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Syska B, Veer AS, Matusik PS, Jarczewski JD, Krzanowska K, Popiela TJ. Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization. Diagnostics (Basel) 2024; 14:1038. [PMID: 38786336 PMCID: PMC11119990 DOI: 10.3390/diagnostics14101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.
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Affiliation(s)
- Barbara Syska
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Anna S. Veer
- Students’ Scientific Group, Department of Diagnostic Imaging, Jagiellonian University Medical College, 31-008 Cracow, Poland; (B.S.); (A.S.V.)
| | - Patrycja S. Matusik
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Jarosław D. Jarczewski
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, 31-008 Cracow, Poland;
| | - Tadeusz J. Popiela
- Department of Diagnostic Imaging, University Hospital, 30-688 Cracow, Poland; (J.D.J.); (T.J.P.)
- Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Cracow, Poland
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Hamri H, Pop CF, Mauriac S, Degreve C, Khaled C, Vouche M, Moreau M, Liberale G. Evaluation of the position of the central venous catheter tip of implantable venous access devices in the occurrence of postoperative thrombotic and non-thrombotic complications. Support Care Cancer 2024; 32:355. [PMID: 38750256 DOI: 10.1007/s00520-024-08563-7] [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: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The position of the catheter tip of totally implantable venous access devices (TIVAD) is a risk factor for postoperative complications. The study aim was to assess the early and late complications (EC and LC) associated with the position of the catheter tip in cancer patients. METHODS We reviewed cancer patients who had a TIVAD placed in 2020. EC (≤ 90 days), LC (> 90 days) and risk factors for TIVAD-associated complications were assessed. The vertical mismatch of the catheter tip was compared to an "ideal position" (> 10 mm below the carina and ≥ 20 mm below the right main bronchus (RMB)) using chest x-ray, post-implantation. RESULTS 301 patients were included. Median follow-up after TIVAD implantation was 9.4 months. All TIVAD catheters were inserted via the internal jugular vein (IJV). The mean distance between the catheter tip and the carina and the RMB was 21.3 mm and 6.63 mm respectively. In total, 11.3% patients developed EC and 5.6% had LC. An association was found between the position of the catheter tip from the carina (≤ 10 mm vs. > 10 mm) and the occurrence of EC (18.3% vs. 8.6%, p = 0.01) and for the catheter insertion side (left IJV vs. right IJV) (19.1% vs. 9.0% p = 0.02). Multivariate analysis showed that left IJV catheter insertion (OR 2.76), and a catheter tip located ≤ 10 mm below the carina (OR 2.71) are significant independent risk factors of EC. CONCLUSIONS TIVAD catheter tip located at ≤ 10 mm below the carina, and a left-side inserted catheter, are higher risk of EC.
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Affiliation(s)
- Hicham Hamri
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - C Florin Pop
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium.
| | - Sybil Mauriac
- Department of Nursing, Institut Jules Bordet - HUB, Brussels, Belgium
| | - Caroline Degreve
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Charif Khaled
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michel Moreau
- Data Center and Statistics, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgery, Institut Jules Bordet - HUB, Université Libre de Bruxelles (ULB), 90 Rue Meylemeersch, 1070, Brussels, Belgium
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Park H, Seo TS, Song MG, Yang WJ. Feasibility and Safety of a Technique Intended to Place the Catheter Tip in the Right Atrium without Abutment Against the Cardiac Wall during Implantation of the Totally Implantable Venous Access Port. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:161-170. [PMID: 38362390 PMCID: PMC10864156 DOI: 10.3348/jksr.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 02/17/2024]
Abstract
Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction.
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Liu W, Han Q, Li L, Chi J, Liu X, Gu Y. Catheter malposition analysis of totally implantable venous access port in breast cancer patients. Front Surg 2023; 9:1061826. [PMID: 36684345 PMCID: PMC9852749 DOI: 10.3389/fsurg.2022.1061826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background To investigate the occurrence of catheter malposition in breast cancer patients undergoing Totally Implantable Venous Access Port (TIVAP) implantation and analyze the effect of TIVAP implantation site on the incidence of catheter malposition. Methods Clinical data of Breast cancer patients underwent TIVAP implantation in our department from 2017 to 2021 was collected by reviewing the electronic medical records. The catheter malposition rate, location and management of malposed catheters in TIVAP implantation were analyzed. We divided the patients into the left internal jugular vein (IJV) group and the right IJV group according to the site of TIVAP implantation and compared the difference in the catheter malposition incidence between the two groups. In addition, we counted the catheter malposition rate of TIVAP implantion via the left and right IJV in right breast cancer patients to analyze the effect of tumor status on the side of TIVAP implantation on the catheter malposition rate. Results A total of 1,510 catheters were implanted in 1,504 patients, and 16 (1.06%) had catheter malposition. The catheter malposition rate was 4.96% (7/141) for TIVAP implanted via the left IJV and 0.66% (9/1,369) for right IJV, with a statistically significant difference (χ 2 = 18.699, P < 0.05). 743 TIVAPs were implanted in patients with right-sided breast tumor, of which the incidence of catheter malposition was 5.15% (7/136) for TIVAP implanted via left IJV and 0.82% (5/607) for right IJV, with a statistically significant difference (χ 2 = 10.290, P < 0.05). Malposed catheters were found in the subclavian vein, IJV, brachiocephalic vein, internal thoracic vein, undefined collateral veins, and outside the blood vessels. All malposed catheters were successfully adjusted to the proper position by simple manipulative repositioning or percutaneous positioning with the assistance of digital subtraction angiography (DSA), except for 1 case was removed the port because the catheter tip was located outside the vessel. Conclusion The catheter malposition rate of ultrasound-guided TIVAP implantation via IJV is low, and the malposed catheter can be successfully adjusted to the proper position by simple manipulative repositioning or DSA-assisted percutaneous positioning, however, the catheter malposition incidence of TIVAP implanted via left IJV is higher than that via the right side.
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Soh NYT, Tan BS, Chan SJM, Patel A, Gogna A, Zhuang KD, Tashi S, Venkatanarasimha N, Tay KH, Chandramohan S. Deeper may not be better: relationship between catheter dysfunction and location of the catheter tip in right-sided tunnelled haemodialysis catheters. Clin Radiol 2022; 77:678-683. [PMID: 35717409 DOI: 10.1016/j.crad.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
AIM To examine the relationship between catheter tip location and catheter dysfunction in the context of tunnelled central venous catheters (CVCs) for haemodialysis. MATERIALS AND METHODS This was a retrospective study of 993 haemodialysis patients who underwent insertion of tunnelled CVCs of step-tip design via the right internal jugular vein (IJV). Based on intra-procedural radiographs, the catheter tip was characterised as being in the superior vena cava (SVC), cavo-atrial junction (CAJ), or deep right atrium (DRA). Patients were tracked for 90 days post-procedure for complications resulting in catheter replacement, and these were compared between cohorts. Statistical analysis was performed with Pearson's chi-square and Fisher's exact tests for categorical variables and two-sample t-test and one-way analysis of variance (ANOVA) for continuous variables. RESULTS Ninety-five patients (9.6%) experienced catheter dysfunction necessitating replacement within 90 days of insertion. Tip location in SVC was associated with lower occurrence of catheter dysfunction (1.9%) as compared with the CAJ (8%) and DRA (11%; p=0.049). Catheter replacement due to other complications (catheter-associated bacteraemia, cuff dislodgement, exit-site infection, external catheter damage) showed no statistically significant relation to location of the CVC tip. CONCLUSION When utilising tunnelled CVCs with a step-tip design inserted via the right IJV, location of the catheter tip in the SVC is associated with reduced occurrence of catheter dysfunction as compared to either the CAJ or DRA.
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Affiliation(s)
- N Y T Soh
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - B S Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S J M Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Patel
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S Tashi
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - N Venkatanarasimha
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - S Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
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Internal Jugular Central Venous Catheter Tip Migration: Patient and Procedural Factors. Tomography 2022; 8:1033-1040. [PMID: 35448717 PMCID: PMC9025797 DOI: 10.3390/tomography8020083] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The ideal central venous catheter (CVC) tip position placement is controversial, and CVCs do not remain in a fixed position after placement. This study evaluates both patient and procedural factors which may influence CVC tip migration and subsequent catheter dysfunction. Materials and Methods: This study evaluates CVC placements at a single institution. Patient age, gender, body mass index (BMI), catheter laterality, CVC type and indication for central venous access were recorded. Catheter tip location relative to the carina was measured at time of placement and removal utilizing supine fluoroscopic imaging. Patients’ electronic medical records were reviewed for evidence of catheter dysfunction. Statistical analysis was performed utilizing odds ratios and two tailed Student’s t-test. Results: 177 patients were included (101 female; mean age 55; mean BMI 29.2). Catheter types included 122 ports, 50 tunneled large bore central venous catheters (≥9 French), and 5 tunneled small bore central venous catheters (<9 French). 127 were right sided catheters, and 50 were left sided. Left sided CVCs had a mean cranial tip migration of 3.2 cm (standard deviation ±2.9 cm) compared to 0.8 cm (standard deviation ±1.9 cm) for right sided catheters (p = 0.000008). Catheters that migrated cranially by >2 cm had more than 7× greater risk of dysfunction compared to catheters that migrated ≤2 cm (odds ratio of 7.2; p = 0.0001). Left sided CVCs were significantly more likely to have >2 cm of cranial migration (odds ratio 6.9, 95% CI 3.4−14.2, p < 0.0001) and had a higher rate of dysfunction, likely due to this cranial migration (32% vs. 4.7%; p = 0.00001). Gender and BMI were not found to be associated with catheter dysfunction or an increased odds ratio of >2 cm cranial migration. Conclusions: Left-sided CVCs migrate an average of 2.4 cm cranially more than right-sided catheters. Additionally, when migration occurs, left-sided catheters are more likely to be dysfunctional. These suggest that lower initial placement may be beneficial in left-sided catheters.
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Yoon SY, Jeon GS, Jung S. Image-guided placement of totally implanted vascular access device: retrospective analysis of the clinical outcomes and associated risk factors. BMJ Support Palliat Care 2021:bmjspcare-2021-002917. [PMID: 33927012 DOI: 10.1136/bmjspcare-2021-002917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine risk factors for catheter survival and complications after image-guided implantation of a totally implanted vascular access device (TIVAD). METHODS A total of 2883 TIVADs (2735 patients, 63.5±13 years old, 1060 men, 1675 women) implanted under guidance by ultrasound and fluoroscopy in our institution from January 2010 to December 2019 were evaluated retrospectively. We used the log rank test and logistic regression to analyse risk factors associated with catheter survival and complications. RESULTS Female patients (n=1778; 61.7%; mean catheter survival days: 780.6 days) and those with a haematological malignancy (n=277; 10.1%; mean catheter survival days: 1019 days) had significantly better catheter survival than male patients (n=1105; 38.3%; mean catheter survival days: 645.9 days) and those with a solid organ malignancy (n=2447; 89.5%; mean catheter survival days: 701 days) (p<0.001 and p=0.003). Patients with haematological malignancies and benign vascular inflammatory disease (n=11; 0.4%) were vulnerable to infection (n=96; 3.3%) (p<0.001 and p=0.004). Thrombotic malfunction (n=38; 1.3%) was significantly more common in females than males (p=0.005). Non-thrombotic malfunction (n=16; 0.6%) showed a significant association with left positioning of the TIVAD (n=410; 14.2%) (p=0.043). Wound dehiscence (n=3; 0.1%) was significantly more frequent in punctured veins other (n=23; 0.8%) than the internal jugular vein (p<0.001). CONCLUSIONS Increased attention should be paid to patients with an underlying haematological malignancy, underlying vascular inflammatory disease, female patients, older patients, those accessed via a vein other than the IJV, those with left positioning of the TIVAD system or those with a prolonged TIVAD maintenance.
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Affiliation(s)
- So Yeon Yoon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Gyeong Sik Jeon
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
| | - Sanghoon Jung
- Department of Radiology, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, Korea (the Republic of)
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McDevitt JL, Quadri RS, Sutphin PD, Zeikus E, Kwon JK, Browning T, Reddick M. Capacity Prioritization Initiative Reduced the Wait Time for Port Placement and Facilitated Increased Volume of Port Placements at a Large County Health System. Curr Probl Diagn Radiol 2020; 50:288-292. [PMID: 33010973 DOI: 10.1067/j.cpradiol.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022]
Abstract
DESCRIPTION OF THE PROBLEM Wait time from request to placement of ports in interventional radiology had increased from 14 to 27 days over a 4-month period. The goal of this project was to reduce the wait time by 15% within 4 months while accommodating additional volume. INSTITUIONAL APPROACH TO ADDRESS PROBLEM Capacity analysis revealed 2 bottlenecks: (1) inadequate provider capacity for preprocedural visits in interventional radiology clinic and (2) inadequate number of spots for port placement in the angiography schedule. The intervention consisted of: (1) 2 reserved slots in the attending physician's morning clinic schedule and (2) 3 daily guaranteed spots for port placement in the angiography suite. Both changes were integrated into the electronic medical record scheduling system. DESCRIPTION OF OUTCOMES After the intervention, per biweekly period, the number of port requests increased by 17% (Preintervention: 16.6 ± 3.1, Postintervention: 20.1 ± 4.1, P = 0.03), the number of completed clinic visits increased by 19% (Preintervention: 16.7 ± 5.1, Postintervention: 20.5 ± 3.6, P = 0.05), and the number of port placements increased by 19% (Preintervention: 16.9 ± 3.9, Postintervention: 21.0 ± 3.5, P = 0.02). The average wait time from request to placement decreased by 22% (Preintervention: 22.2 ± 4.4 days, Postintervention: 18.3 ± 3.4 days, P = 0.03), driven by a 49% decrease in wait time between request and clinic visit (Preintervention: 11.0 ± 2.3 days, Postintervention: 7.4 ± 1.0 days, P = 0.03). CONCLUSIONS Prioritization of clinic and angiography suite capacity, integrated into the electronic scheduling system, significantly reduced the wait time for port placement, even with significant increases in the volume of port requests.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX.
| | - Rehan S Quadri
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | | | - Eric Zeikus
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Jeannie K Kwon
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Travis Browning
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
| | - Mark Reddick
- Department of Radiology, University of Texas-Southwestern Medical Center, Dallas, TX
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Michell H, Nezami N, Morris C, Hong K. Dual-chambered venous access port as alternative access for extracorporeal apheresis therapy. J Vasc Access 2020; 22:173-177. [PMID: 32538271 DOI: 10.1177/1129729820932425] [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: 11/17/2022] Open
Abstract
PURPOSE To evaluate the use of a dual-chambered venous access port for extracorporeal apheresis therapy. METHODS This was a single-center retrospective analysis of all patients who received a dual-chambered venous access port for apheresis therapy over a 36-month period. Clinical success was defined as successful completion of at least one round of apheresis via the venous access port. Major complications were defined as any event requiring elevation of patient care and/or venous access port removal or repositioning. Minor complications were defined as venous access port issues resolved with clinical intervention. RESULTS Forty-four patients had a venous access port placed at the time of this study. Patients underwent red cell exchange (n = 33), therapeutic plasma exchange (n = 6) or extracorporeal photopheresis (n = 5). Forty (90%) patients had autoimmune diseases and four (10%) had neoplastic processes. Clinical success was achieved in 42 (95.5%) patients. Average venous access port dwell time was 632 days (range = 42-1191 days). All therapies through the venous access ports were well tolerated and no patients reported pain or discomfort. Major complications were seen in nine (20.5%) patients-the majority (n = 7) of which were due to venous access port malfunction-and resolved with catheter revision. One (2.27%) major complication involved an infected venous access port, and one involved a large hematoma at the venous access port site. Minor complications were seen in eight (18.2%) patients, where simple flushing of the catheter with saline or tissue plasminogen activator resolved the issue. CONCLUSION The dual-chambered venous access port was successfully used for sustained blood flow in apheresis therapy with a moderate, yet correctable complication rate.
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Affiliation(s)
- Hans Michell
- Division of Interventional Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| | - Nariman Nezami
- Division of Interventional Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Christopher Morris
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| | - Kelvin Hong
- Division of Interventional Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Wu CY, Fu JY, Wu CF, Hsieh MJ, Wen CT, Cheng CH, Liu YH, Ko PJ. Superior Vena Cava Port Catheter Tip Confirmation: Quantified Formula for Intravascular Catheter Length versus Anatomic Landmark Reference. Ann Vasc Surg 2019; 60:193-202. [PMID: 31075484 DOI: 10.1016/j.avsg.2019.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate tip location is crucial for intravenous port implantation because it can minimize catheter-related complications. Adequate tip location cannot be observed directly and needs to be confirmed by imaging tools. A quantified intravascular catheter length formula has been proposed and we attempt to compare its clinical effectiveness with anatomic landmark references. METHODS During the period from March 2012 to February 2013, 503 patients who received port implantation where implanted catheter length depended on carina level as confirmed by intraoperative fluoroscopy were assigned to Group A. From March 2013 to February 2014, 521 patients who received port implantation based on quantified intravascular catheter length formula were assigned to Group B. Clinical outcomes were compared. RESULTS Catheter tip location of Group A, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.18 ± 0.51 and 1.1 ± 1.3 cm below carina, respectively. Catheter tip location of Group B, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.25 ± 1.05 and 1.05 ± 1.32 cm below carina, respectively. Similar catheter tip location was identified in both groups. The functional period of implanted ports, complication rate (3.58% and 2.53%), and incidence (0.049 and 0.0506 episodes/1,000 catheter days) were similar in both groups. CONCLUSIONS The quantified intravascular catheter length formula can predict an adequate catheter length just as well as carina do and results in good catheter tip location. The formula could replace the clinical use of anatomic landmarks and serve as an easy tool for practitioners.
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Affiliation(s)
- Ching-Yang Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Jui-Ying Fu
- Chest Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Feng Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tsung Wen
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hui Cheng
- Cardiovascular Physiology Laboratory, Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Makary MS, Lionberg A, Khayat M, Lustberg MB, AlTaani J, Pan XJ, Layman RR, Raman SV, Layman RM, Dowell JD. Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement. Phlebology 2018; 34:107-114. [PMID: 29771187 DOI: 10.1177/0268355518774442] [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: 01/23/2023]
Abstract
PURPOSE Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.
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Affiliation(s)
- Mina S Makary
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Lionberg
- 2 Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mamdouh Khayat
- 3 Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryam B Lustberg
- 4 Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jamal AlTaani
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xueliang J Pan
- 5 Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard R Layman
- 6 Division of Diagnostic Imaging, Department of Imaging Physics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Subha V Raman
- 7 Division of Cardiovascular Medicine, Department of Internal Medicine, Richard R. Ross Heart Hospital and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel M Layman
- 8 Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joshua D Dowell
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,9 Northwest Radiology, St. Vincent Health, Indianapolis, IN, USA
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12
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Yin L, Jiang S. Evaluation of EMLA cream for relieving pain during needle insertion on totally implantable venous access device. J Vasc Access 2018; 19:634-638. [PMID: 29629603 DOI: 10.1177/1129729818768182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Needle insertion is a routine procedure performed on cancer patients with totally implantable venous access device. Although this procedure is painful for most of the patients, it is regularly performed without topical application of local anesthetics. In our study, we assess the degree of pain associated with different duration times of EMLA cream. Methods: A total of 361 cancer patients with totally implantable venous access devices were randomly divided into three groups: group 1—placebo, group 2—30 min after application of EMLA, and group 3—60 min after application of EMLA. In this double-blinded prospective study, the efficacy of EMLA cream was compared with a placebo cream by comparing the degree of pain experienced by the patient who was evaluated during and after needle insertion on a numeric rating scale. Results: The mean ± standard deviation of pain experienced by the patients was significantly (p < 0.05) lower in group C (0.69 ± 0.98) than groups B (1.11 ± 1.14) and A (1.91 ± 1.40). No significant (p > 0.05) difference was found in mean scores from inexperienced and experienced procedures of needle insertions among three groups. Comparing male patients, the female patients in group 1 and group 2 had lower numeric rating scale (1.59 ± 0.94, 1.39 ± 1.35; p < 0.01). Conclusion: The present results review that the application of EMLA cream for 30 min is suitable, acceptable, and convenient in cancer patients with totally implantable venous access device undergoing needle insertion.
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Affiliation(s)
- Lijuan Yin
- Center of Oncology, Jiangsu Province Hospital, Nanjing, China
| | - Shudi Jiang
- Center of Oncology, Jiangsu Province Hospital, Nanjing, China
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13
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Song MG, Seo TS, Kim YH, Cho SB, Chung HH, Lee SH, Jung E. Effect of catheter diameter on left innominate vein in breast cancer patients after totally implantable venous access port placement. J Vasc Access 2018; 19:615-619. [PMID: 29560786 DOI: 10.1177/1129729818765062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: To evaluate the effect of catheter diameter on left innominate vein stenosis in breast cancer patients after placement of totally implantable venous access ports. MATERIALS AND METHODS: Totally implantable venous access ports were placed via the left internal jugular vein in 241 women with right breast cancer from January 2010 to December 2014 (mean age, 51.5 years; range, 19-83 years). There were 67 totally implantable venous access ports with a 6.5F catheter and 142 totally implantable venous access ports with an 8F catheter. Medical records were retrospectively reviewed. The presence of significant left innominate vein stenosis and tip location of the catheter was evaluated on chest computed tomography images. Statistical analysis was performed. RESULTS: Left innominate vein stenosis developed in 1 (1.5%) and 13 (9.2%) patients after implantation with 6.5 and 8F catheters, respectively. Difference in the cumulative incidence of left innominate vein stenosis was statistically significant between the two groups (log rank test p-value: 0.002). In Cox regression analysis, the hazard ratio for left innominate vein stenosis was 20.766 ( p = 0.005) for an 8F catheter. CONCLUSION: The incidence of left innominate vein stenosis was higher after implantation of totally implantable venous access ports with 8F catheter rather than with 6.5F catheter. Considering that using 8F catheter versus 6.5F catheter has no advantage in terms of performance of the device, the results of our study suggest that ports with catheters >7F should be avoided.
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Affiliation(s)
- Myung Gyu Song
- 1 Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Seok Seo
- 1 Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yun Hwan Kim
- 2 Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Bum Cho
- 2 Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Hoon Chung
- 3 Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Hwa Lee
- 3 Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Euichul Jung
- 4 Department of Radiology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
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14
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Transitioning from anatomic landmarks to ultrasound guided central venous catheterizations: guidelines applied to clinical practice. J Vasc Access 2017; 18:328-333. [DOI: 10.5301/jva.5000756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Centrally inserted central catheter (CICC) insertion is a commonly performed procedure that may give rise to different complications. Despite the suggestion of guidelines to use ultrasound guidance (USG) for vascular access, not all centers use it systematically. The aim of this study is to illustrate the experience with ultrasound in CICC placement at a high-volume oncological center, in a country where the landmark technique is standard. Methods Retrospective analysis of a prospective database was performed on CICC placement under USG in the Central Venous Catheter Unit of Instituto Português de Oncologia de Lisboa Francisco Gentil, from 2012 to 2015. Results Three thousand five hundred and seventy-two procedures were recorded. From 2728 CICC placements, 1187 (43.5%) were done using USG. The majority of CICC placements were successful without immediate complications (96.1%). In 55 cases (4.6%), more than three attempts were necessary to puncture the vein. Pneumothorax occurred in 5 cases (0.4%) and arterial puncture was registered in 41 cases (3.5%). An increasing use of USG for placing CICCs was planned and observed over the years and, in the last year of the study, 67.3% of the CICC placements were with USG. Conclusions CICC placement with USG is a safe and effective technique. Despite some resistance that is observed, these results support that it is worth following the guidelines that advocate the use of the USG in the placement of CICC.
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15
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Chick JFB, Reddy SN, Yam BL, Kobrin S, Trerotola SO. Institution of a Hospital-Based Central Venous Access Policy for Peripheral Vein Preservation in Patients with Chronic Kidney Disease: A 12-Year Experience. J Vasc Interv Radiol 2017; 28:392-397. [DOI: 10.1016/j.jvir.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022] Open
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16
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Clark K, Chick JFB, Reddy SN, Shin BJ, Nadolski GJ, Clark TW, Trerotola SO. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. J Vasc Interv Radiol 2017; 28:602-607. [PMID: 28238580 DOI: 10.1016/j.jvir.2016.12.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. MATERIALS AND METHODS CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. RESULTS All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). CONCLUSIONS Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
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Affiliation(s)
- Katherine Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Shilpa N Reddy
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Radiology Associates of the Main Line, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Benjamin J Shin
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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17
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Long-term outcomes of totally implantable venous access devices. Support Care Cancer 2017; 25:2049-2054. [DOI: 10.1007/s00520-017-3592-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/16/2017] [Indexed: 01/17/2023]
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18
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Krzywda EA, Andris DA. Twenty-five Years of Advances in Vascular Access: Bridging Research to Clinical Practice. Nutr Clin Pract 2017; 20:597-606. [PMID: 16306296 DOI: 10.1177/0115426505020006597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Vascular access has become a key component for a multitude of IV therapies, including parenteral nutrition. Access of the central venous system has been long recognized for its associated complications of infection, thrombosis, and occlusion. Over the past 25 years, clinical practice based on research and innovation has attempted to decrease complication rates and therefore improve the safety of vascular access. This article highlights the research and its influence on catheter care procedures, technology, and education that has led to advances in vascular access. An improved understanding of the pathophysiology associated with catheter-related complications and an ongoing evaluation of new treatment modalities has provided clinicians today with new options for improved patient care and the ability to preserve vascular access options for patients.
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Affiliation(s)
- Elizabeth A Krzywda
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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19
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Etezadi V, Trerotola SO. Comparison of Inversion ("flipping") Rates Among Different Port Designs: A Single-Center Experience. Cardiovasc Intervent Radiol 2016; 40:553-559. [PMID: 28004169 DOI: 10.1007/s00270-016-1546-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/14/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare incidence of port inversion among different types of implantable venous access devices. MATERIALS AND METHODS Records of patients who underwent imaging-guided subcutaneous port placement without port fixation between July 2001 and April 2015 were reviewed with use of a quality assurance database. 1930 patients with complete follow-up (death or explant) were included in the study. Collected data included date and indication for port placement, port type, venous access site, immediate and long-term complications, indication for removal, and total number of catheter days. BMI of patients with inverted ports was also calculated. RESULTS Port inversion within the pocket was observed in 18 patients (0.9%) including 7/82 (9%) of Dignity ports, 4/126 (3%) of Vaxcel plastic arm ports, 3/142 (2%) of Smartports, 2/100 (2%) of Powerports, 1/14 (7%) of Vaccess ports, and 1/1421 (0.07%) of Vortex LP ports. Among these designs, the inversion rate was significantly lower in Vortex LP ports (0.1%) (P < 0.05). There was a trend toward higher inversion rate of Dignity ports, which have a rectangular design with a relatively narrow base. Mean dwell in inverted ports was 114 days (7-580). CONCLUSION The incidence of port inversion without suture fixation of the port base to the pocket is extremely low. The present study shows differences in inversion incidence based on port design. LEVEL OF EVIDENCE Case Series, Level IV.
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Affiliation(s)
- Vahid Etezadi
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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20
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Sarode R, Ballas SK, Garcia A, Kim HC, King K, Sachais B, Williams LA. Red blood cell exchange: 2015 American Society for Apheresis consensus conference on the management of patients with sickle cell disease. J Clin Apher 2016; 32:342-367. [DOI: 10.1002/jca.21511] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Ravi Sarode
- Department of Pathology, Division of Transfusion Medicine and Hemostasis; UT Southwestern Medical Center; Dallas Texas
| | - Samir K. Ballas
- Department of Medicine, Cardeza Foundation for Hematologic Research; Jefferson Medical College, Thomas Jefferson University; Philadelphia Pennsylvania
| | - Alicia Garcia
- Children's Hospital & Research Center; Oakland California
| | - Haewon C Kim
- Departments of Pediatrics and Pathology; Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Karen King
- Department of Pathology, Transfusion Medicine; Johns Hopkins University; Baltimore Maryland
| | | | - Lance A. Williams
- Department of Pathology, Division of Laboratory Medicine; University of Alabama at Birmingham; Birmingham Alabama
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21
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Duncan C, Trerotola SO. Outcomes of a Percutaneous Technique for Shortening of Totally Implanted Indwelling Central Venous Chest Port Catheters. J Vasc Interv Radiol 2016; 27:1034-7. [PMID: 27338498 DOI: 10.1016/j.jvir.2016.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Central venous port catheters that are too long are typically removed or revised. The subcutaneous position of port reservoirs precludes standard over-the-wire exchange techniques, and a method of percutaneous revision using an intravascular loop snare technique has been previously described. A retrospective review was conducted of 38 procedures that were performed at a single academic institution between 2005 and 2015. Technical success was 100%, without immediate or delayed complications with follow-up until port removal or death in 94% of patients. Percutaneous revision is an effective method for shortening too-long port catheters, allowing uninterrupted use of the port.
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Affiliation(s)
- Christopher Duncan
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Interventional Radiology, and Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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22
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Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up. Eur Radiol 2016; 27:97-104. [DOI: 10.1007/s00330-016-4354-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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23
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Effectiveness of Breast Fixation to Reduce Migration of the Tip of a Totally Implantable Venous Access Port in Women. J Vasc Access 2016; 17:348-52. [DOI: 10.5301/jva.5000565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate effectiveness of breast fixation to reduce migration of the catheter tip of a totally implantable venous access port (TIVP) in women. Materials and Methods TIVPs were placed in 129 women via the right axillary vein from July 2012 to December 2014, with a final study population of 118 patients (mean age, 55.3 ± 13.8 years; range, 21-91 years). The patients were divided into two groups according to breast fixation during TIVP placement. A total of 56 patients received TIVP placement without breast fixation (Group 1); the remaining 62 received TIVP placement in the supine position after fixation of the ipsilateral breast on the abdominal wall in the sitting position (Group 2). Medical records were retrospectively reviewed for age, weight, height, body mass index, and underlying malignancy. We evaluated the difference in distance ratios between the port chamber and the catheter tip on supine chest and erect chest radiographs, respectively. Statistical analysis was performed using Student's t test. Results Differences in all parameters between Group 1 and Group 2 were not statistically significant. Mean distance ratio between the port chamber and the catheter tip was 1.95 ± 0.97 in Group 1 and 1.33 ± 0.59 in Group 2. Differences in distance ratios between the port chamber and the catheter tip were statistically significant between Group 1 and Group 2 (p = 0.001). Conclusions Breast fixation seems to be effective in reducing migration of the port chamber and catheter tip with position changes in female patients during TIVP placement.
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Wu CY, Fu JY, Wu CF, Ko PJ, Liu YH, Kao TC, Yu SY. Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route? Medicine (Baltimore) 2015; 94:e2199. [PMID: 26656351 PMCID: PMC5008496 DOI: 10.1097/md.0000000000002199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.
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Affiliation(s)
- Ching-Yang Wu
- From the Chang Gung University; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (C-YW, C-FW, P-JK, Y-HL, T-CK, S-YY); and Chang Gung University; Division of Pulmonary and Critical care, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan (J-YF)
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Abstract
The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.
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LaRoy JR, White SB, Jayakrishnan T, Dybul S, Ungerer D, Turaga K, Patel PJ. Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room. J Am Coll Radiol 2015; 12:563-71. [PMID: 26047398 PMCID: PMC4655878 DOI: 10.1016/j.jacr.2015.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). METHODS This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. RESULTS Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P < .0001). Overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. CONCLUSIONS Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections.
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Affiliation(s)
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thejus Jayakrishnan
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Stephanie Dybul
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dirk Ungerer
- Decision Support, Financial Department, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiran Turaga
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parag J Patel
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Massmann A, Jagoda P, Kranzhoefer N, Buecker A. Percutaneous Re-positioning of Dislocated Port-Catheters in Patients with Dysfunctional Central-Vein Port-Systems. Ann Surg Oncol 2015; 22:4124-9. [DOI: 10.1245/s10434-015-4549-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Indexed: 11/18/2022]
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Factors that predict increased catheter tip movement in left internal jugular vein implantable venous access ports upon standing. J Vasc Access 2015; 16:223-6. [PMID: 25613147 DOI: 10.5301/jva.5000331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the characteristics that predict catheter tip movement with positional changes in patients with left-sided, internal jugular vein (IJV) implantable venous access ports. METHODS A retrospective review revealed 264 patients with left IJV ports placed at one academic institution from 2008 to 2013 with follow-up upright chest radiographs. Demographic information was recorded and anatomic measurements were made on both procedural fluoroscopic imaging and upright chest radiographs. Multivariate regression analysis was performed to determine which factors had statistically significant relationships with catheter tip movement distance. RESULTS Mean catheter tip movement was 1.49 ± 1.97 cm. There was a statistically significant positive relationship between catheter tip movement distance and age (p = 0.03), body mass index (BMI) (p = 0.02), innominate vein angle (p<0.01) and dual- compared to single-lumen ports (p = 0.02). Port pocket location, venous access site and gender did not demonstrate statistical significance. CONCLUSIONS The factors associated with increased positional catheter tip movement for left IJV ports include patient age, BMI, innominate vein angle and dual- vs single-lumen port. This information can be useful in determining initial placement position and avoiding complications associated with catheter malposition.
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Wu CY, Lin FS, Wang YC, Chou WH, Lin WY, Sun WZ, Lin CP. Fast Track ultrasound protocol to detect acute complications after totally implantable venous access device placement. Ann Surg Oncol 2014; 22:1943-9. [PMID: 25404473 DOI: 10.1245/s10434-014-4222-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization. METHODS Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared. RESULTS Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001). CONCLUSIONS Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.
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Affiliation(s)
- Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction. Cardiovasc Intervent Radiol 2014; 38:642-50. [DOI: 10.1007/s00270-014-0968-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
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Nadolski G, Shlansky-Goldberg RD, Stavropoulos SW, Soulen MC, Farrelly C, Trerotola SO. Chest radiograph-based algorithm for managing malfunctioning ports. J Vasc Interv Radiol 2014; 24:1337-42. [PMID: 23973022 DOI: 10.1016/j.jvir.2013.05.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate a chest x-ray-based algorithm for managing malfunctioning ports. MATERIALS AND METHODS A review of interventional radiology procedures on malfunctioning ports during the period 2000-2012 was performed. Events were divided into two periods: before and after implementation of an algorithm beginning with tip position evaluation using a chest x-ray. Time to return to usability, frequency of interventions to restore function, and frequency of malfunctioning ports remaining in use after the procedure were calculated. RESULTS The review included 303 procedures before implementation of the algorithm on 237 access sites in 227 patients (mean age, 56 y; 38% male) and 155 procedures after implementation of the algorithm on 131 access sites in 130 patients (mean age, 55 y; 35% male). Implementation of the algorithm was associated with significantly fewer repeat checks on the same access (27% before algorithm, 9% after algorithm, P < .001) and reduced frequency of a malfunctioning port remaining in use after the interventional radiology procedure (43% before algorithm to 14% after algorithm, P < .001). Median time from consultation to revision was significantly less after implementing the algorithm (13 days before algorithm, 1 day after algorithm, P < .001). Median time from consultation to port usability was also less after implementing the algorithm (2.7 days before algorithm, 1 day after algorithm, P < .001). CONCLUSIONS Implementation of the algorithm was associated with significantly less frequent repeat procedures on the same port and a lower frequency of malfunctioning ports remaining in place. Use of the algorithm was associated with significantly reduced time from consultation to revision and to return to usability. These findings suggest the algorithm allows triage of patients with malfunctioning ports to the appropriate intervention before undergoing a procedure.
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Affiliation(s)
- Gregory Nadolski
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava. Surg Today 2014; 44:1513-21. [PMID: 24711121 DOI: 10.1007/s00595-014-0893-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 08/20/2013] [Indexed: 10/25/2022]
Abstract
PURPOSES The optimal tip position for an intravenous port and the angle between the locking nut and the catheter are still debatable. This study evaluates the use of chest X-ray plain films for screening patients with potential intravenous port complications. METHODS We reviewed, retrospectively, 1505 patients who had an intravenous port implanted between January 1 and December 31, 2006 at Chang Gung Memorial Hospital, and were followed up until June 30, 2010. Of the 1119 patients with an intravenous port implanted via the superior vena cava (SVC), 279 underwent re-interventions for complications. There were four different types of single lumen port, and entry vessels on the right side were utilized as the predominant entry sites through the vessel cut-down method for catheter cannulation. The anatomic catheter tip was confirmed on the postero-anterior view of plain chest X-ray films. We used the Picture Arching and Communicating System (PACS) (GE, Fairfield, CT, USA) to record the angle and distance in degrees and centimeters, respectively. RESULTS The tracheal carina was seen easily on the chest X-ray plain film and the location of the catheter tip and the angle between the locking nut and the catheter were identified. The location of the catheter tip was significantly related to migration (p < 0.0001). The cut-off value of the receiver operating characteristic (ROC) curve for location and migration was 0.68 cm below the carina. The area under the curve (AUC) was 0.8385 and had favorable predictive power. CONCLUSION The ideal position of an intravenous port to avoid migration is 0.68 cm below the carina. For surgeons, a quantified reference may minimize technical errors. Patients with shallow tip location should be followed up regularly and aggressive intervention initiated for any intravenous port malfunction.
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Seok JP, Kim YJ, Cho HM, Ryu HY, Hwang WJ, Sung TY. A retrospective clinical study: complications of totally implanted central venous access ports. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:26-31. [PMID: 24570862 PMCID: PMC3928259 DOI: 10.5090/kjtcs.2014.47.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 11/23/2022]
Abstract
Background When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.
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Affiliation(s)
- June Pill Seok
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Young Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Hyun Min Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Korea
| | - Han Young Ryu
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Wan Jin Hwang
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Korea
| | - Tae Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Korea
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The Role of Saline Flush Injection Rate in Displacement of CT-Injectable Peripherally Inserted Central Catheter Tip During Power Injection of Contrast Material. AJR Am J Roentgenol 2014; 202:W13-8. [DOI: 10.2214/ajr.13.10625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Engstrom BI, Horvath JJ, Stewart JK, Sydnor RH, Miller MJ, Smith TP, Kim CY. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates. J Vasc Interv Radiol 2013; 24:1295-302. [PMID: 23891045 DOI: 10.1016/j.jvir.2013.05.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To determine rates of dysfunction and infection for tunneled internal jugular vein hemodialysis catheters based on laterality of insertion and catheter tip position. MATERIALS AND METHODS Retrospective review of a procedural database for tunneled internal jugular vein hemodialysis catheter placements between January 2008 and December 2009 revealed 532 catheter insertions in 409 patients (234 male; mean age, 54.9 y). Of these, 398 catheters were placed on the right and 134 on the left. The catheter tip location was categorized as superior vena cava (SVC), pericavoatrial junction, or mid- to deep right atrium based on review of the final intraprocedural radiograph. The rates of catheter dysfunction and catheter-related infection (reported as events per 100 catheter-days) were analyzed. RESULTS Catheters terminating in the SVC or pericavoatrial junction inserted from the left showed significantly higher rates of infection (0.50 vs 0.27; P = .005) and dysfunction (0.25 vs 0.11; P = .036) compared with those inserted from the right. No difference was identified based on laterality for catheter tip position in the mid- to deep right atrium. Left-sided catheters terminating in the SVC or pericavoatrial junction had significantly more episodes of catheter dysfunction or infection than catheters terminating in the mid- to deep right atrium (0.84 vs 0.35; P = .006), whereas no significant difference was identified for right-sided catheters based on tip position. CONCLUSIONS When inserted from the left internal jugular vein, catheter tip position demonstrated a significant impact on catheter-related dysfunction and infection; this relationship was not demonstrated for right-sided catheters.
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Affiliation(s)
- Bjorn I Engstrom
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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Keum DY, Kim JB, Chae MC. Safety of a totally implantable central venous port system with percutaneous subclavian vein access. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:202-7. [PMID: 23772408 PMCID: PMC3680606 DOI: 10.5090/kjtcs.2013.46.3.202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 10/30/2012] [Accepted: 11/20/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method. MATERIALS AND METHODS Between March 2009 and December 2010, 245 ports were implanted in 242 patients by surgeon. These procedures were performed with one small skin incision and subcutaneous puncture of subclavian vein. Patient's profiles, indications of port system, early and delayed complications, and implanted period were evaluated. RESULTS There were 82 men and 160 women with mean age of 55.74. Port system was implanted on right chest in 203, and left chest in 42 patients. There was no intraoperative complication. Early complications occurred in 11 patients (4.49%) including malposition of catheter tip in 6, malfunction of catheter in 3, and port site infection in 2. Late complication occurred in 12 patients (4.90%). CONCLUSION Surgical insertion of TICVP system with percutaneous subclavian venous access is safe procedures with lower complications. Careful insertion of system and skilled management would decrease complication incidence.
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Affiliation(s)
- Dong-Yoon Keum
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Korea
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Outpatient Placement of Subcutaneous Venous Access Ports Reduces the Rate of Infection and Dehiscence Compared with Inpatient Placement. J Vasc Interv Radiol 2013; 24:849-54. [DOI: 10.1016/j.jvir.2013.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 11/19/2022] Open
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Impact of phase of respiration on central venous catheter tip position. J Vasc Access 2013; 14:383-7. [PMID: 23599138 DOI: 10.5301/jva.5000135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the impact of the phase of respiration on CVC tip position using cross-sectional imaging. METHODS We retrospectively analyzed the CT scans of 24 consecutive patients (eight men and 16 women, mean age 56.3 years, range 18-79) who underwent a CT scan protocol that includes both imaging of the thorax in inspiration and expiration. Only patients with a central venous catheter and absence of any substantial pulmonary pathology that might affect lung volumes were included. Measurements of the catheter tip location and central venous structures were obtained from inspiratory and expiratory phase images in each patient and compared using the paired <i>t</i> test. RESULTS The length of the SVC and superior mediastinum were significantly longer during inspiration compared to expiration (9 mm and 7 mm respectively, P<0.001 for both). The distance between the superior and inferior cavo-atrial junction did not change significantly with respiration. The catheter tip location moved on average 9 mm (range 0-25 mm) cephalad during inspiration compared to expiration (P=0.001) in relation to the superior cavoatrial junction. The amount of catheter tip movement correlated significantly with the degree of diaphragmatic excursion with respiration (R=0.58). During inspiration, the cavo-atrial junction was on average 11 mm inferior to the right cardiomediastinal angle observed on radiography, but was nearly identical during expiration (R=0.78, P<0.001). CONCLUSIONS The central catheter tip position varied significantly with respiratory motion, with a mean excursion of 9 mm. The right cardiomediastinal border demonstrated a strong correlation with the actual location of the superior cavo-atrial junction in expiration, but not in inspiration.
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Wang YC, Huang CH, Lin FS, Lin WY, Fan SZ, Lin CP, Sun WZ. Intravenous electrocardiography helps inexperienced operators to place totally implantable venous access device more accurately. J Surg Oncol 2012; 105:848-51. [PMID: 22161950 DOI: 10.1002/jso.23000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/15/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Proper tip position is a major determinant of totally implantable venous access device (TIVAD) outcome. The aim of this study is to analyze the potential utilization of intravenous electrocardiography (IV-ECG) to help inexperienced operators for TIVAD placement. PATIENTS AND METHODS This is a retrospective, observational, uni-institutional study. 331 patients receiving TIVAD implantation from July 2008 to December 2008 were recruited. In IV-ECG group, IV-ECG was used to help decide catheter tip location and catheter length. In Landmark group, catheter length was decided by surface landmarks. Catheter tip position was confirmed by post-operative supine chest X-ray. RESULTS There were 153 patients in IV-ECG group, and 178 patients in Landmark group. No immediate reoperation due to catheter mal-position was noted in IV-ECG group, but it happened in eight patients in Landmark group. In IV-ECG group, 97.3% of the catheter tip located at proper position (within 2 cm from junction of right atrium and superior vena cava, as compared to 88.8% of the tip position in Landmark group was proper. The difference was statistically significant (P < 0.05). There was no complication associated with the use of IV-ECG. CONCLUSION IV-ECG is a safe and convenient method to help inexperienced operators placing TIVAD.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
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Risk factors and possible mechanisms of intravenous port catheter migration. Eur J Vasc Endovasc Surg 2012; 44:82-7. [PMID: 22531452 DOI: 10.1016/j.ejvs.2012.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/19/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify the risk factors for catheter migration and demonstrate possible mechanisms of this migration. DESIGN Retrospective study. SETTING Chang Gung Memorial Hospital, a tertiary medical centre in Taiwan. PATIENTS Patients who underwent implantation of intravenous ports via the superior vena cava (SVC). INTERVENTIONS Procedures involving catheter placement and re-intervention for catheter migration. MAIN OUTCOME MEASURES The anatomic location of the catheter tip was confirmed by plain chest X-rays (postero-anterior view). From these plain radiographs, the distance (in cm) between the carina and catheter tip and the angle (in degrees) between the locking nut and catheter were measured. METHODS A total of 1542 procedures related to intravenous port implantation were retrospectively reviewed but only procedures involving implantation via the SVC were included in the analysis. The study group was composed of 31 interventions because of catheter migration, while the control group consisted of 1475 implantation and re-intervention procedures except those involving catheter migrations. RESULTS Shallow catheter-tip location (p < 0.0001) and the presence of lung cancer (p = 0.006) were risk factors for catheter migration. CONCLUSIONS Shallow catheter-tip location and the presence of lung cancer are risk factors for catheter migration. Strategies that ensure low catheter-tip location and avoid increased thoracic pressure may be useful preventive measures.
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Ahn SJ, Kim HC, Chung JW, An SB, Yin YH, Jae HJ, Park JH. Ultrasound and fluoroscopy-guided placement of central venous ports via internal jugular vein: retrospective analysis of 1254 port implantations at a single center. Korean J Radiol 2012; 13:314-23. [PMID: 22563269 PMCID: PMC3337868 DOI: 10.3348/kjr.2012.13.3.314] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/10/2011] [Indexed: 12/28/2022] Open
Abstract
Objective To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. Materials and Methods We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. Results A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Conclusion Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.
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Affiliation(s)
- Se Jin Ahn
- Department of Radiology, College of Medicine, Seoul National University, Seoul 110-744, Korea
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Goossens GA, Stas M, Jérôme M, Moons P. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer 2011; 19:883-98. [DOI: 10.1007/s00520-011-1171-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/18/2011] [Indexed: 11/25/2022]
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Guttmann DM, Trerotola SO, Clark TW, Dagli M, Shlansky-Goldberg RD, Itkin M, Soulen MC, Mondschein JI, Stavropoulos SW. Malfunctioning and Infected Tunneled Infusion Catheters: Over-the-Wire Catheter Exchange versus Catheter Removal and Replacement. J Vasc Interv Radiol 2011; 22:642-6; quiz 646. [DOI: 10.1016/j.jvir.2011.01.440] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/18/2011] [Accepted: 01/21/2011] [Indexed: 11/15/2022] Open
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Feasibility and safety of endovascular stripping of totally implantable venous access devices. Cardiovasc Intervent Radiol 2011; 35:607-12. [PMID: 21479744 DOI: 10.1007/s00270-011-0158-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/22/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the safety and feasibility of percutaneous stripping of totally implantable venous access devices (TIVAD) in case of catheter-related sleeve and to report a technique to free the catheter tip from vessel wall adherence. MATERIALS AND METHODS A total of 37 stripping procedures in 35 patients (14 men, 40%, and 21 women, 60%, mean age 53±14 years) were reviewed. Totally implantable venous access devices were implanted because of malignancy in most cases (85.7%). Catheter-related sleeve was confirmed as cause of persistent catheter dysfunction despite instillation of thrombolytics. A technique to mobilize the catheter tip from the vessel wall was used when stripping with the snare catheter was impossible. Technical success, complication rate, and outcome were noted. RESULTS A total of 55.9% (n=19) of the 34 technically successful procedures (91.9%) could be done with the snare catheter. In 15 cases (44.1%), additional maneuvers to free the TIVAD's tip from the vessel wall were needed. Success rate was not significantly lower before (72.4%) than after (96.7%) implementation of the new technique (P=0.09). No complications were observed. Follow-up was available in 67.6% of cases. Recurrent catheter dysfunction was found in 17 TIVADs (78.3%) at a mean of 137.7 days and a median of 105 days. CONCLUSIONS Stripping of TIVADs is technically feasible and safe, with an overall success rate of 91.9%. Additional endovascular techniques to mobilize the distal catheter tip from the wall of the superior vena cava or right atrium to allow encircling the TIVAD tip with the snare catheter may be needed in 44.1% of cases.
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Goossens E, Goossens GA, Stas M, Janssens C, Jérôme M, Moons P. Sensory Perceptions of Patients With Cancer Undergoing Surgical Insertion of a Totally Implantable Venous Access Device: A Qualitative, Exploratory Study. Oncol Nurs Forum 2010; 38:E20-6. [DOI: 10.1188/11.onf.e20-e26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010; 256:312-20. [PMID: 20574104 DOI: 10.1148/radiol.10091860] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To prospectively evaluate outcomes associated with use of a triple-lumen (TL) peripherally inserted central catheter (PICC) in the intensive care unit (ICU) setting. MATERIALS AND METHODS Patients were prospectively enrolled in this HIPAA-compliant, institutional review board-approved study. Informed consent was obtained. All patients were in one hospital's ICUs and needed intermediate-term central venous access requiring three lumina. A 6-F tapered TL PICC was placed by a bedside nursing-based team with backup from the Interventional Radiology department. Placement complications, as well as long-term complications, were recorded. At catheter removal, ultrasonography (US) of the veins containing the TL PICC was performed to detect occult venous thrombosis. Regardless of indication for removal, catheters were sent for culture to detect colonization. RESULTS The study was stopped prematurely after 50 of a planned 167 patients were enrolled when a scheduled interim analysis detected a venous thrombosis rate that was considered unacceptably high by the study oversight committee (thrombosis was symptomatic in 20% of patients [10 of 50]). Venous thrombosis (symptomatic or asymptomatic) was detected in 26 of 45 patients (58%; 95% confidence interval [CI]: 43%, 72%) examined with US. Documented catheter-related bloodstream infection did not occur (0%; 95% CI: 0%, 7%); colonization was detected in three of 29 catheter tips sent for culture (10%; 95% CI: 2%, 27%). Catheter malfunction and dislodgment occurred in one patient each. CONCLUSION The TL PICC design used in this study resulted in unacceptably high venous thrombosis rates. Even when used in a high-risk setting for infection (ie, the ICU), rates of clinically evident infection and colonization were absent and low, respectively.
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Affiliation(s)
- Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, Philadelphia, PA 19104, USA.
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Transbrachial access for radiologic manipulation of problematic central venous catheters in a pediatric population. Cardiovasc Intervent Radiol 2009; 33:756-9. [PMID: 20033164 DOI: 10.1007/s00270-009-9774-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
A transfemoral venous approach is the current standard for accessing malpositioned and fractured central venous catheters (CVCs). The purpose of this study was (1) to describe a transbrachial approach for correction and (2) to assess the success and failure of this method in a pediatric population. A 12-year retrospective review of all patients referred for correction of malpositioned, retained, and fractured CVCs was conducted. Based on the performing interventionalist's preference, transbrachial or transfemoral venous sheaths where placed under ultrasonographic guidance. Diagnostic angiographic catheters and snares were used to manipulate the catheters. Patients who underwent the transfemoral approach received postprocedural monitoring for 4 hours, whereas patients who underwent the transbrachial approach were allowed unrestricted activity immediately after hemostasis was obtained. Technical success of malpositioned lines was defined (1) by final position in the superior vena cava or at the cavoatrial junction on postprocedural imaging or (2) by successful removal of retained catheter fragments, if present. Transbrachial approach was used for access in 11 patients. Problematic lines included malpositioned (n = 10) and retained (n = 1) lines. The ipsilateral arm was used for transbrachial entry in 7 patients. Initial use of angiographic catheters was attempted in 7 cases, of which 4 were successful. All 3 unsuccessful cases had tips positioned in the contralateral brachiocephalic vein, and these were successfully repositioned using snares. A combination of snares and angiographic catheters was used in 2 cases. Snares were used for all other cases. Technical success by way of the transbrachial approach was observed in all cases. Periprocedural follow-up demonstrated no immediate complications. We conclude that the transbrachial approach is a suitable alternative to the transfemoral approach for catheter tip position correction. Tip malposition in the contralateral brachiocephalic vein suggests higher rate of conversion to use of snare devices.
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Liu H, Han T, Zheng Y, Tong X, Piao M, Zhang H. Analysis of Complication Rates and Reasons for Nonelective Removal of PICCs in Neonatal Intensive Care Unit Preterm Infants. JOURNAL OF INFUSION NURSING 2009; 32:336-40. [DOI: 10.1097/nan.0b013e3181bd5668] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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