An audit of ultrasound-assisted catheter insertion in patients receiving chemotherapy

Peripherally Inserted Central Catheter Placement @ the Speed of Sound

Over the past few years, one of the major advancements in bedside peripherally inserted central catheter (PICC) placement has been the addition of portable ultrasound for vascular access. Traditional bedside PICC insertion success rates varied from 65% to 75% due to the limited visualized area of access available for PICC placement (1.5 inches above to 1.5 inches below the antecubital fossa). With the implementation of ultrasound, success rates have climbed to 91%-94% for bed-side-placed PICC. This article reviews the dynamics of ultrasound, provides practical tips to use image visualization, and illustrates the important key functions of this technology.

The role of interventional surgery in oral potentially malignant disorders

Oral potentially malignant disorders are mucosal diseases with a significantly increased risk of squamous carcinoma development – a lethal and deforming disease with rising incidence, especially in young people. Despite the ability to recognise pre-cancer disorders in patients, clinicians remain unable to predict individual mucosal lesion behaviour or quantify the risk of malignant transformation. No clear management guidelines exist and the available scientific literature is unable to answer the fundamental question: does early diagnosis and interventional management treat pre-cancer effectively and prevent malignant transformation?

Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications

PURPOSE

Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications.

METHODS

All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded.

RESULTS

194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases.

CONCLUSION

Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained.

Ultrasound-guided percutaneous insertion of Hickman lines in children. Prospective study of 500 consecutive procedures

AIM

The ultrasound-guided percutaneous technique of Hickman line insertion has not been widely adopted in pediatric surgical practice. We wished to review our own experience of using this technique for insertion into the internal jugular vein.

METHODS

Our vascular access team consists of a consultant surgeon and 2 consultant anesthetists. All procedures were prospectively recorded on a database and were either performed or directly supervised by our team.

RESULTS

Five hundred consecutive Hickman lines were inserted between June 2004 and October 2006. Patients' ages ranged from 14 days to 19 years (median, 44 months). Patients weighed between 600 g to more than 100 kg. Lines inserted were all tunneled silicone Hickman lines with a Dacron cuff (size 2.7F-10F, with 1-3 lumens), of which 60% were 7F double-lumen lines. Successful cannulation occurred in 99.8%. Perioperative complications (within 30 days) occurred in 12 patients (2.4%) and were all treated conservatively with no need for either blood transfusion or chest drain. Catheter-related sepsis rate was 3.16 per 1000 line days.

DISCUSSION

1. The technique of ultrasound-guided percutaneous insertion of Hickman line to the internal jugular vein is safe and is applicable to all children regardless of size, age, or diagnosis. 2. Pediatric surgeons and anesthetists can learn this technique without specific training in interventional radiology. 3. A learning curve does exist, and we recommend concentrating pediatric vascular access procedures to a specialist team.