square test, and binary logistic regression were analyzed using SPSS software. RESULTS In total, 166 patients were found to have CRT using MDCTA, and this was verified by DSA. Central CRT was usually irregular in the superior vena cava segment, and the angle of the contact area between central CRT and catheter was <180° (all P < 0.05). Age, collateral circulation, and venous stenosis were shown to have significant differences when compared to patients without CRT (all P < 0.05), but there were no significant differences about the sex or catheter insertion site. In addition, age and collateral circulation were the factors found to be significantly associated with thrombosis (P < 0.05). In particular, the thrombosis was 2.213 times more likely to be found in those patients with collateral circulation (odds ratio = 2.213, 95% confidence interval = 1.236-3.961). CONCLUSION Chest multi-phase MDCTA can effectively reduce the missed diagnosis and misdiagnosis of central CRT. It is worth paying more attention to the central CRT especially when the collateral circulation is observed.
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Affiliation(s)
- Yushu Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Wanjiang Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Hongli Bai
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yiteng Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Chunyan Lu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Fiore G, Stella S, Conversano A, Agricola E. An Unusual Cause of Stroke: A "Forgotten" Intracardiac Catheter Discovered After 48 Years. JACC Case Rep 2022; 6:101668. [PMID: 36704064 PMCID: PMC9871056 DOI: 10.1016/j.jaccas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
A 48-year-old man with recurrent cerebral ischemic events underwent transesophageal echocardiography to investigate cardioembolic sources because transthoracic echocardiography had spotted a dubious filamentous mass on the mitral valve. A venous umbilical catheter, lost during the hospital stay after his birth, was surprisingly identified in his cardiac chambers. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Giorgio Fiore
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Address for correspondence: Dr. Giorgio Fiore, Department of Clinical Cardiology, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy.
| | - Stefano Stella
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Conversano
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Classification of Central Venous Catheter Tip Position on Chest X-ray Using Artificial Intelligence. J Pers Med 2022; 12:jpm12101637. [PMID: 36294776 PMCID: PMC9605589 DOI: 10.3390/jpm12101637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Recent studies utilizing deep convolutional neural networks (CNN) have described the central venous catheter (CVC) on chest radiography images. However, there have been no studies for the classification of the CVC tip position with a definite criterion on the chest radiograph. This study aimed to develop an algorithm for the automatic classification of proper depth with the application of automatic segmentation of the trachea and the CVC on chest radiographs using a deep CNN. This was a retrospective study that used plain chest supine anteroposterior radiographs. The trachea and CVC were segmented on images and three labels (shallow, proper, and deep position) were assigned based on the vertical distance between the tracheal carina and CVC tip. We used a two-stage approach model for the automatic segmentation of the trachea and CVC with U-net++ and automatic classification of CVC placement with EfficientNet B4. The primary outcome was a successful three-label classification through five-fold validations with segmented images and a test with segmentation-free images. Of a total of 808 images, 207 images were manually segmented and the overall accuracy of the five-fold validation for the classification of three-class labels (mean (SD)) of five-fold validation was 0.76 (0.03). In the test for classification with 601 segmentation-free images, the average accuracy, precision, recall, and F1-score were 0.82, 0.73, 0.73, and 0.73, respectively. We achieved the highest accuracy value of 0.91 in the shallow position label, while the highest F1-score was 0.82 in the deep position label. A deep CNN can achieve a comparative performance in the classification of the CVC position based on the distance from the carina to the CVC tip as well as automatic segmentation of the trachea and CVC on plain chest radiographs.
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6
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Liu G, Zhang J, Wang F, Liu H. Fourth thoracic vertebra as landmark for depth of right internal jugular vein catheterization in infants. Sci Rep 2022; 12:14569. [PMID: 36028521 PMCID: PMC9418216 DOI: 10.1038/s41598-022-18787-4] [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] [Received: 01/06/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
The carina is considered a reliable marker for the depth of right internal jugular vein catheterization in infants on chest radiograph. In adult anatomy, the carina is typically located at the level of the fifth thoracic vertebra. We are not aware of a positional relationship between infant carina and thoracic vertebrae. Thus, we evaluated that a vertebral body may be at the same level as carina and can be as radiographic landmarks for the depth of right internal jugular vein catheterization in infants. In this retrospective analysis, 108 infants (aged 1–12 months) who underwent congenital heart surgery between January 1, 2019 and June 30, 2019 were included. We analyzed the post-operative chest radiographs of those who underwent right internal jugular vein catheterization and assessed the positional relationship of the carina and vertebral bodies. We measured the vertical distance of the central venous catheter (CVC) catheter tip from the carina (below the carina 22 mm, it may be close to or into the right atrium). In total, 95 children were enrolled; The carina was located at the third thoracic vertebra in two cases (2%) and at the fourth thoracic vertebra in 93 cases (98%). The distance between the tip of CVC and the carina was 10 (4, 15) mm, and 6.3% (6 cases) had the catheter tip at more than 22 mm below the carina. Most fourth thoracic vertebrae were at the same level as the carina on chest radiographs. Therefore, it has potential as a radiographic landmark for the depth of right internal jugular vein catheterization in infants on chest radiograph.
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Affiliation(s)
- Guoliang Liu
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Jianmin Zhang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
| | - Fang Wang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China.
| | - Heqi Liu
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China
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7
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Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. J Intensive Care Med 2022; 37:1215-1222. [PMID: 35723623 DOI: 10.1177/08850666221076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention. This study aims to evaluate local practices of mechanical complication frequency, type, and subsequent intervention(s) related to mechanical AE with an emphasis on catheter malpositioning. Methods: This is a retrospective review of CVC placements in a tertiary hospital setting from 1/2013 to 12/2013. Pneumothorax and CVC positioning were evaluated on post-insertion chest x-ray (CXR). Malposition was defined as unintended placement of the catheter in a vessel other than the intended superior vena cava on CXR. Catheter reposition was defined as radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included pneumothorax and thoracostomy rate, CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Result: Among 2045 eligible CVC insertions, pneumothoraces occurred in 14 (0.7%; 95%CI 0.38, 1.17) and malpositions were identified in 275 (13.4%; 95% CI 12.3, 15.3). The proportion of pneumothoraces that required tube thoracostomy was 57%. The proportion of CVCs with malposition that were removed or replaced within 24h was 32.7%. "Malpositioned" catheters that were left in place by the clinical team (n = 185) had an average catheter duration of 8.2 days (95% CI 7.2, 9.3) versus 7.2 days (95% CI 6.17, 8.23) for catheters that were replaced after initial malposition (p = 0.14, t test). The incidence of venous thrombosis in repositioned "malpositioned" catheters was 7.8% versus 4.9% for "malpositioned" catheters that were left in place. Conclusions: Clinically significant catheter malposition and pneumothorax after CVC insertion are low. In this study, replaced and non-replaced "malpositioned" catheters had similar catheter duration and rates of complications, challenging the current dogma of CVC malposition practice.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Huang
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian Holley
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Willman
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Griffey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel L Theodoro
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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8
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Tanimoto A, Chapman T, Otjen JP, Stanescu AL. The undulating line sign and other more common pediatric central catheter malpositions. Pediatr Radiol 2022; 52:1381-1391. [PMID: 35362762 DOI: 10.1007/s00247-022-05303-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: 08/09/2021] [Revised: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Abstract
Central venous and arterial catheters are among the most commonly assessed support devices by radiologists. The position of these catheters must be carefully assessed to ensure proper placement, as malpositioning may lead to life-threatening consequences. Therefore, it is important for radiologists to understand the anatomy of the central vessels and the expected location of catheters. While this can be difficult in small children and especially in neonates, knowledge of the expected course and ideal termination of catheters allows for recognition of a malpositioned line, which may be unsuspected clinically. The purpose of this article is to discuss appropriate positioning of central catheters in pediatric patients, focusing primarily on venous catheters. We also propose a new radiographic sign to recognize, the undulating line sign, as an indication of an inappropriate course of a newly placed venous catheter.
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Affiliation(s)
- Aki Tanimoto
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. .,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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9
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Delayed diagnosis of a retained guidewire after bedside femoral venous catheter insertion: A preventable complication. Radiol Case Rep 2022; 17:647-649. [PMID: 35027989 PMCID: PMC8715130 DOI: 10.1016/j.radcr.2021.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Central venous catheter (CVC) insertion is a commonly performed procedure that is used for continuous invasive hemodynamic monitoring, fluid resuscitation, drug therapy, and hemodialysis. CVC placement can be associated with serious complications that are mostly preventable. One of these complications is the loss of the guidewire within the intravascular space, which carries a high morbidity and mortality. Here, we describe a 44-year old patient who presented with acute kidney injury and metabolic derangements that necessitated bedside right femoral dialysis catheter to initiate emergent renal replacement therapy. A day after the catheter insertion, the guidewire was noted on a routine chest X-ray extending into the base of the skull. The clinical course was complicated with cerebral infarction. Subsequently, the retained guidewire was removed a few days after the CVC insertion. In summary, the retained guidewire within the circulation is associated with potentially life-threatening and hazardous outcomes. Continuing education, vigilant supervision, and implementing certain protocols are likely to prevent such undesirable events.
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10
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Rodríguez-Herrera Á, Solaz-García Á, Mollá-Olmos E, Ferrer-Puchol D, Esteve-Claramunt F, Trujillo-Barberá S, García-Bermejo P, Casaña-Mohedo J. Use of the Ultrasound Technique as Compared to the Standard Technique for the Improvement of Venous Cannulation in Patients with Difficult Access. Healthcare (Basel) 2022; 10:healthcare10020261. [PMID: 35206876 PMCID: PMC8872129 DOI: 10.3390/healthcare10020261] [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] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model InsyteTM AutoguardTM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.
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Affiliation(s)
- Ángeles Rodríguez-Herrera
- Department of Health Sciences, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain; (Á.R.-H.); (Á.S.-G.); (S.T.-B.); (P.G.-B.)
| | - Álvaro Solaz-García
- Department of Health Sciences, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain; (Á.R.-H.); (Á.S.-G.); (S.T.-B.); (P.G.-B.)
- Neonatal Research Unit, Health Research Institute La Fe, 46026 Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | - Enrique Mollá-Olmos
- Emergency Department, Hospital de La Ribera, 46600 Valencia, Spain; (E.M.-O.); (D.F.-P.)
| | - Dolores Ferrer-Puchol
- Emergency Department, Hospital de La Ribera, 46600 Valencia, Spain; (E.M.-O.); (D.F.-P.)
| | - Francisca Esteve-Claramunt
- Department of Health Sciences, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain; (Á.R.-H.); (Á.S.-G.); (S.T.-B.); (P.G.-B.)
- Correspondence:
| | - Silvia Trujillo-Barberá
- Department of Health Sciences, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain; (Á.R.-H.); (Á.S.-G.); (S.T.-B.); (P.G.-B.)
| | - Pedro García-Bermejo
- Department of Health Sciences, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain; (Á.R.-H.); (Á.S.-G.); (S.T.-B.); (P.G.-B.)
- Emergency Department, Hospital de La Ribera, 46600 Valencia, Spain; (E.M.-O.); (D.F.-P.)
| | - Jorge Casaña-Mohedo
- Department of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain;
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Pandey V, Khurana S, Goyal S. Image Intensifier guided repositioning of a malpositioned internal jugular vein introducer sheath. Indian J Anaesth 2022; 66:306-307. [PMID: 35663211 PMCID: PMC9159405 DOI: 10.4103/ija.ija_563_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: 06/20/2021] [Revised: 07/20/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
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12
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Diep J, Makris A, De Guzman I, Wong J, Aravindan A, Nandakoban H, Narayanan G. Impact of Previous Tunneled Vascular Catheters and their Location on Upper Limb Arteriovenous Fistula Function. KIDNEY360 2021; 2:1953-1959. [PMID: 35419532 PMCID: PMC8986056 DOI: 10.34067/kid.0003362021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/07/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Long-term arteriovenous fistula (AVF) survival has been shown to be adversely affected by the presence of previous tunneled vascular catheters (TVC). We analyzed the effect of previous TVCs and their location (ipsilateral versus contralateral) on the successful function of upper-limb AVFs in the first 12 months after creation. METHODS We retrospectively reviewed clinical data on patients' first upper-limb AVFs, created between January 2013 and December 2017. We analyzed the rates of successful AVF function (successful cannulation using two needles for ≥50% sessions over a 2-week period) at 6 and 12 months after creation, time to AVF maturation, and rates of assisted maturation. RESULTS In total, 287 patients with first AVFs were identified, of which 142 patients had a previous TVC (102 contralateral, 40 ipsilateral) and 145 had no previous TVC. The no TVC group had higher rates of AVF function at both 6 months (69% versus 54%, OR, 1.84; 95% CI, 1.00 to 3.39, P=0.05) and 12 months (84% versus 64%, OR, 3.10; 95% CI, 1.53 to 6.26, P=0.002) compared with the TVC group. The contralateral TVC group had higher rates of AVF function at 6 months (60% versus 40%, OR, 2.21; 95% CI, 1.01 to 4.88, P=0.05), but not at 12 months (66% versus 58%, OR, 1.42; 95% CI, 0.62 to 3.25, P=0.40) compared with the ipsilateral TVC group. The median time to AVF maturation in the contralateral and ipsilateral TVC groups were 121.5 and 146 days respectively (P=0.07). Assisted maturation rates were lower in no TVC group compared with the TVC group (12% versus 28%, P=0.007), but similar between the contralateral and ipsilateral TVC groups (29% versus 26%, P=0.74). CONCLUSIONS Previous TVC use was associated with poorer AVF function at 6 and 12 months, with a higher rate of assisted maturation. The presence of an ipsilateral TVC was associated with lower successful AVF use at 6 months, compared with contralateral TVC.
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Affiliation(s)
- Jason Diep
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Imelda De Guzman
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | - Jeffery Wong
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
| | | | - Hareeshan Nandakoban
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Govind Narayanan
- Department of Renal Medicine, Liverpool Hospital, Liverpool, Australia
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Janc J, Szamborski M, Milnerowicz A, Łysenko L, Leśnik P. Evaluation of the Effectiveness of Modified Pectoral Nerve Blocks Type II (PECS II) for Vascular Access Port Implantation Using Cephalic Vein Venesection. J Clin Med 2021; 10:jcm10245759. [PMID: 34945054 PMCID: PMC8703813 DOI: 10.3390/jcm10245759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
The vascular access port implantation procedure can be performed using the venesection method by inserting a catheter into the cephalic vein in the region of the deltopectoral groove. This method eliminates the need for catheter tunneling. An alternative method to infiltration anaesthesia for port implantation may be a modified pectoral nerve block type II (PECS II). This study aimed to evaluate the effectiveness of modified PECS II for vascular access port implantation using cephalic vein venesection. This retrospective observational study was conducted at the 4th Military Clinical Hospital in Wroclaw, Poland. A group of 114 patients underwent the modified PECS II block and additional cutaneous infiltration anesthesia at the incision line. Pain intensity was assessed on the NRS scale measured intraoperatively at four points. The QoR-15 questionnaire was used to assess patient satisfaction during the first 24 h after surgery. The operator’s condition assessment score was used to assess surgical conditions and operator comfort. The analysis showed that the median pain intensity during vascular port implantation was 0. A statistically significant difference in pain intensity was demonstrated between the specialist’s group and the resident’s group at the second and third measurement points (p < 0.008; p < 0.012). The mean value on the QoR-15 scale was 132. There was a significant difference between the pain scores of the groups. The mean score in the pain position in the specialist’s group was 18 points and in the resident’s group, it was 19 points (p < 0.029). In conclusion, the present study revealed that the modified PECS II block is an effective and safe method of anesthesia for Port-A-Cath implantation.
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Affiliation(s)
- Jarosław Janc
- Department of Anaesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (J.J.); (M.S.); (L.Ł.)
| | - Marek Szamborski
- Department of Anaesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (J.J.); (M.S.); (L.Ł.)
| | - Artur Milnerowicz
- Department of Vascular Surgery, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland;
| | - Lidia Łysenko
- Department of Anaesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (J.J.); (M.S.); (L.Ł.)
| | - Patrycja Leśnik
- Department of Anaesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (J.J.); (M.S.); (L.Ł.)
- Correspondence: ; Tel.: +48-71-289-45-46
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14
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Ablordeppey EA, Drewry AM, Anderson AL, Casali D, Wallace LA, Kane DS, Tian L, House SL, Fuller BM, Griffey RT, Theodoro DL. Point-of-care Ultrasound-guided Central Venous Catheter Confirmation in Ultrasound Nonexperts. AEM EDUCATION AND TRAINING 2021; 5:e10530. [PMID: 34124497 PMCID: PMC8173448 DOI: 10.1002/aet2.10530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Emerging evidence suggests that chest radiography (CXR) following central venous catheter (CVC) placement is unnecessary when point-of-care ultrasound (POCUS) is used to confirm catheter position and exclude pneumothorax. However, few providers have adopted this practice, and it is unknown what contributing factors may play a role in this lack of adoption, such as ultrasound experience. The objective of this study was to evaluate the diagnostic accuracy of POCUS to confirm CVC position and exclude a pneumothorax after brief education and training of nonexperts. METHODS We performed a prospective cohort study in a single academic medical center to determine the diagnostic characteristics of a POCUS-guided CVC confirmation protocol after brief training performed by POCUS nonexperts. POCUS nonexperts (emergency medicine senior residents and critical care fellows) independently performed a POCUS-guided CVC confirmation protocol after a 30-minute didactic training. The primary outcome was the diagnostic accuracy of the POCUS-guided CVC confirmation protocol for malposition and pneumothorax detection. Secondary outcomes were efficiency and feasibility of adequate image acquisition, adjudicated by POCUS experts. RESULTS Twenty-six POCUS nonexperts collected data on 190 patients in the final analysis. There were five (2.5%) CVC malpositions and six (3%) pneumothoraxes on CXR. The positive likelihood ratios of POCUS for malposition detection and pneumothorax were 12.33 (95% confidence interval [CI] = 3.26 to 46.69) and 3.41 (95% CI = 0.51 to 22.76), respectively. The accuracy of POCUS for pneumothorax detection compared to CXR was 0.93 (95% CI = 0.88 to 0.96) and the sensitivity was 0.17 (95% CI = 0.00 to 0.64). The median (interquartile range) time for CVC confirmation was lower for POCUS (9 minutes [8.5-9.5 minutes]) compared to CXR (29 minutes [1-269 minutes]; Mann-Whitney U, p < 0.01). Adequate protocol image acquisition was achieved in 76% of the patients. CONCLUSION Thirty-minute training of POCUS in nonexperts demonstrates adequate diagnostic accuracy, efficiency, and feasibility of POCUS-guided CVC position confirmation, but not exclusion of pneumothorax.
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Affiliation(s)
- Enyo A. Ablordeppey
- From theDepartment of AnesthesiologyWashington University School of MedicineSt. LouisMOUSA
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Anne M. Drewry
- From theDepartment of AnesthesiologyWashington University School of MedicineSt. LouisMOUSA
| | - Adam L. Anderson
- theDepartment of Internal MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Diego Casali
- and theDepartment of SurgeryWashington University School of MedicineSt. LouisMOUSA
- and theDepartment of SurgeryDivision of Cardiothoracic SurgeryCedars Sinai Medical CenterLos AngelesCAUSA
| | - Laura A. Wallace
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Deborah S. Kane
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - LinLin Tian
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Stacey L. House
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Brian M. Fuller
- From theDepartment of AnesthesiologyWashington University School of MedicineSt. LouisMOUSA
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Richard T. Griffey
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
| | - Daniel L. Theodoro
- theDepartment of Emergency MedicineWashington University School of MedicineSt. LouisMOUSA
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15
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Puspitasari M, Sinorita H, Bagaswoto HP, Kuswadi I, Prasanto H, Wardhani Y, Kurniawan WT. Persistent Left Superior Vena Cava Identified After Hemodialysis Catheter Insertion: A Case Report. Int Med Case Rep J 2020; 13:465-469. [PMID: 33061669 PMCID: PMC7534844 DOI: 10.2147/imcrj.s266858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Central venous catheter (CVC) insertion is the most commonly performed clinical procedure when a patient initiates hemodialysis. Despite its clinical benefits, CVC insertion has several risks of complications. Thrombosis, venous stenosis, infection, arrhythmia, pneumothorax, and bleeding are among these complications. Malposition of the tip of the CVC can also occur with an incidence of up to 7%. One of several factors that could contribute to malposition is venous anatomy variation. Persistent left superior vena cava (PLSVC) is an extremely rare venous anatomical disorder but might have a significant clinical impact. Case Presentation Here we report a PLSVC case that was identified in chest radiography after the insertion of a CVC catheter in a patient with end-stage renal disease (ESRD). A 40-year-old woman with a history of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was presented in the emergency room with dyspnea for 1 week. Acute hemodialysis was required because of the ESRD and pulmonary edema. The PLSVC condition accompanied by various complications that occurred in this patient became a dilemma for the nephrologist in determining the diagnosis and proper CVC management. Discussion PLSVC is the most common congenital abnormality of the vena cava, even though it has a very small incidence. PLSVC occurs in about 0.1–0.5% of the total population and reaches 10% in individuals with congenital heart abnormalities. Most PLSVC presents along with normal superior vena cava and drains into the right atrium, which makes it very difficult to see the clinical signs and symptoms. Almost all PLSVC conditions are found incidentally during or after invasive procedures such as CVC insertion. CVC insertion in the PLSVC condition needs proper management to minimize the risk of complications. Conclusion This case shows the importance of understanding the PLSVC condition, which, although very rare, is expected to increase the awareness of the nephrologist in making the diagnosis, determining appropriate management, and preventing complications, thereby improving patient safety.
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Affiliation(s)
- Metalia Puspitasari
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hemi Sinorita
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hendry Purnasidha Bagaswoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Iri Kuswadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Heru Prasanto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Yulia Wardhani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wahyu Tri Kurniawan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia
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16
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Hirschl JR, Gadepalli SK, Derstine BA, Holcombe SA, Smith EA, Wang SC, Ehrlich PF, Jarboe MD. CT validation of SVC-RA junction location for pediatric central line placement: is vertebral bodies below the carina accurate? Pediatr Surg Int 2020; 36:1055-1060. [PMID: 32666296 DOI: 10.1007/s00383-020-04712-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The key landmark for tip position of a central venous catheter (CVC) is the SVC-RA junction. In adults, localization of the SVC-RA junction may be assessed as a function of vertebral body units (VBU) below the carina during CVC placement. We investigated the relationship between the SVC-RA junction and the carina in children. MATERIALS AND METHODS 584 CT scans of 0-18 years were analyzed. The carina was marked automatically by software while the SVC-RA junction and vertebrae were marked manually. The SVC-RA junction to carina (JC) distance was the primary study measurement reported in both VBU and mm. RESULTS The data show an average JC distance of 1.25 VBU for 0-1 year, 1.27 VBU for 1-4 years, 1.34 VBU for 4-9 years, 1.53 VBU for 9-15 years, and 1.64 VBU for 15-18 years. A positive relationship between weight and JC distance was also demonstrated. CONCLUSION JC distance is a useful predictor of SVC-RA junction location in children. Significant relationships were shown between JC distance and both age and weight. Due to small differences between age groups, however, average JC distance for all comers (1.48 VBU, 95% CI 0.7 - 2.3) can be used for SVC-RA junction identification in CVC placement.
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Affiliation(s)
- Jacob R Hirschl
- Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive., SPC 4211, Ann Arbor, MI, 48109-4211, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive., SPC 4211, Ann Arbor, MI, 48109-4211, USA
| | - Brian A Derstine
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Sven A Holcombe
- Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive., SPC 4211, Ann Arbor, MI, 48109-4211, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive., SPC 4211, Ann Arbor, MI, 48109-4211, USA.
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17
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Ultrasound to Detect Central Venous Catheter Placement Associated Complications: A Multicenter Diagnostic Accuracy Study. Anesthesiology 2020; 132:781-794. [PMID: 31977519 DOI: 10.1097/aln.0000000000003126] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mechanical complications arising after central venous catheter placement are mostly malposition or pneumothorax. To date, to confirm correct position and detect pneumothorax, chest x-ray film has been the reference standard, while ultrasound might be an accurate alternative. The aim of this study was to evaluate diagnostic accuracy of ultrasound to detect central venous catheter malposition and pneumothorax. METHODS This was a prospective, multicenter, diagnostic accuracy study conducted at the intensive care unit and postanesthesia care unit. Adult patients who underwent central venous catheterization of the internal jugular vein or subclavian vein were included. Index test consisted of venous, cardiac, and lung ultrasound. Standard reference test was chest x-ray film. Primary outcome was diagnostic accuracy of ultrasound to detect malposition and pneumothorax; for malposition, sensitivity, specificity, and other accuracy parameters were estimated. For pneumothorax, because chest x-ray film is an inaccurate reference standard to diagnose it, agreement and Cohen's κ-coefficient were determined. Secondary outcomes were accuracy of ultrasound to detect clinically relevant complications and feasibility of ultrasound. RESULTS In total, 758 central venous catheterizations were included. Malposition occurred in 23 (3.3%) out of 688 cases included in the analysis. Ultrasound sensitivity was 0.70 (95% CI, 0.49 to 0.86) and specificity 0.99 (95% CI, 0.98 to 1.00). Pneumothorax occurred in 5 (0.7%) to 11 (1.5%) out of 756 cases according to chest x-ray film and ultrasound, respectively. In 748 out of 756 cases (98.9%), there was agreement between ultrasound and chest x-ray film with a Cohen's κ-coefficient of 0.50 (95% CI, 0.19 to 0.80). CONCLUSIONS This multicenter study shows that the complication rate of central venous catheterization is low and that ultrasound produces a moderate sensitivity and high specificity to detect malposition. There is moderate agreement with chest x-ray film for pneumothorax. In conclusion, ultrasound is an accurate diagnostic modality to detect malposition and pneumothorax.
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18
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Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters. Shock 2020; 51:613-618. [PMID: 30052580 DOI: 10.1097/shk.0000000000001218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax are commonly performed, emerging evidence suggests that this practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. We hypothesize that a knowledge translation gap exists in this area. We aim to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared with chest radiography. METHODS We used a modified Dillman technique to conduct a brief web-based survey to Critical Care Medicine and Emergency Medicine physicians (targeted group of early adopters) evaluating the current practice related to CVC position confirmation and PTX exclusion via CXR or POCUS. RESULTS Of 200 post-training clinicians contacted, 136 (68%) responded to the survey. For routine CVC confirmation and PTX evaluation, 50.7% of Critical Care Medicine physicians and 65.4% of Emergency Medicine physicians reported using CXR alone while 49.3% and 33.1% respectively reported using CXR and ultrasound together. Though 84.6% of clinicians use ultrasound for CVC insertion "most of the time" or "always," none use ultrasound alone for CVC position confirmation, and only 1% has used ultrasound alone for PTX exclusion. CONCLUSIONS Though data support its utility and advantages for POCUS as a sole modality for CVC position confirmation and PTX evaluation, POCUS is rarely used for this indication. We identified several perceived barriers toward widespread utilization suggesting areas for dissemination and implementation strategy development that will benefit patient care practices.
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19
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Oliveira L, Pilz L, Tognolo CM, Bischoff C, Becker KA, Oliveira GG, Neves PJF, Fachin CG, Agulham MA, Dias AIBS. Comparison between ultrasonography and X-ray as evaluation methods of central venous catheter positioning and their complications in pediatrics. Pediatr Surg Int 2020; 36:563-568. [PMID: 32232550 DOI: 10.1007/s00383-020-04642-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates the capacity of ultrasonography as a diagnostic method to confirm the proper positioning of central venous catheter (CVC) when compared to the current gold standard, chest radiography (CR). METHODS A prospective study was performed including children from 0 to 14 incomplete years, who underwent CVC placement between March and May 2018 at a teaching hospital in Brazil. A four-chamber view of the heart was performed with ultrasound during a rapid injection of saline solution to identify hyperechoic images and confirm the central position of the catheter. After that, a CR was performed. The diagnostic quality of ultrasound was evaluated based on accuracy, sensitivity, specificity, positive and negative predictive values. RESULTS A total of 21 patients were analyzed. The mean age was 3.95 ± 4.01 years. The preferred puncture site was the right internal jugular vein (71.4%). Ultrasound accuracy to detect CVC positioning was 81%. Sensitivity, specificity and positive and negative predictive values were 33%, 100%, 100% and 79%, respectively. CONCLUSION Ultrasound is a reliable method for detection of CVC positioning. Even so, with the four-chamber cardiac view, this method is unable to identify catheters inside heart chambers, therefore, needing to confirm the positioning with CR.
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Affiliation(s)
- L Oliveira
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil.
| | - L Pilz
- Medical Student, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - C M Tognolo
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - C Bischoff
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - K A Becker
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - G G Oliveira
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - P J F Neves
- Medical Student, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - C G Fachin
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - M A Agulham
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
| | - A I B S Dias
- Pediatric Surgery Department, Hospital de Clínicas, Universidade Federal Do Paraná, Pedro Viriato Parigot de Souza, 1609/602, Curitiba, Paraná, CEP 81200-100, Brazil
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20
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Cao D, Shen Z, Gui Q, He Y. Misplacement of the tunnel hemodialysis catheter through the left jugular vein to the azygos vein: A case report. Medicine (Baltimore) 2020; 99:e19805. [PMID: 32282745 PMCID: PMC7220763 DOI: 10.1097/md.0000000000019805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The percutaneous catheterization of central veins is widely applied in patients with end-stage renal diseases as a permanent vascular access. To our knowledge, inadvertent placement of a hemodialysis catheter into the azygos vein through the left internal jugular vein is not described. PATIENT CONCERNS A 72-year-old female patient was admitted to the hospital for replacement of another new tunneled hemodialysis catheter due to poor flow in the left internal jugular vein tunneled catheter during hemodialysis. DIAGNOSIS The catheter tip was incorrectly positioned into the azygos vein as confirmed by conventional anteroposterior and lateral chest radiographs. INTERVENTIONS The catheter was removed and replaced under Digital Subtraction Angiography. OUTCOMES The catheter tip was finally placed in the proper position. LESSIONS The insertion of central vein catheterization is not always in suitable position especially through left jugular vein in hemodialysis patients. DSA technology should be performed to confirm the correct position of the tip and to ensure good blood flow.
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21
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Burbelko M. [Thoracic Central Venous Occlusive Disease and Haemodialysis Access]. Zentralbl Chir 2020; 145:473-480. [PMID: 32120444 DOI: 10.1055/a-1014-3538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Benign central venous thoracic occlusion is a frequent issue in haemodialysis patients. Symptomatic stenosis affects quality of life and can cause dysfunction of arteriovenous access or make it impossible to implant a haemodialysis catheter. Common risk factors for the development of the occlusions are central venous catheters and cardiac rhythm devices. The gold standard for diagnosis is venous angiography. Treatment of asymptomatic lesions can lead to clinical deterioration and should be avoided. The primary method of treatment for symptomatic patients is endovascular therapy. Repeat balloon angioplasty is a standard therapy. In case of elastic recoiling or early recurrence, placement of bare metal stent or stent graft could be considered. Surgical options should be preserved only for refractory cases. Further randomised trials are needed to prove the efficacy of new devices, such as dedicated venous stents and drug coated balloons.
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Affiliation(s)
- Michael Burbelko
- Institut für Radiologie und Interventionelle Therapie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
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22
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Yi X, Adams SJ, Henderson RDE, Babyn P. Computer-aided Assessment of Catheters and Tubes on Radiographs: How Good Is Artificial Intelligence for Assessment? Radiol Artif Intell 2020; 2:e190082. [PMID: 33937813 DOI: 10.1148/ryai.2020190082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/11/2019] [Accepted: 10/31/2019] [Indexed: 12/23/2022]
Abstract
Catheters are the second most common abnormal finding on radiographs. The position of catheters must be assessed on all radiographs because serious complications can arise if catheters are malpositioned. However, due to the large number of radiographs obtained each day, there can be substantial delays between the time a radiograph is obtained and when it is interpreted by a radiologist. Computer-aided approaches hold the potential to assist in prioritizing radiographs with potentially malpositioned catheters for interpretation and automatically insert text indicating the placement of catheters in radiology reports, thereby improving radiologists' efficiency. After 50 years of research in computer-aided diagnosis, there is still a paucity of study in this area. With the development of deep learning approaches, the problem of catheter assessment is far more solvable. This review provides an overview of current algorithms and identifies key challenges in building a reliable computer-aided diagnosis system for assessment of catheters on radiographs. This review may serve to further the development of machine learning approaches for this important use case. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Xin Yi
- Department of Medical Imaging (X.Y., S.J.A., P.B.) and College of Medicine (R.D.E.H.), University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Scott J Adams
- Department of Medical Imaging (X.Y., S.J.A., P.B.) and College of Medicine (R.D.E.H.), University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Robert D E Henderson
- Department of Medical Imaging (X.Y., S.J.A., P.B.) and College of Medicine (R.D.E.H.), University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Paul Babyn
- Department of Medical Imaging (X.Y., S.J.A., P.B.) and College of Medicine (R.D.E.H.), University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
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23
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Tran QK, Foster M, Bowler J, Lancaster M, Tchai J, Andersen K, Matta A, Haase DJ. Emergency and critical care providers' perception about the use of bedside ultrasound for confirmation of above-diaphragm central venous catheter placement. Heliyon 2020; 6:e03113. [PMID: 32042935 PMCID: PMC7002808 DOI: 10.1016/j.heliyon.2019.e03113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/21/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Chest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications. Recent studies have shown that point-of-care ultrasound (POCUS) has better sensitivity and is faster than CXR for these purposes. We were interested in documenting how often emergency medicine and critical care practitioners perform POCUS to confirm proper CVC positioning as well as their confidence in performing it. Methods We surveyed members of our state's chapters of the College of Emergency Physicians and the Society of Critical Care Medicine between April and December 2018. Our primary outcome was the percentage of providers who would agree to perform only POCUS, forgoing CXR, for confirmation of CVC position. We performed multivariable logistic regressions to measure associations between demographic, clinical information, and outcomes. Results One hundred thirty-six providers participated (a 25% participation rate). Their specialties were as follows: emergency medicine, 75%; critical care, 13%; and emergency medicine/critical care, 11%. Thirty-one percent would use POCUS only for CVC confirmation, while 42% were confident in performing POCUS for this purpose. Multivariable logistic regressions showed that performing more non-procedural ultrasound examinations was associated with a higher likelihood of agreeing to perform POCUS only (OR, 2.9; 95% CI: 1.3-6.3). Forty-six percent of relevant comments suggested more training to increase the use of POCUS. Conclusion Participants in this study did not frequently use POCUS for CVC confirmation. Designers of training curricula should consider including more instruction in the use of POCUS to confirm proper CVC placement and to detect complications.
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Affiliation(s)
- Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mark Foster
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Bowler
- University of Maryland at College Park, College Park, MD, USA
| | - Mia Lancaster
- University of Maryland at College Park, College Park, MD, USA
| | - Jennifer Tchai
- University of Maryland at College Park, College Park, MD, USA
| | - Katie Andersen
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Ann Matta
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel J Haase
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Mira FS, Cabral JP, Rodrigues L, Oliveira N, Agostinho G, Galvão A, Alves R. Multiple complications of a 14-year-old hemodialysis catheter. J Vasc Access 2019; 20:567-569. [PMID: 31190613 DOI: 10.1177/1129729819854828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.
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Affiliation(s)
- Filipe Santos Mira
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - João Pina Cabral
- 3 Internal Medicine Department, Coimbra University Hospital, Coimbra, Portugal
| | - Luís Rodrigues
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Nuno Oliveira
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gil Agostinho
- 4 Interventional Radiology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Ana Galvão
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Rui Alves
- 1 Nephrology Department, Coimbra University Hospital, Coimbra, Portugal.,2 Faculty of Medicine, Coimbra University, Coimbra, Portugal
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Vose J, Odunayo A, Price JM, Daves M, Schildt JC, Tolbert MK. Comparison of heparinized saline and 0.9% sodium chloride for maintaining central venous catheter patency in healthy dogs. PeerJ 2019; 7:e7072. [PMID: 31183263 PMCID: PMC6546076 DOI: 10.7717/peerj.7072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine whether heparinized saline (HS) would be more effective in maintaining the patency of central venous catheters (CVCs) in dogs compared to 0.9% sodium chloride. This was a prospective randomized blinded study conducted at a University Veterinary Teaching Hospital. METHODS A total of 24 healthy purpose-bred dogs were randomized into two groups: a treatment and a control group. A CVC was placed in the jugular vein of each dog. Each dog in the treatment group had their CVC flushed with 10 IU/mL HS, while dogs in the control group had their CVC flushed with 0.9% sodium chloride every 6 h for 72 h. Immediately prior to flushing, each catheter was evaluated for patency by aspiration of blood. The catheter site was also evaluated for phlebitis, and a rectal temperature was obtained in each dog every 6 h. Prothrombin (PT) and activated partial thromboplastin (aPTT) times were evaluated prior to the administration of any flush solution. Results were then compared to values obtained 72 h later. RESULTS All CVCs in both groups were patent after 72 h, which was demonstrated by aspiration of blood and ease of flushing the catheter. Two CVCs in the 0.9% sodium chloride group had a negative aspiration at hour 12 and 36, respectively. One CVC in the HS group had a negative aspiration at hour 18. Signs of phlebitis occurred in three dog: two in the 0.9% sodium chloride group and one in the HS group. No dog was hyperthermic (>103 °F). Two catheters were inadvertently removed by dogs in the HS group during the study. There were no significant differences in catheter patency, incidence of phlebitis, or incidence of negative aspirations between both groups. aPTT and PT values remained within the normal reference range for all dogs in both groups. Ultimately, 0.9% sodium chloride was as effective as 10 IU/mL HS in maintaining the patency of CVCs for up to 72 h in healthy dogs. Further evaluation in clinical patients is warranted.
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Affiliation(s)
- Julieann Vose
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Joshua M. Price
- Office of Information Technology, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Maggie Daves
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - Julie C. Schildt
- Department of Small Animal Clinical Sciences, University of Tennessee—Knoxville, Knoxville, TN, USA
| | - M. Katherine Tolbert
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
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Sugak AB, Shchukin VV, Konstantinova AN, Feoktistova EV. Complications of central venous catheters insertion and exploitation. ACTA ACUST UNITED AC 2019. [DOI: 10.24287/1726-1708-2019-18-1-127-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- A. B. Sugak
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - V. V. Shchukin
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation; Russian National Research Medical University named after N.I. Pirogov
| | - A. N. Konstantinova
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - E. V. Feoktistova
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
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Akaba T, Takeyama K, Hara H, Tamaoki J. Obturator Artery Pseudoaneurysm. Intern Med 2019; 58:1187-1188. [PMID: 30626804 PMCID: PMC6522394 DOI: 10.2169/internalmedicine.1037-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tomohiro Akaba
- First Department of Medicine, Tokyo Women's Medical University School of Medicine, Japan
| | - Kiyoshi Takeyama
- First Department of Medicine, Tokyo Women's Medical University School of Medicine, Japan
| | - Hiroko Hara
- First Department of Medicine, Tokyo Women's Medical University School of Medicine, Japan
| | - Jun Tamaoki
- First Department of Medicine, Tokyo Women's Medical University School of Medicine, Japan
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28
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Brown RS, Kim D. A Central Venous Catheter That Cannot Be Dislodged Easily by a Confused Patient. Ann Intern Med 2019; 170:503-504. [PMID: 30583294 DOI: 10.7326/l18-0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Robert S Brown
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.S.B.)
| | - Ducksoo Kim
- Boston Veterans Administration Health Care and Boston University School of Medicine, Boston, Massachusetts (D.K.)
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29
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Zhang X, Geng C. Unsuccessful removal of a totally implantable venous access port caused by thrombosis in the left brachiocephalic vein: A case report. Medicine (Baltimore) 2019; 98:e14985. [PMID: 30921208 PMCID: PMC6455955 DOI: 10.1097/md.0000000000014985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Thrombosis is a common complication associated with implantable venous access ports (IVAPs) and often results in loss of catheter function but is rarely associated with difficulty in IVAP removal. PATIENT CONCERNS A 53-year-old woman presented to the hospital due to difficulty in IVAP removal. The patient had been diagnosed with breast cancer and received modified radical mastectomy. After that, she underwent IVAP implantation. Four and half years later, the IVAP catheter had become stuck while the catheter remained unobstructed. The patient had no special chief complaints. DIAGNOSIS Postoperative breast cancer; difficulty in removal of IVAP (caused by thrombus in the left brachiocephalic vein). INTERVENTIONS We injected urokinase 5 ml 1000U/L into the catheter once a day for three days but failed to remove the IVAP. Vasography showed a thrombus in the left brachiocephalic vein. Removal of the thrombus would have been very dangerous, so we decided to leave both thrombus and catheter in the body and used heparin and warfarin as anticoagulants. OUTCOMES The general situation of the patient, followed-up for 20 months, was good and there was no psychological impact or other special chief complaints. LESSONS It is best to remove the IVAP in a timely manner once all treatments are finished.
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Dralle H, Kols K, Agha A, Sohn M, Gockel I, Lainka M. [Arterial malpositioning of a port catheter]. Chirurg 2019; 90:149-152. [PMID: 30734079 DOI: 10.1007/s00104-018-0765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - K Kols
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hans-Böckler-Allee 3, 30173, Hannover, Deutschland.
| | - A Agha
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - M Sohn
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - I Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - M Lainka
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Gefäßchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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The success rate and safety of internal jugular vein catheterization under ultrasound guidance in infants undergoing congenital heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:23-28. [PMID: 32082823 DOI: 10.5606/tgkdc.dergisi.2019.16185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In this study, we aimed to investigate the effect of central venous catheterization under ultrasound guidance on the success and complication rates in low-weight infants (under 5 kg) undergoing surgery due to congenital heart disease. METHODS A total of 70 infants (38 boys, 32 girls; mean age of patients <1 month was 16.4±9.5 days [n=20; 28.6%]; 1-7.5 months was 126.3±47.8 [n=50; 71.4%]) who underwent ultrasound-guided internal jugular venous catheterization between October 2014 and October 2015 were retrospectively analyzed. All catheterizations were done under the guidance of ultrasound by two skilled anesthesiologists. Data including demographic characteristics of the patients, procedural success rate, catheter access time, number of attempts, and complications were recorded. RESULTS The overall success rate of the procedure was 92.8% (n=65). In 82% of the patients (n=53), the insertion was successful at the first attempt. The mean catheter access time (time from the first puncture to the catheter insertion) was 214±0.48 sec. Complications were seen in five patients (7.14%), and the body weight of these patients was less than 2,500 g. There was no arterial puncture in any patients. One patient (1.42%) developed pneumothorax and four patients (5.7%) developed hematoma due to repeated attempts. CONCLUSION Our study results suggest that ultrasound-guided central venous cannulation is a safe and effective technique in pediatric population weighing less than 5 kg undergoing congenital heart surgery.
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Hendriksz CJ, Harmatz P, Giugliani R, Roberts J, Arul GS. Risks of long-term port use in enzyme replacement therapy for lysosomal storage disorders. Mol Genet Metab Rep 2018; 15:71-73. [PMID: 29845015 PMCID: PMC5966583 DOI: 10.1016/j.ymgmr.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 11/21/2022] Open
Abstract
Totally implantable vascular access devices (TIVADs) are commonly used in conjunction with enzyme replacement therapy (ERT) for lysosomal storage disorders (LSDs). This case series describes potential complications associated with long-term TIVAD use, such as compromise of skin integrity, infection, or port failures. Best practices and skilled specialists are essential for minimizing complications from long-term TIVAD use for ERT.
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Affiliation(s)
- Christian J. Hendriksz
- Salford Royal Foundation NHS Trust, Manchester, UK
- University of Pretoria, Department of Paediatrics and Child Health, Steve Biko Academic Unit, Pretoria, South Africa
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Roberto Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS and INAGEMP, Porto Alegre, Brazil
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33
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Shaw CM, Shah S, Kapoor BS, Cain TR, Caplin DM, Farsad K, Knuttinen MG, Lee MH, McBride JJ, Minocha J, Robilotti EV, Rochon PJ, Strax R, Teo EYL, Lorenz JM. ACR Appropriateness Criteria ® Radiologic Management of Central Venous Access. J Am Coll Radiol 2018; 14:S506-S529. [PMID: 29101989 DOI: 10.1016/j.jacr.2017.08.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 01/15/2023]
Abstract
Obtaining central venous access is one of the most commonly performed procedures in hospital settings. Multiple devices such as peripherally inserted central venous catheters, tunneled central venous catheters (eg, Hohn catheter, Hickman catheter, C. R. Bard, Inc, Salt Lake City UT), and implantable ports are available for this purpose. The device selected for central venous access depends on the clinical indication, duration of the treatment, and associated comorbidities. It is important for health care providers to familiarize themselves with the types of central venous catheters available, including information about their indications, contraindications, and potential complications, especially the management of catheters in the setting of catheter-related bloodstream infections. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Colette M Shaw
- Principal Author, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Shrenik Shah
- Research Author, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Drew M Caplin
- Hofstra Northwell School of Medicine, Manhasset, New York
| | | | | | - Margaret H Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jeet Minocha
- University of California San Diego, San Diego, California
| | - Elizabeth V Robilotti
- Memorial Sloan Kettering Cancer Center, New York, New York; Infectious Diseases Society of America
| | - Paul J Rochon
- University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | | | - Elrond Y L Teo
- Emory University School of Medicine, Atlanta, Georgia; Society of Critical Care Medicine
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Smit JM, Raadsen R, Blans MJ, Petjak M, Van de Ven PM, Tuinman PR. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018. [PMID: 29534732 PMCID: PMC5851097 DOI: 10.1186/s13054-018-1989-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US). Methods This is a systematic review and meta-analysis registered at PROSPERO (CRD42016050698). PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. Articles which reported the diagnostic accuracy of US in detecting the position of CVCs and the mechanical complications associated with insertion were included. Primary outcomes were specificity and sensitivity of US. Secondary outcomes included prevalence of malposition and pneumothorax, feasibility of US examination, and time to perform and interpret both US and chest x-ray. A qualitative assessment was performed using the QUADAS-2 tool. Results We included 25 studies with a total of 2548 patients and 2602 CVC placements. Analysis yielded a pooled specificity of 98.9 (95% confidence interval (CI): 97.8–99.5) and sensitivity of 68.2 (95% CI: 54.4–79.4). US examination was feasible in 96.8% of the cases. The prevalence of CVC malposition and pneumothorax was 6.8% and 1.1%, respectively. The mean time for US performance was 2.83 min (95% CI: 2.77–2.89 min) min, while chest x-ray performance took 34.7 min (95% CI: 32.6–36.7 min). US was feasible in 97%. Further analyses were performed by defining subgroups based on the different utilized US protocols and on intra-atrial and extra-atrial misplacement. Vascular US combined with transthoracic echocardiography was most accurate. Conclusions US is an accurate and feasible diagnostic modality to detect CVC malposition and iatrogenic pneumothorax. Advantages of US over chest x-ray are that it can be performed faster and does not subject patients to radiation. Vascular US combined with transthoracic echocardiography is advised. However, the results need to be interpreted with caution since included studies were often underpowered and had methodological limitations. A large multicenter study investigating optimal US protocol, among other things, is needed. Electronic supplementary material The online version of this article (10.1186/s13054-018-1989-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasper M Smit
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Reinder Raadsen
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michiel J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Manfred Petjak
- Department of Intensive Care medicine, Groene Hart Ziekenhuis, Bleulandweg 10, 2803 HH, Gouda, The Netherlands
| | - Peter M Van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Nestler T, Huber J, Laury AM, Isbarn H, Heidenreich A, Schmelz HU, Ruf CG. Thromboprophylaxis and the route of administration of chemotherapy in testicular cancer patients in German-speaking countries. World J Urol 2018; 36:913-920. [PMID: 29417289 DOI: 10.1007/s00345-018-2222-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Due to the excellent cure rates for testicular cancer (TC), focus has shifted towards decreasing therapy-related morbidities. Thrombosis is a frequent complication of cisplatin chemotherapy. Furthermore, the optimal route of administration for chemotherapy is still under debate. The purpose of this study was to assess the patterns of care concerning dosing and duration of thromboprophylaxis currently utilized in TC patients in German-speaking countries as well as the route of chemotherapy administration. METHODS A standardized questionnaire was sent to all members of the German TC Study Group (GTCSG) and to all the urological university hospitals in Germany. The questionnaire was also sent to the oncologic clinics at those universities where urologists do not administer chemotherapy. RESULTS The response rate was 87% (55/63). Prophylactic anticoagulation with low-molecular-weight heparin (LMWH) was administered in 94% of the clinics. The dosing of LMWH was prophylactic (85%), high prophylactic (adjusted to bodyweight) (7%), or risk adapted (9%). After completion of chemotherapy, anticoagulation was continued in 15 clinics (33%) for 2 to 24 weeks, while the remainder stopped the LMWH upon cessation of chemotherapy. Chemotherapy was administered via central venous access in 59%, peripheral IV in 27%, or both in 14% of the clinics. CONCLUSIONS Most of the institutions performed some form of thromboprophylaxis, although the modes of application varied by institution type and amongst the urologists and oncologists. Prospective studies are needed to evaluate the incidence, date of occurrence, and risk factors of venous thrombosis during TC chemotherapy to provide a recommendation concerning prophylactic anticoagulation.
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Affiliation(s)
- Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany. .,Department of Urology, University Hospital Cologne, Cologne, Germany.
| | - Johannes Huber
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, Texas, USA
| | - Hendrik Isbarn
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Hans U Schmelz
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Christian G Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
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36
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Lee JH, Byon HJ, Choi YH, Song IK, Kim JT, Kim HS. Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study. Paediatr Anaesth 2017; 27:1220-1226. [PMID: 29044814 DOI: 10.1111/pan.13258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. METHODS A two-stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I-A-B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants. RESULTS In the first study, the data of 67 patients were analyzed. The infant's height and I-A-B distance were highly correlated with the level of the central venous catheter tip (R2 =0.763 and 0.772, respectively; all P < .01), using the regression equations 0.11 × height (cm) + 0.19 and 1.02 × I-A-B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants (r = .938, P = <.001). In a Bland-Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15 cm, respectively. The limits of agreement were -0.19 and 0.38 cm, respectively. CONCLUSION In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Hyeong Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Vaish H, Kumar V, Anand R, Chhapola V, Kanwal SK. The Correlation Between Inferior Vena Cava Diameter Measured by Ultrasonography and Central Venous Pressure. Indian J Pediatr 2017; 84:757-762. [PMID: 28868586 DOI: 10.1007/s12098-017-2433-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 07/20/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To find a correlation between inferior vena cava (IVC) diameters, IVC compressibility index (CI) and central venous pressure (CVP). METHODS Prospective observational study was done at pediatric intensive care unit (PICU) of Kalawati Saran Children's Hospital (KSCH). Fifty children aged 5-18 y, presenting with shock were enrolled for the study. IVC diameters, CI and relevant clinical data were noted at enrollment, 30 min, 1 h, 6 h, and 12 h. Central line was placed at the time of admission. RESULTS Of 50 children enrolled, 28 were boys, with a mean age of 11 y. More than 80% of cases were diagnosed as septic shock. Mean maximum and minimum IVC diameter of 8.3 ± 2 mm and 3.7 ± 1.7 mm, respectively CI 58.2 ± 7% and CVP of 5.4 ± 1.5 cm of H2O was observed at admission. CVP and IVC diameters showed a serial improvement with treatment; CI showed a serial decrease with treatment. Heart rate (HR) and systolic blood pressure (SBP) also showed a serial improvement at 12 h (p < 0.05). CVP showed a positive correlation with IVC diameter (r +0.312; p < 0.05), and a negative correlation with CI (r -0.343; p < 0.05). CONCLUSIONS Effective fluid resuscitation improves IVC diameters with a decrease in CI. IVC diameter has a positive correlation to CVP and CI has a negative correlation to CVP.
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Affiliation(s)
- Hans Vaish
- Department of Pediatric Intensive Care Unit, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, Cannaught Place, New Delhi, 110001, India.
| | - Virendra Kumar
- Department of Pediatric Intensive Care Unit, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, Cannaught Place, New Delhi, 110001, India
| | - Rama Anand
- Department of Pediatric Intensive Care Unit, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, Cannaught Place, New Delhi, 110001, India
| | - Viswas Chhapola
- Department of Pediatric Intensive Care Unit, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, Cannaught Place, New Delhi, 110001, India
| | - Sandeep Kumar Kanwal
- Department of Pediatric Intensive Care Unit, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, Cannaught Place, New Delhi, 110001, India
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Long B, April MD. Is Bedside Ultrasonography Rapid and Accurate for Confirmation of Central Venous Catheter Position and Exclusion of Pneumothorax Compared With Chest Radiograph? Ann Emerg Med 2017; 70:585-587. [DOI: 10.1016/j.annemergmed.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Indexed: 11/30/2022]
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Mysona DP, Lassiter RL, Walters KC, Pipkin WL, Hatley RM. Azygos vein erosion: A potential complication of central venous access. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Ghahremani-Ghajar M, Jin A, Borghei P, Chen JLT. An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease. Hemodial Int 2017; 22:E1-E5. [DOI: 10.1111/hdi.12584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mehrdad Ghahremani-Ghajar
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Anna Jin
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Peyman Borghei
- Department of Interventional Radiology; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
| | - Joline L. T. Chen
- Division of Nephrology and Hypertension, Department of Medicine; University of California Irvine; Orange USA
- Nephrology Section, Medical Health Care Group; Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System; Long Beach California USA
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Bas A, Goksedef D, Kandemirli SG, Gulsen F, Numan F. Central venous catheter insertion into the false lumen of a complicated aortic dissection. Scott Med J 2017. [PMID: 28633595 DOI: 10.1177/0036933017715962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thoracic endovascular repair is considered the first-line treatment in complicated acute type B dissection. Central venous catheters provide valuable vascular access during endovascular treatments. However, central venous catheters are not without complications. Herein, we report a case of central venous catheter insertion into the false lumen of a complicated acute type B aortic dissection by direct aortic puncture. The tip of the central venous catheter was in the false lumen. The central venous catheter was left in place initially and was removed after graft stent deployment. This case illustrates the importance of image guidance during central venous catheter insertion, which may further complicate an already complicated aortic dissection case.
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Affiliation(s)
- Ahmet Bas
- 1 Associate Professor, Department of Radiology, Cerrahpasa University Faculty of Medicine, Turkey
| | - Deniz Goksedef
- 2 Associate Professor, Department of Cardiovascular Surgery, Cerrahpasa University Faculty of Medicine, Turkey
| | - Sedat G Kandemirli
- 3 MD, Department of Radiology, Cerrahpasa University Faculty of Medicine, Turkey
| | - Fatih Gulsen
- 1 Associate Professor, Department of Radiology, Cerrahpasa University Faculty of Medicine, Turkey
| | - Furuzan Numan
- 1 Associate Professor, Department of Radiology, Cerrahpasa University Faculty of Medicine, Turkey
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Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:715-724. [PMID: 27922877 DOI: 10.1097/ccm.0000000000002188] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. DATA SOURCES PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. STUDY SELECTION Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. DATA EXTRACTION Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. DATA SYNTHESIS Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. CONCLUSIONS Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.
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Mou LJ, Wang SH, Li QH, Zhang RS, Pan NZ, Wang JF. Malpositioning of a Tunneled Hemodialysis Catheter into the Azygos Vein: A Case Report and Literature Review. Blood Purif 2017; 44:108-109. [DOI: 10.1159/000475593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/06/2017] [Indexed: 11/19/2022]
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Moon J, Cho SU, Lee JW, Ryu S, Cho YC, Jeong WJ, Ahn HJ, Joo KH. Usefulness of new method of central venous catheter securement using a continuous suture. Am J Emerg Med 2017; 35:961-963. [PMID: 28188058 DOI: 10.1016/j.ajem.2017.01.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/15/2017] [Accepted: 01/26/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To reduce the time required for suture closure for central venous catheterization, a new procedure was developed using a continuous suture technique. The present study was conducted to investigate the usefulness of this method. METHOD The study was conducted with 90 volunteers among the doctors in the university hospital. Preliminary training (using video) on the two fixation methods was given to the participants prior to the experiment. After applying the central vein of the pig skin, a suture up to the butterfly seal was prepared, and the participant was allowed to fix the suture using the classic method and the new method. The time required for suturing was measured in seconds, and the tension was determined using a tension measuring device after suturing. RESULT When using the new "one-time method," the time required was shortened by about 20.50s on average compared with the conventional method (P<0.001). The median and quartile of the tension of the thread for the one-time method was 1.10kg (1.00-1.20kg) and of the conventional method was 1.10kg (1.00-1.20kg), which showed no statistically significant difference between the two groups (P=0.476). CONCLUSION We found that the new one-time method provided faster and more convenient central catheterization and catheter securement than the conventional methods.
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Affiliation(s)
- Janghyuck Moon
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Sung Uk Cho
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea.
| | - Jin Woong Lee
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Seung Ryu
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Hong Joon Ahn
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
| | - Ki Hyuk Joo
- Department of Emergency Medicine, National Chungnam University Hospital, Republic of Korea
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45
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Wang L, Liu ZS, Wang CA. Malposition of Central Venous Catheter: Presentation and Management. Chin Med J (Engl) 2017; 129:227-34. [PMID: 26830995 PMCID: PMC4799551 DOI: 10.4103/0366-6999.173525] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Zhang-Suo Liu
- Department of Nephropathy, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, China
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Lathey RK, Jackson RE, Bodenham A, Harper D, Patle V. A multicentre snapshot study of the incidence of serious procedural complications secondary to central venous catheterisation. Anaesthesia 2016; 72:328-334. [PMID: 27981565 DOI: 10.1111/anae.13774] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 12/18/2022]
Abstract
Despite the high number of central venous access devices inserted annually, there are limited data on the incidence of the associated procedural complications, many of which carry substantial clinical risk. This point was highlighted in the recently published Association of Anaesthetists of Great Britain and Ireland 'Safe vascular access 2016' guidelines. This trainee-led snapshot study aimed to identify the number of central venous catheter insertions and the incidence of serious complications across multiple hospital sites within a fixed two-week period. Secondary aims were to identify the availability of resources and infrastructure to facilitate safe central venous catheter insertion and management of potential complications. Fifteen hospital sites participated, completing an initial resource survey and daily identification of all adult central venous catheter insertions, with subsequent review of any complications detected. A total of 487 central venous catheter insertions were identified, of which 15 (3.1%) were associated with a significant procedural complication. The most common complication was failure of insertion, which occurred in seven (1.4%) cases. Facilities to enable safer central venous catheter insertion and manage complications varied widely between hospitals, with little evidence of standardisation of guidelines or protocols.
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Affiliation(s)
- R K Lathey
- Department of Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - R E Jackson
- Department of Anaesthesia, Harrogate District Hospital, Harrogate, UK
| | - A Bodenham
- Department of Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D Harper
- Department of Anaesthesia, Hull Royal Infirmary, Hull, UK
| | - V Patle
- Department of Anaesthesia, East Sussex Hospitals NHS Trust, East Sussex, UK
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Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis. Crit Care Med 2016. [PMID: 27922877 DOI: 10.1097/ccm.0000000000002188.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. DATA SOURCES PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. STUDY SELECTION Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. DATA EXTRACTION Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. DATA SYNTHESIS Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. CONCLUSIONS Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.
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Krishna VN, Eason JB, Allon M. Central Venous Occlusion in the Hemodialysis Patient. Am J Kidney Dis 2016; 68:803-807. [DOI: 10.1053/j.ajkd.2016.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/27/2016] [Indexed: 11/11/2022]
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49
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Armstrong L, Rodrigues J, Lawton C, Tyrell-Price J, Hamilton M, Manghat N. Application of TWIST MR angiography to aid successful central venous access in challenging patients: initial single-centre experience. Clin Radiol 2016; 71:1104-12. [DOI: 10.1016/j.crad.2016.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/31/2015] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
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Fracture of Totally Implanted Central Venous Access Devices: A Propensity-Score-Matched Comparison of Risks for Groshong Silicone versus Polyurethane Catheters. J Vasc Access 2016; 17:535-541. [DOI: 10.5301/jva.5000606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate retrospectively the fracture risk of totally implanted venous access devices connected to Groshong silicone (SC) versus polyurethane (PU) catheters, inserted via the internal jugular vein. Materials and methods The study population comprised 384 SC and 221 PU central venous catheters implanted via the internal jugular vein. The presence of catheter fracture was evaluated. Variables possibly related to catheter fracture were evaluated. First, in order to determine the factors associated with fracture, fracture rates were compared with the log-rank test between the two groups divided by each of the variables. Then, in order to adjust for potential confounders, propensity-score matching of the variables was employed in the two catheter groups. Finally, the rates of fracture were compared between the two propensity-score-matched catheter groups. Results There were 16 cases of catheter fracture, for an overall fracture percentage of 2.6% (16/605). All 16 cases of fracture occurred in the SC catheter group. Smaller patient body mass index (p = 0.039), deeper catheter tip position (p = 0.022), and SC catheters (p = 0.019) were significantly associated with fracture. With the propensity-score-matching method, 180 cases were selected in each catheter group. Comparison of the two propensity-score-matched groups showed that fracture rates for SC catheters remained significantly (p = 0.018) higher than those for PU catheters. Conclusions Ports connected to Groshong SC catheters – when implanted via the internal jugular vein – posed a higher risk of fracture than did ports connected to PU catheters.
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