1
|
Borghese O, Campion M, Magana M, Pisani A, Di Centa I. Re-hospital admission, morbidity and mortality rate in patients undergoing tunnelled catheter implantation for haemodialysis. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:65-71. [PMID: 38697712 DOI: 10.1016/j.jdmv.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Despite the effort to increase the proportion of patients starting dialysis on native accesses, many of them are still dialyzed on tunnelled catheter. Catheter-related complications are often serious and responsible for re-hospital admission, high morbidity and mortality. Several multicenter trials have reported results in the use of tunnelled dialysis catheter (TDC). However, few single-center studies have been published to verify the outcome from real-world experience. This study presents our center's experience in managing such patients in the context of relevant literature. METHODS Demographics and operative data were retrospectively collected from medical charts. A prospective follow-up was performed to investigate complications, number of re-hospitalizations and mortality. Kaplan-Meier estimate was used to evaluate catheter primary patency and patients' overall survival. RESULTS Among a total 298 haemodialysis accesses interventions, 105 patients (56 men, 53.3% and 49 women, 46.7%) with a median age of 65 years (range 32-88 years) were included in the study. All insertions were successful with an optimal blood flow achieved during the first session of dialysis in all cases. A catheter-related complication was detected in 33.3% (n=35) patients (48.6% infections; 28.6% TDC dysfunction; 14.3% local complications; 5.7% accidental catheter retractions; 2.8% catheter migrations). At a median follow-up of 10.5±8.5 months, a total of 85 patients (80.9%) was re-hospitalized, in 28 cases (26.7%) for a catheter-related cause. The median catheter patency rate was 122 days. At the last follow-up, 39 patients (37.1%) were still dialyzed on catheter, 30(28.6%) were dialyzed on an arteriovenous fistula and 7(6.7%) received a kidney transplantation. Two patients (2%) were transferred to peritoneal dialysis and two patients (2%) recover from renal insufficiency. Mortality rate was 23.8% (25 patients). Causes of death were myocardial infarction (n=13, 52%), sepsis (n=9, 36%); one patient (4%) died from pneumonia, one (4%) from uremic encephalopathy and one (4%) from massive hematemesis. CONCLUSION TDCs may represent the only possible access in some patients, however they are burned with a high rate of complications, re-hospital admission and mortality. Results from this institutional experience are in line with previously published literature data in terms of morbidity and mortality. The present results reiterate once more that TDC must be regarded as a temporary solution while permanent access creation should be prioritized. Strict surveillance should be held in patients having TDC for the early identification of complications allowing the prompt treatment and modifying the catheter insertion site whenever needed.
Collapse
Affiliation(s)
- Ottavia Borghese
- Department of Vascular Surgery, Foch Hospital, Suresnes, France; PhD school angio-cardio-thoracic pathophysiology and imaging, Sapienza University, Rome, Italy.
| | - Margaux Campion
- Department of Vascular Surgery, Foch Hospital, Suresnes, France
| | - Marie Magana
- Department of Vascular Surgery, Foch Hospital, Suresnes, France
| | - Angelo Pisani
- PhD school angio-cardio-thoracic pathophysiology and imaging, Sapienza University, Rome, Italy; Department of Cardiovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | |
Collapse
|
2
|
Oguslu U, Gümüş B, Yalçin M, Sahin OZ, Yilmaz G. Comparison of supraclavicular brachiocephalic and femoral vein approaches for tunneled dialysis catheter placement in patients with thrombosed internal jugular veins. Hemodial Int 2024; 28:24-31. [PMID: 37798865 DOI: 10.1111/hdi.13117] [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: 04/26/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION There is still debate on the best access route in case of bilateral internal jugular vein thrombosis. We aimed to compare the safety, effectiveness, and outcomes of tunneled dialysis catheter placement via supraclavicular brachiocephalic and femoral vein approaches in patients with bilateral internal jugular vein thrombosis. METHODS Between January 2018 and December 2021, data of the patients in whom tunneled dialysis catheters were placed via the supraclavicular brachiocephalic vein (n = 42) and femoral vein (n = 57) approaches were extracted. Patient demographics, technical and clinical success rates, complications, and outcomes were noted. The Likert scale was used to assess patient satisfaction. FINDINGS Forty two (42.4%) patients were men, and the mean age was 61.9 (range, 12-93) years. The technical and clinical success rate was 100% for both groups. No major complication was encountered. The mean follow-up period was 497.5 (range, 32-1698) catheter days. Thirty-day patency was similar for the brachiocephalic vein and femoral vein group (40 [95.2%] vs. 55 [96.5%], p = 0.754). Also, primary and cumulative patency rates were comparable (p = 0.158; p = 0.660). The infection rate was 2.6 and 4.1 per 1000 catheter days for the brachiocephalic vein and femoral vein group. The infection-free survival was significantly higher in the brachiocephalic vein group (71.9% vs. 35.3% at 12 months, p < 0.001). Patient satisfaction was higher in the brachiocephalic vein group (median satisfaction, 5 vs. 4, p < 0.001). DISCUSSION Both supraclavicular brachiocephalic vein and femoral vein approaches have high technical and clinical success with comparable patency rates. However, low infection rate and high patient satisfaction make the supraclavicular brachiocephalic vein approach a reasonable alternative before proceeding to the femoral vein access.
Collapse
Affiliation(s)
- Umut Oguslu
- Department of Radiology, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Burçak Gümüş
- Department of Radiology, Medicana Health Group, Istanbul, Turkey
| | - Murat Yalçin
- Department of Cardiology, Medicana Health Group, Istanbul, Turkey
| | | | - Gökalp Yilmaz
- Department of Radiology, Bahçelievler Public Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Wang Z, Li T, Zhou J, Yu Y, Chen Y, Fu P. Patient-specific hemodynamic feature of central venous disease intervened by stent: A numerical study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3737. [PMID: 37269226 DOI: 10.1002/cnm.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
Central venous disease (CVD) with stenosis or occlusion is a severe and prevalent complication for chronic hemodialysis (HD) patients, resulting in dialysis access dysfunction. Percutaneous transluminal angioplasty with stent placement (PTS) has become one of the first-line treatments for CVD. In clinical practice, the extra stents would be used if the curative efficacy of a single stent were unsatisfactory. Aiming to evaluate the therapeutic effect of different PTS schemes, computational fluid dynamics (CFD) simulations on four patients were performed to compare the hemodynamic characteristics of real-life HD patients after stent placement. The three-dimensional central vein's models of each patient were built using computational tomography angiography (CTA) images, and idealized models were constructed as contrast. Two inlet velocity modes were imposed to imitate the blood flow rate of healthy and HD patients. The hemodynamic parameters for different patients were investigated, including wall shear stress (WSS), velocity, and helicity. The results showed that the implantation of double stents is able to improve flexibility. When subjected to external force, the double stents have better radial stiffness. This paper evaluated the therapeutic efficacy of stent placement and provided a theoretical basis for CVD intervention in hemodialysis patients.
Collapse
Affiliation(s)
- Zhaoli Wang
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Tao Li
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Jingyuan Zhou
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Yang Yu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Aguado A. Role of Interventional Radiology in Pediatric Cancer Patients. Curr Oncol Rep 2022; 24:1731-1740. [PMID: 36057070 DOI: 10.1007/s11912-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Pediatric interventional radiology (IR) is a growing subspecialty. Here, we review the current role of IR in children with cancer, which uses imaging such as ultrasound, fluoroscopy, and computed tomography to perform minimally invasive procedures. These include biopsy, needle localization, central venous access, thermal ablation, transarterial chemoembolization, transarterial radioembolization with yttrium-90, non-tunneled/tunneled drainage catheter placement, and lymphatic interventions. RECENT FINDINGS Although locoregional therapies for the treatment of cancer in adults are common, they are less common in children, perhaps due to the relative rarity of cancer in children, their typically better performance status, and paucity of comorbidities. Preliminary results from small-scale studies for ablation, transarterial chemoembolization, and transarterial radioembolization with yttrium-90 used in the front-line armamentarium of curative therapy are encouraging. Pediatric IR offers an array of minimally invasive procedures intended to diagnose and treat pediatric cancer patients. However, more research is required to determine the efficacy of locoregional therapy in children and to define the clinical scenarios where benefit is likely to be optimized.
Collapse
Affiliation(s)
- Allison Aguado
- Division of Interventional Radiology, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| |
Collapse
|
5
|
Regmi S, Manandhar D, Pyakurel S, Shrestha B, Khanal P, Paudel S, Gyawali P. Central Venous Catheter-related Thrombosis in a Dialysis Patient: A Case Report. JNMA J Nepal Med Assoc 2022; 60:648-650. [PMID: 36705189 PMCID: PMC9297364 DOI: 10.31729/jnma.7603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/25/2022] [Indexed: 01/31/2023] Open
Abstract
Hemodialysis is one of the treatment modalities for advanced kidney disease and can help an individual live an active life despite failing kidneys. Although it improves the quality of life, it is not completely risk-free. It has several complications, among which, thrombus formation is common. We report a case of a 63-year-old man who presented at our institution for regular hemodialysis with recurrent arteriovenous graft failure. Because doppler ultrasound is a non-invasive procedure that can identify a thrombus in a vein, it is the best initial option for patients with internal jugular vein thrombosis. The use of ultrasound not only can guide a catheter pathway but can also help in early diagnosis and prevent complications following catheterization in a vein with a thrombus. Keywords central venous catheterization; chronic kidney disease; hemodialysis; thrombus.
Collapse
Affiliation(s)
- Sachit Regmi
- Nepal Mediciti Hospital, Karyabinayak, Lalitpur, Nepal,Correspondence: Dr Sachit Regmi, Nepal Mediciti Hospital, Karyabinayak, Lalitpur, Nepal. , Phone: +977-9849192172
| | - Dilasha Manandhar
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | | | - Bibek Shrestha
- Om Hospital and Research Center, Pvt. Ltd., Chabahil, Kathmandu, Nepal
| | - Pitamber Khanal
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Sandip Paudel
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Pawan Gyawali
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|
6
|
Zhou Y, Lan Y, Zhang Q, Song J, He J, Peng N, Peng X, Yang X. Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures. Phlebology 2022; 37:279-288. [DOI: 10.1177/02683555211069772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method. Methods Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis. Results A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43–1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15–3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14–8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22–3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22–1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01–2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16–89.76, p = .41) between the two implantation paths. Conclusions There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.
Collapse
Affiliation(s)
- Ya Zhou
- Department of Oncology, Chongqing General Hospital, Chomgqing, China
| | - Yanqiu Lan
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Qiang Zhang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Jifang Song
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Juan He
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Na Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xingqiao Peng
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| | - Xinxin Yang
- Department of Oncology, Army Medical Center of PLA, Chongqing, China
| |
Collapse
|
7
|
Pinto E, Granziera E, Cagol M, Cappellato S, Alfieri R, Mari V, Meroni M, Zagonel V, Conte P, Pilati P, Castoro C, Cavallin F, Scarpa M. Totally Implantable Venous Access Devices: A Randomized Controlled Trial on the Effect of Psychological Support on Quality of Life and Body Image (BI-PORT). Front Psychol 2021; 12:703497. [PMID: 34867586 PMCID: PMC8632700 DOI: 10.3389/fpsyg.2021.703497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The presence of totally implantable venous access devices (TIVADs), as any permanent or semipermanent medical devices, has an impact on the quality of life (QoL) of patients. Therefore, the purpose of this trial was to evaluate the efficacy of psychological support for patients undergoing this procedure. Methods: This randomized controlled trial (RCT) aimed to compare the efficacy of a psychological intervention vs. standard care on QoL in patients receiving TIVAD for chemotherapy treatment (ClinicalTrials.gov NCT02075580). The trial was conducted at the Veneto Institute of Oncology IOV-IRCCS (Padua, Italy) between October 2013 and September 2018. Participants were neoplastic adults receiving TIVAD for chemotherapy treatment for any cancer, not undergoing visible demolitive interventions, without psychopathological diagnosis and language understanding. The exclusion criteria were patients without a diagnosis of cancer, with psychopathological diagnosis, or with language misunderstanding. Results: The variation of C30-QL2 and BR32-BI was not statistically different between intervention and control arms in men and women. However, the variation of C30-SF was statistically better in the intervention than control arm in men [mean difference (MD) 22.3, 95% CI 3.5 to 41.0] but not in women (MD −2.7, 95% CI −24.0 to 18.7). The variations of the other secondary outcome measures were not statistically different between intervention and control arms. Conclusion: Psychological support did not show any clear advantages on global QoL and body image perception in patients at 15 days after TIVAD insertion for chemotherapy. In contrast, male patients might benefit from even a very short psychological counseling before or during chemotherapy even if they do not seem to ask for it.
Collapse
Affiliation(s)
- Eleonora Pinto
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Sandra Cappellato
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Rita Alfieri
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Valentina Mari
- General Surgery Unit 3, Azienda Ospedale University of Padua (AOUP), Padua, Italy
| | - Muzio Meroni
- Anesthesiology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Pierfranco Conte
- Medical Oncology Unit 2, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Pierluigi Pilati
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Carlo Castoro
- Department of Upper GI Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | | | - Marco Scarpa
- General Surgery Unit 3, Azienda Ospedale University of Padua (AOUP), Padua, Italy
| |
Collapse
|
8
|
Illig KA, Gober L. Invited Review: Optimal Management of Upper Extremity DVT: Is Venous Thoracic Outlet Syndrome Underrecognized? J Vasc Surg Venous Lymphat Disord 2021; 10:514-526. [PMID: 34352421 DOI: 10.1016/j.jvsv.2021.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND UEDVT accounts for approximately 10% of all cases of deep vein thrombosis. In the most widely referenced general review of deep vein thrombosis (DVT the American Academy of Chest Physicians essentially recommend that upper extremity DVT (UEDVT) essentially be treated identically to that of lower extremity DVT, with anticoagulation being the default therapy. Unfortunately, the medical literature does not well differentiate between DVT in the arm and the leg, and does not emphasize the effects of the costoclavicular junction (CCJ) and the lack of effect of gravity, to the point where UEDVT due to extrinsic bony compression at the CCJ is classified as "primary." METHODS Comprehensive literature review, beginning with both Medline and Google Scholar searches in addition to collected references, then following relevant citations within the initial manuscripts studied. Both surgical and medical journals were explored RESULTS: It is proposed that effort thrombosis be classified as a secondary cause of UEDVT, limiting the definition of primary to that which is truly idiopathic. Other causes of secondary UEDVT include catheter- and pacemaker-related thrombosis (the most common cause, but often asymptomatic), thrombosis related to malignancy and hypercoagulable conditions, and the rare case of thrombosis due to compression of the vein by a focal malignancy or other space-occupying lesion. In true primary UEDVT and in those secondary cases where no mechanical cause is present or can be corrected, anticoagulation remains the treatment of choice, usually for three months or the duration of a needed catheter. However, evidence suggests that many cases of effort thrombosis are likely missed by a too-narrow adherence to this protocol. CONCLUSIONS Because proper treatment of effort thrombosis drops the long-term symptomatic status rate from 50% to almost zero and these are healthy patients with a long lifespan ahead, it is proposed that a more aggressive attitude toward thrombolysis be followed in any patient who has a reasonable degree of suspicion for venous thoracic outlet syndrome.
Collapse
|
9
|
Benichou N, Lebbah S, Hajage D, Martin-Lefèvre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Tubach F, Ricard JD, Dreyfuss D, Gaudry S. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial. Ann Intensive Care 2021; 11:56. [PMID: 33830370 PMCID: PMC8032839 DOI: 10.1186/s13613-021-00843-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. PATIENTS AND METHODS We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. RESULTS Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34-4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98-1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64-1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. CONCLUSION Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
Collapse
Affiliation(s)
- Nicolas Benichou
- AP-HP, Hôpital Européen Georges Pompidou, Service de Néphrologie, 75015, Paris, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Saïd Lebbah
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Université, Paris, France
| | | | - Bertrand Pons
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- Réanimation Polyvalente, CH René Dubos, 95301, Pontoise, France
| | - Alexandre Boyer
- Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Guillaume Chevrel
- Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale Et Médecine Hyperbare, CHU Angers, Université D'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.,CARMAS Research Group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional D'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie Et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, Faculté de Médecine, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation Polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de Réanimation Des Détresses Respiratoires Aiguës Et Infections Sévères, Hôpital Nord Marseille, 13015, Marseille, France
| | - Julien Maizel
- Service de Réanimation Médicale INSERM U1088, Centre Hospitalier Universitaire de Picardie, Amiens, France
| | - Hodane Yonis
- Réanimation Médicale, Hôpital de La Croix Rousse, 69004, Lyon, France
| | | | - Guillaume Thiery
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Frederique Schortgen
- Centre Hospitalier Inter-Communal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Florence Tubach
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Univ Pierre Et Marie Curie, Sorbonne Universités, 75013, Paris, France
| | - Jean-Damien Ricard
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, 75018, Paris, France.,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 93008, Bobigny, France. .,Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France.
| |
Collapse
|
10
|
Najmuddin S, Taneja S, Kulkarni S. Adverse hemodynamic response due to malposition of central venous catheter. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_66_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Premuzic V, Mihaljevic D, Pasini M, Mesar I, Luetic T, Antabak A. Durability of tunneled catheters in children is associated with catheter tip depth: A single-center report. Ther Apher Dial 2020; 25:490-496. [PMID: 33026706 DOI: 10.1111/1744-9987.13593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/21/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine the impact of different catheter tip positions on catheter duration and dysfunction of tunneled catheters in children. Catheters were evaluated for place of insertion, time of insertion, catheter tip depth and position, duration of use, and reason for removal. The mean duration of implanted catheters with tips placed in cavo-atrial junction/right atrium was significantly longer with significantly lower percentage of complications than tips placed in superior vena cava. Only catheter tips placed in cavo-atrial junction/right atrium was a predictor of catheter functionality and survival. Shorter catheter survival in children with tunneled catheters is a consequence of a catheter tip depth proximal of CAJ and RA. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth of the catheter tip, which reduces need for future catheter insertions with increased catheter durability.
Collapse
Affiliation(s)
- Vedran Premuzic
- Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dragan Mihaljevic
- Anesthesiology, Reanimatology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miram Pasini
- Pediatric Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ines Mesar
- Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tomislav Luetic
- Pediatric Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Anko Antabak
- Pediatric Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
12
|
Karim MS, Aryal P, Gardezi A, Clark DF, Aziz F, Parajuli S. Vascular access in kidney transplant recipients. Transplant Rev (Orlando) 2020; 34:100544. [PMID: 32205010 DOI: 10.1016/j.trre.2020.100544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/28/2022]
Abstract
Vascular access is an important element in the overall care provided to kidney transplant recipients. The transplanted kidney is not indestructible, and chronic kidney disease after transplantation may result in needing another transplant or beginning dialysis. Commonly used vascular accesses, like peripheral and central lines, can preclude the creation of future, permanent dialysis access. Therefore, there is urgent need to preserve vessels for the future access needs for hemodialysis among kidney transplant recipients without functional vascular access for dialysis. Moreover, the proper care of functional vascular access among kidney transplant recipients is crucial. In this review article, we will address the common vascular access procedures and complications among kidney transplant recipients.
Collapse
Affiliation(s)
- Muhammad Sohaib Karim
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Prabesh Aryal
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ali Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Dana F Clark
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
| |
Collapse
|
13
|
Central venous catheter-related thrombosis in children and adults. Thromb Res 2020; 187:103-112. [DOI: 10.1016/j.thromres.2020.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
|
14
|
Kao CY, Fu CH, Cheng YC, Chen JL, Cheng YC, Chen CCC, Chai JW. Outcome analysis in 270 radiologically guided implantations of totally implantable venous access ports via basilic vein. J Chin Med Assoc 2020; 83:295-301. [PMID: 31990818 DOI: 10.1097/jcma.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single-center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications. METHODS We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter-related complications were recorded. RESULTS The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77 543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a postprocedural complication rate of 0.26 incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p = 0.914), or between the left and right basilic veins (p = 0.319). CONCLUSION Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.
Collapse
Affiliation(s)
- Chia-Yu Kao
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chien-Hua Fu
- Division of Radiology, Everan Hospital, Taichung, Taiwan, ROC
| | - Yun-Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jian-Ling Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Chi Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| |
Collapse
|
15
|
Stent-Graft Length Is Associated with Decreased Patency in Treatment of Central Venous Stenosis in Hemodialysis Patients. Ann Vasc Surg 2019; 59:225-230. [DOI: 10.1016/j.avsg.2019.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022]
|
16
|
El Nekidy WS, Soong D, Kadri A, Tabbara O, Ibrahim A, Ghazi IM. Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist. Case Rep Nephrol Dial 2018; 8:121-129. [PMID: 30140677 PMCID: PMC6103365 DOI: 10.1159/000489923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.
Collapse
Affiliation(s)
| | - Derrick Soong
- Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Albert Kadri
- Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Osama Tabbara
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amina Ibrahim
- Faculty of Biological Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Islam M. Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Anton S, Oechtering T, Stahlberg E, Jacob F, Kleemann M, Barkhausen J, Goltz JP. Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach. Support Care Cancer 2017; 26:1881-1888. [PMID: 29274029 DOI: 10.1007/s00520-017-3997-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this paper is to evaluate the safety and efficacy of endovascular revascularization of malignant superior vena cava syndrome (SVCS) and simultaneous implantation of a totally implantable venous access port (TIVAP) using a dual venous approach. MATERIALS AND METHODS Retrospectively, 31 patients (mean age 67 ± 8 years) with malignant CVO who had undergone revascularization by implantation of a self-expanding stent into the superior vena cava (SVC) (Sinus XL®, OptiMed, Germany; n = 11 [Group1] and Protégé ™ EverFlex, Covidien, Ireland; n = 20 [Group 2]) via a transfemoral access were identified. Simultaneously, percutaneous access via a subclavian vein was used to (a) probe the lesion from above, (b) facilitate a through-and-through maneuver, and (c) implant a TIVAP. Primary endpoints with regard to the SVC syndrome were technical (residual stenosis < 30%) and clinical (relief of symptoms) success; with regard to TIVAP implantation technical success was defined as positioning of the functional catheter within the SVC. Secondary endpoints were complications as well as stent and TIVAP patency. RESULTS Technical and clinical success rate were 100% for revascularization of the SVS and 100% for implantation of the TIVAP. One access site hematoma (minor complication, day 2) and one port-catheter-associated sepsis (major complication, day 18) were identified. Mean catheter days were 313 ± 370 days. Mean imaging follow-up was 184 ± 172 days. Estimated patency rates at 3, 6, and 12 months were 100% in Group 1 and 84, 84, and 56% in Group 2 (p = 0.338). CONCLUSION Stent-based revascularization of malignant SVCS with concomitant implantation of a port device using a dual venous approach appears to be safe and effective.
Collapse
Affiliation(s)
- Susanne Anton
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - T Oechtering
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - E Stahlberg
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - F Jacob
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Kleemann
- Clinic for Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J Barkhausen
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J P Goltz
- Clinic for Radiology and Nuclear Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
19
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2017. [PMID: 28270922 DOI: 10.1177/2054358116669130.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
Wang L, Liu ZS, Wang CA. Malposition of Central Venous Catheter: Presentation and Management. Chin Med J (Engl) 2017; 129:227-34. [PMID: 26830995 PMCID: PMC4799551 DOI: 10.4103/0366-6999.173525] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Zhang-Suo Liu
- Department of Nephropathy, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan 450052, China
| | | |
Collapse
|
22
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2016; 3:2054358116669130. [PMID: 28270922 PMCID: PMC5332086 DOI: 10.1177/2054358116669130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
23
|
Kato K, Iwasaki Y, Onodera K, Higuchi M, Kato K, Kato Y, Matsuda M, Endo S, Kobashi Y, Taniguchi M. Totally implantable venous access port via the femoral vein in a femoral port position with CT-venography. J Surg Oncol 2016; 114:1024-1028. [PMID: 27658579 DOI: 10.1002/jso.24441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/02/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to determine the success rate and any complications using a percutaneous approach to the femoral vein (FV) for placement of a totally implantable access port (TIVAP), with a preoperative assessment of the femoral and iliac veins using computed tomography-venography (CT-V). METHODS A prospective study of 72 patients was conducted where placement of a TIVAP was attempted via the right FV, with the port placed in the anterior thigh, when subclavian vein or jugular vein access was contraindicated. Preoperative assessment of the femoral venous plexus was performed with CT-V in 72 patients. RESULTS CT-V success was achieved in 72 of 72 patients (100%). The average distance between the inguinal ligament and the saphenofeomral (FV-GSV) junction was 42.8 ± 12.9 mm. The FV approach had a 97% successful cannulation rate. Two patients had a thrombosis in either the femoral vein or the great saphenous vein. One procedural complication (1.4%) and one initial complication (1.4%) occurred. Late complications occurred in four patients (5.7%). CONCLUSIONS The percutaneous FV approach with CT-V guidance is an option for patients with multiple central venous cannulations, as well as those with bilateral breast cancer, or those undergoing hemodialysis. J. Surg. Oncol. 2016;114:1024-1028. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun, Hokkaido, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology and Hepatology, Okayama University, Okayama City, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Sapporo Hokuyu Hospital, Shiroishi-Ku, Sapporo City, Japan
| | - Mineko Higuchi
- Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun, Hokkaido, Japan
| | - Kimitaka Kato
- Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun, Hokkaido, Japan
| | - Yurina Kato
- Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun, Hokkaido, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, Chiyoda-Ku, Tokyo, Japan
| | - Seiya Endo
- Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun, Hokkaido, Japan
| | - Yuko Kobashi
- Department of Radiology, Jikei University, Tokyo, Japan
| | - Masahiko Taniguchi
- Department of Surgery, Asahikawa Medical University, Asahikawa City, Japan
| |
Collapse
|
24
|
Wang Y, Ivany JN, Perkovic V, Gallagher MP, Woodward M, Jardine MJ. Anticoagulants and antiplatelet agents for preventing central venous haemodialysis catheter malfunction in patients with end-stage kidney disease. Cochrane Database Syst Rev 2016; 4:CD009631. [PMID: 27039404 PMCID: PMC7097886 DOI: 10.1002/14651858.cd009631.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Catheter malfunction, including thrombosis, is associated with reduced dialysis adequacy, as well as an increased risk of catheter-related bacteraemia and mortality. The role of anticoagulants in the prevention of catheter malfunction remains uncertain. OBJECTIVES This review aimed to compare the prophylactic effect of different anticoagulant agents, preparations, doses and administration on the incidence of central venous haemodialysis catheter-related malfunction and sepsis in patients with end-stage kidney disease (ESKD). SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register to 7 January 2016 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA We included all randomised controlled trials (RCT) assessing anticoagulants compared with conventional care for the prevention of catheter malfunction in adult patients receiving haemodialysis for ESKD. DATA COLLECTION AND ANALYSIS The primary outcome was catheter malfunction defined as a catheter blood flow of 200 mL/min or less, or as defined by study authors. Secondary outcomes were catheter-related bacteraemia, all-cause mortality and bleeding events. Relative risks (RR) with 95% confidence intervals (CI) for individual studies were pooled using random effects models within treatment classes. Analyses were conducted by class, with subgroup analyses performed of individual agents within classes. MAIN RESULTS We included 27 studies (3003 participants) that were followed up for a median of six months. Study interventions included alternative anticoagulant locking solutions (19 studies, 2216 patients), systemic agents (6 studies, 664 patients) and low or no dose heparin (2 studies, 123 patients). The most common comparison treatment was a locking solution of heparin 5000 IU/mL, used in 17 studies. No significant effect on catheter malfunction was observed for alternative anticoagulant locking solutions (RR 0.96, 95% CI 0.74 to 1.26), systemic agents (RR 0.59, 95% CI 0.28 to 1.23), or low or no dose heparin (RR 0.90, 95% CI 0.10 to 8.31). A significant reduction on incidence of catheter-related bacteraemia was observed for alternative anticoagulant locking solutions (RR 0.46, 95% CI 0.32 to 0.66) but not systemic agents (RR 2.41, 95% CI 0.89 to 6.55), and could not be assessed in reports of low or no dose heparin studies. No significant effect on all-cause mortality was observed for alternative anticoagulant locking solutions (RR 0.88, 95% CI 0.54 to 1.43) or systemic agents (RR 0.78, 95% CI 0.37 to 1.65), and was not reported in studies of low or no dose heparin. Bleeding events were only reported in eight studies, including only 2/5 studies of systemic warfarin, with no clear effect demonstrated (RR 1.43, 95% CI 0.86 to 2.39). For individual agents, recombinant tissue plasminogen (rt-PA) was the only locking solution shown to reduce catheter malfunction (RR 0.58, 95% CI 0.37 to 0.91) based on the results of a single study. No significant on catheter malfunction was observed for other individual classes of alternative anticoagulant locking solutions (citrate: RR 1.14, 95% CI 0.76 to 1.69; antibiotic: RR 1.48, 95% CI 0.79 to 2.77; ethanol: RR 0.88, 95% CI 0.21 to 3.67). On the other hand, all individual classes of alternative anticoagulant locking solutions, except ethanol, reduced catheter-related bacteraemia (citrate: RR 0.49, 95% CI 0.36 to 0.68; antibiotic: RR 0.27, 95% CI 0.11 to 0.70; rt-PA: RR 0.35, 95% CI 0.13 to 0.93; ethanol: RR 0.33, 95% CI 0.03 to 4.05). No significant effect on all-cause mortality was observed for any individual agent within the class of alternative locking solutions. Studies were mainly of low quality and underpowered with an average participant number of 75 and study duration of six months. The interpretation of the study evidence was further limited by the variation in tested interventions and outcome reporting. AUTHORS' CONCLUSIONS The relative net benefit of anticoagulant therapies for prevention of catheter malfunction remains uncertain. Multiple agents appear to reduce catheter-related bacteraemia although the lack of clear assessment of harms and the limitations of study quality mean these results should be interpreted with caution. Methodological approaches can be used to avoid methods of reporting unduly affecting on the results of meta-analyses incorporating studies employed mixed reporting methods. Further high quality randomised studies, including safety outcomes, are needed.
Collapse
Affiliation(s)
- Ying Wang
- The George Institute for Global Health, The University of SydneyRenal and Metabolic DivisionLevel 10, King George V Building83‐117 Missenden RdCamperdownNSWAustralia2050
| | - Jessica N Ivany
- Concord Repatriation General HospitalDepartment of Renal MedicineHospital RoadConcordNSWAustralia2139
| | - Vlado Perkovic
- The George Institute for Global Health, The University of SydneyLevel 10, King George V Building83‐117 Missenden RoadCamperdownNSWAustralia
| | - Martin P Gallagher
- The George Institute for Global Health, The University of SydneyRenal and Metabolic DivisionLevel 10, King George V Building83‐117 Missenden RdCamperdownNSWAustralia2050
- Concord Repatriation General HospitalDepartment of Renal MedicineHospital RoadConcordNSWAustralia2139
| | - Mark Woodward
- The George Institute for Global Health, The University of SydneyRenal and Metabolic DivisionLevel 10, King George V Building83‐117 Missenden RdCamperdownNSWAustralia2050
| | - Meg J Jardine
- The George Institute for Global Health, The University of SydneyRenal and Metabolic DivisionLevel 10, King George V Building83‐117 Missenden RdCamperdownNSWAustralia2050
- Concord Repatriation General HospitalDepartment of Renal MedicineHospital RoadConcordNSWAustralia2139
| | | |
Collapse
|
25
|
Bream PR. Update on Insertion and Complications of Central Venous Catheters for Hemodialysis. Semin Intervent Radiol 2016; 33:31-8. [PMID: 27011425 PMCID: PMC4803506 DOI: 10.1055/s-0036-1572547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed.
Collapse
Affiliation(s)
- Peter R. Bream
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Nephrology, Department of Internal Medicine, Vascular and Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
26
|
Wang P, Wang Y, Qiao Y, Zhou S, Liang X, Liu Z. A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein. PLoS One 2016; 11:e0146411. [PMID: 26751380 PMCID: PMC4709068 DOI: 10.1371/journal.pone.0146411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/16/2015] [Indexed: 12/30/2022] Open
Abstract
Background Right internal jugular vein (IJV) is a preferred access route for tunneled (cuffed) dialysis catheters (TDCs), and both right external jugular vein (EJV) and left IJV are alternative routes for patients in case the right IJV isn’t available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs. Methods 49 hemodialysis patients who required TDCs through right EJV (n = 21) or left IJV (n = 28) as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI). Results A total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262–605) catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007). Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031). There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363–3.588; p = 0.001). Conclusions Right EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.
Collapse
Affiliation(s)
- Pei Wang
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- * E-mail:
| | - Yufei Wang
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjin Qiao
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sijie Zhou
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianhui Liang
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhangsuo Liu
- Department of Nephrology, Blood purification center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
27
|
Tagliari AP, Staub FL, Guimarães JR, Migliavacca A, Mossmann DDF. Evaluation of three different techniques for insertion of totally implantable venous access device: A randomized clinical trial. J Surg Oncol 2015; 112:56-9. [DOI: 10.1002/jso.23962] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Ana Paula Tagliari
- Department of General Surgery of Hospital de Cl; í; nicas de Porto Alegre; Porto Alegre, Rio Grande do Sul; Brazil
| | - Fernanda Luiza Staub
- Federal University of Rio Grande do Sul; Porto Alegre, Rio Grande do Sul; Brazil
| | - José Ricardo Guimarães
- Department of General Surgery of Hospital de Cl; í; nicas de Porto Alegre; Porto Alegre, Rio Grande do Sul; Brazil
| | - Alceu Migliavacca
- Department of General Surgery of Hospital de Cl; í; nicas de Porto Alegre; Porto Alegre, Rio Grande do Sul; Brazil
| | - Diego da Fonseca Mossmann
- Department of General Surgery of Hospital de Cl; í; nicas de Porto Alegre; Porto Alegre, Rio Grande do Sul; Brazil
| |
Collapse
|
28
|
Abstract
Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
Collapse
|
29
|
Czyzewska D, Ustymowicz A, Kosel J. Internal jugular veins must be measured before catheterization. J Clin Anesth 2014; 27:129-31. [PMID: 25468583 DOI: 10.1016/j.jclinane.2014.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 09/01/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE The study objective is to determine the cross-sectional area (CSA) of the right and left internal jugular vein (IJV) in supine position in healthy subjects. DESIGN This is a prospective, nonrandomized study. SETTING The setting is a university hospital. PATIENTS The patients are 185 consenting healthy subjects. INTERVENTIONS B-mode ultrasonography examinations of the right and left IJV were performed with the use of a linear 14-MHz transducer at the level of the cricoid cartilage. The CSA of the examined vessels was measured in a supine position. MEASUREMENTS AND MAIN RESULTS The CSA on both sides differed by up to 850%. There were no statistically significant differences between CSA of IJVs in men and women. The CSA of the IJV on the right side was significantly greater than on the left side. The right IJV was more often classified as the "dominant" vessel (CSA being more than twice as large as the opposite side). A "small" vessel (CSA ≤ 0.4 cm(2)) was found in 54 cases (14.6%). In 9 subjects (4.9%), they were detected bilaterally. CONCLUSION The CSA of IJVs varies widely. Although the CSA was found to be often greater on the right than on the left side, a "small" vessel may occur on both sides.
Collapse
Affiliation(s)
- Dorota Czyzewska
- Department of Radiology, Medical University of Bialystok Children's Clinical Hospital, Bialystok, Poland.
| | - Andrzej Ustymowicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Poland
| | - Juliusz Kosel
- Department of Anesthesiology and Intensive Therapy, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
30
|
Wiegering V, Schmid S, Andres O, Wirth C, Wiegering A, Meyer T, Winkler B, Schlegel PG, Eyrich M. Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience. BMC HEMATOLOGY 2014; 14:18. [PMID: 25317335 PMCID: PMC4195887 DOI: 10.1186/2052-1839-14-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/22/2014] [Indexed: 12/23/2022]
Abstract
Background Reliable central venous access (CVC) is essential for hematology–oncology patients since frequent puncture of peripheral veins—e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring—can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage. Methods Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation. Results Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis. Conclusions We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.
Collapse
Affiliation(s)
- Verena Wiegering
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| | - Sophie Schmid
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| | - Oliver Andres
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| | - Clemens Wirth
- Division of Pediatric Radiology, University Department of Radiology, Würzburg, Germany
| | - Armin Wiegering
- Division of Pediatric Surgery, University Medical Center ZOM, Würzburg, Germany
| | - Thomas Meyer
- Division of Pediatric Surgery, University Medical Center ZOM, Würzburg, Germany
| | - Beate Winkler
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| | - Paul G Schlegel
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| | - Matthias Eyrich
- Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany
| |
Collapse
|
31
|
Granziera E, Scarpa M, Ciccarese A, Filip B, Cagol M, Manfredi V, Alfieri R, Celentano C, Cappellato S, Castoro C, Meroni M. Totally implantable venous access devices: retrospective analysis of different insertion techniques and predictors of complications in 796 devices implanted in a single institution. BMC Surg 2014; 14:27. [PMID: 24886342 PMCID: PMC4024213 DOI: 10.1186/1471-2482-14-27] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 04/25/2014] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to assess the efficacy and safety of totally implanted vascular devices (TIVAD) using different techniques of insertion. Methods We performed a retrospective study using a prospective collected database of 796 consecutive oncological patients in which TIVADs were inserted. We focused on early and late complications following different insertion techniques (surgical cutdown, blind and ultrasound guided percutaneous) according to different techniques. Results Ultrasound guided technique was used in 646 cases, cephalic vein cutdown in 102 patients and percutaneous blind technique in 48 patients. The overall complication rate on insertion was 7.2% (57 of 796 cases). Early complications were less frequent using the ultrasound guided technique: arterial puncture (p = 0.009), technical failure (p = 0.009), access site change after first attempt (p = 0.002); pneumothorax occurred in 4 cases, all using the blind percutaneus technique. Late complications occurred in 49 cases (6.1%) which required TIVAD removal in 43 cases and included: sepsis (29 cases), thrombosis (3 cases), dislocation (7 cases), skin dehiscence (3 cases), and severe pain (1 case). Conclusion Ultrasound guided technique is the safest option for TIVAD insertion, with the lowest rates of immediate complications.
Collapse
Affiliation(s)
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
FRYKHOLM P, PIKWER A, HAMMARSKJÖLD F, LARSSON AT, LINDGREN S, LINDWALL R, TAXBRO K, ÖBERG F, ACOSTA S, ÅKESON J. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2014; 58:508-24. [PMID: 24593804 DOI: 10.1111/aas.12295] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
Collapse
Affiliation(s)
- P. FRYKHOLM
- Department of Surgical Sciences; Anaesthesiology and Intensive Care Medicine; University Hospital; Uppsala University; Uppsala Sweden
| | - A. PIKWER
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - F. HAMMARSKJÖLD
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
- Division of Infectious Diseases; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - A. T. LARSSON
- Department of Anaesthesiology and Intensive Care Medicine; Gävle-Sandviken County Hospital; Gävle Sweden
| | - S. LINDGREN
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. LINDWALL
- Department of Clinical Sciences; Division of Anaesthesiology and Intensive Care Medicine; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - K. TAXBRO
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
| | - F. ÖBERG
- Department of Anaesthesiology and Intensive Care Medicine; Karolinska University Hospital Solna; Stockholm Sweden
| | - S. ACOSTA
- Department of Clinical Sciences Malmö; Vascular Centre; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. ÅKESON
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| |
Collapse
|
33
|
Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Higuchi M, Kobashi Y, Furukawa H. Computed tomography (CT) venography using a multidetector CT prior to the percutaneous external jugular vein approach for an implantable venous-access port. Ann Surg Oncol 2014; 21:1391-1397. [PMID: 24306665 DOI: 10.1245/s10434-013-3405-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to determine the success rate and complications of using the percutaneous approach of the external jugular vein (EJV) for placement of a totally implantable venous-access port (TIVAP) with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V). METHODS A prospective cohort study of 45 patients in whom placement of a TIVAP was attempted via the right EJV was conducted. The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using a Multidetector Helical 16-section CT. The angulation between the right EJV and the right subclavian vein, anterior jugular vein, transverse cervical vein, and suprascapular vein was estimated. RESULTS CT-V success was achieved in 45 of 45 patients (100 %). A plexus of veins under the clavicle was most commonly responsible for the insertion of the central venous catheter. The EJV approach resulted in a successful cannulation rate of 93 %. No initial complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Late complications occurred in three patients. These included one port erosion (2 %), one catheter occlusion (2 %), and one wound hematoma (2 %). Catheter-related infections were observed in one patient (2 %). CONCLUSIONS The percutaneous EJV approach with CT-V guidance is an optional method for patients with multiple central venous cannulations, those in hemodialysis, or those with long catheter indwelling periods.
Collapse
Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, Kamikawa-gun, Hokkaido, Japan,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Seo TS, Song MG, Kang EY, Lee CH, Yong HS, Doo K. A single-incision technique for placement of implantable venous access ports via the axillary vein. J Vasc Interv Radiol 2014; 25:1439-46. [PMID: 24613268 DOI: 10.1016/j.jvir.2013.12.571] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the technical feasibility and safety of a single-incision technique for placement of implantable venous access ports via the axillary vein. MATERIALS AND METHODS Ports were placed in 216 patients between May and October 2012 using a single-incision technique via the axillary vein. Patients included 112 men and 104 women with a mean age of 58.2 years. After making a single vertical incision without subcutaneous tunneling, ports were placed via the left axillary vein in 172 patients and via the right axillary vein in 44 patients. Axillary vein punctures were directed medially at the incision site under ultrasound guidance. We retrospectively reviewed success rates, technical difficulties, procedure times, and immediate and delayed complications of the procedure. RESULTS All single-incision port placements were technically successful. Technical difficulties occurring during the procedure included advancement of the wire or catheter into an unintended vein (n = 33), kinking at the cuff-catheter junction (n = 13), bleeding via the puncture tract (n = 5), bending of the peel-away sheath (n = 3), and puncture of the axillary artery (n = 3). All technical problems were overcome with additional manipulation. The only immediate complication was puncture site hematoma in two patients. The mean follow-up period was 165.7 days, and there were no reports of port malfunction. Axillary vein thrombosis was observed in one patient. CONCLUSIONS The single-incision technique for placing ports via the axillary vein was a feasible and safe procedure with high technical success and low risk of complications.
Collapse
Affiliation(s)
- Tae-Seok Seo
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea.
| | - Myung Gyu Song
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea
| | - KyungWon Doo
- Department of Radiology, Korea University College of Medicine, Korea University Guro Hospital, #148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea
| |
Collapse
|
35
|
Kato K, Taniguchi M, Iwasaki Y, Sasahara K, Nagase A, Onodera K, Matsuda M, Higuchi M, Nakano M, Kobashi Y, Furukawa H. Central venous access via external jugular vein with CT-venography using a multidetector helical 16-section CT. J INVEST SURG 2013; 27:176-82. [PMID: 24354389 DOI: 10.3109/08941939.2013.865818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the success rate and complications of using the external jugular vein (EJV) for central venous access with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V). DESIGN Prospective, observational human study. SETTING Surgical intensive care unit. PATIENTS Fifty-two patients who were undergoing EJV cannulations with CT-V using a Multidetector Helical 16-section CT (MDCT). INTERVENTION The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using an MDCT. In particular, the angulation between the EJV and the right subclavian vein (SCV) was measured. The anatomical abnormalities and the angulation between the EJV and the anterior jugular vein (AJV), transverse cervical vein (TCV), and suprascapular vein (SSV) were estimated. MEASUREMENTS AND MAIN RESULTS The success of CT-V was achieved in 52 of 52 patients (100%). The mean angulation between the right EJV and the right SCV was 144 ± 36 degrees in the obtuse-angle cases (88%) and 72 ± 28 degrees in the sharp-angle cases (12%). A plexus of veins under the clavicle was most commonly responsible for insertion of the central venous catheter (CVC). The EJV approach resulted in a 93% rate of successful cannulations. No complications of pneumothorax or carotid artery puncture occurred during insertion procedures. CONCLUSIONS The EJV route is associated with comparable technical success and lower major procedural complication. The EJV approach with CT-V guidance is an option as the initial method when central venous cannulation must be performed under suboptimal conditions.
Collapse
Affiliation(s)
- Kazuya Kato
- 1Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun , Hokkaido , Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
The Role of Interventional Radiology in Management of Benign and Malignant Gynecologic Diseases. Obstet Gynecol Surv 2013; 68:691-701. [DOI: 10.1097/ogx.0b013e3182a878c6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68:529-44. [PMID: 23415017 DOI: 10.1016/j.crad.2012.10.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022]
Abstract
Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques.
Collapse
|
38
|
Nguyen V, Jarry J, Farthouat P, Bourilhon N, Milou F, Michel P. Pose de chambre implantable par abord percutané échoguidé : à propos d’une série de 102 patients. ACTA ACUST UNITED AC 2013; 38:6-12. [DOI: 10.1016/j.jmv.2012.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/14/2012] [Indexed: 01/21/2023]
|
39
|
Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology for venous catheter placement and maintenance. J Vasc Interv Radiol 2013; 23:997-1007. [PMID: 22840801 DOI: 10.1016/j.jvir.2012.04.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/13/2012] [Accepted: 04/14/2012] [Indexed: 01/27/2023] Open
|
40
|
Central venous disease in hemodialysis patients: an update. Cardiovasc Intervent Radiol 2012; 36:898-903. [PMID: 23073561 DOI: 10.1007/s00270-012-0498-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.
Collapse
|
41
|
Koh KW, Chanyaputhipong J, Tan SG. Killing Two Birds with One Stone: Subclavian Vein Bypass Graft for Relief of Venous Obstruction and Haemodialysis Access. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Subclavian and brachio-cephalic vein stenosis or occlusion occurs, most commonly, as an iatrogenic complication of the placement of central venous catheter. This occurrence can cause ipsilateral arm swelling in a newly-created arteriovenous fistula (AVF). Critical central vein stenoses are often successfully managed by endovascular approach; occasionally, complete occlusion with symptomatic severe arm swelling and pain that does not respond to angioplasty requires ligation of the dialysis access. We report successful surgical management of an end-stage-renal-failure (ESRF) patient with symptomatic subclavian vein occlusion refractory to angioplasty in an ipsilateral arm with an existing functional brachio-basilic transposition arteriovenous fistula by performing a basilic to internal jugular vein (IJV) bypass graft, relieving both the arm swelling and salvaging the existing vascular access for future haemodialysis.
Collapse
Affiliation(s)
- Kar Wee Koh
- Department of General Surgery, Singapore General Hospital, Singapore
| | | | - Seck Guan Tan
- Department of General Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
42
|
Zaghal A, Khalife M, Mukherji D, El Majzoub N, Shamseddine A, Hoballah J, Marangoni G, Faraj W. Update on totally implantable venous access devices. Surg Oncol 2012; 21:207-15. [DOI: 10.1016/j.suronc.2012.02.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/17/2012] [Accepted: 02/10/2012] [Indexed: 11/26/2022]
|
43
|
Aribaş BK, Arda K, Aribaş O, Ciledağ N, Yoloğlu Z, Aktaş E, Seber T, Kavak S, Coşar Y, Kaygusuz H, Tekin E. Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center. Exp Ther Med 2012; 4:675-680. [PMID: 23170125 PMCID: PMC3501443 DOI: 10.3892/etm.2012.649] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/26/2012] [Indexed: 12/03/2022] Open
Abstract
The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.
Collapse
Affiliation(s)
- Bilgin Kadri Aribaş
- Department of Radiology, A. Y. Ankara Oncology Education and Research Hospital, Ankara 06200
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Koçak G, Huddam B, Azak A, Yalçin F, Voyvoda N, Hidiroğlu M, Kiliç H, Duranay M. Internal jugular vein catheterization-induced mediastinal hematoma. Hemodial Int 2011; 16:326-7. [PMID: 22099379 DOI: 10.1111/j.1542-4758.2011.00620.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Interventional radiology and the care of the oncology patient. Radiol Res Pract 2011; 2011:160867. [PMID: 22091374 PMCID: PMC3196980 DOI: 10.1155/2011/160867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 01/27/2011] [Indexed: 12/21/2022] Open
Abstract
Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis.
Collapse
|
46
|
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis 2011; 52:1087-99. [PMID: 21467014 DOI: 10.1093/cid/cir138] [Citation(s) in RCA: 313] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
For patients dependent on permanent venous catheters for survival, the progressive loss of venous access sites should prompt a systematic approach to alternative sites and techniques to maximize patient survival and minimize complications. Interventional radiologists should be familiar with the appropriate use of both conventional and unconventional types of venous access and their associated risks. This article discusses the use of venous access sites available as alternatives to occluded internal jugular veins, including the subclavian veins, the femoral veins, the inferior vena cava, and the hepatic veins. In addition, unconventional techniques for venous access are reviewed, including recannulization of occluded neck and chest veins, catheterization of small thyrocervical veins, and sharp recannulization of occluded central veins.
Collapse
Affiliation(s)
- Jonathan M Lorenz
- Department of Radiology, Section of Interventional Radiology, University of Chicago Hospitals, Chicago, Illinois
| |
Collapse
|
48
|
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39:S1-34. [PMID: 21511081 DOI: 10.1016/j.ajic.2011.01.003] [Citation(s) in RCA: 696] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
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
|
50
|
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:e162-93. [PMID: 21460264 DOI: 10.1093/cid/cir257] [Citation(s) in RCA: 1200] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|