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Wang L, Bai J, Jin J, Zhi K, Nie S, Qu L. Treatment of inadvertent cervical arterial catheterization: Single-center experience. Vascular 2023; 31:791-798. [PMID: 35422197 DOI: 10.1177/17085381221083161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Inadvertent arterial catheterization can occur during transjugular central venous catheter insertion and should be promptly treated to prevent serious consequences. Although many treatment modalities are available, no exist guidelines regarding the selection of treatment. We aimed to describe our experience with the treatment of 11 patients who underwent inadvertent cervical arterial catheterization and propose an algorithm for the selection of treatment methods. METHODS We retrospectively identified all patients who were treated for inadvertent arterial catheterization at our center between January 2016 and March 2021. We reviewed patient profiles, images, treatment methods, and follow-up data. RESULTS Eleven patients were included (eight men and three women, age: 36-73 years). Ten catheter misplacements were in the right common carotid artery. The remaining catheter was inserted into the right subclavian artery after penetrating the right common carotid artery. Two catheters were 5-Fr and nine catheters were 11.5-Fr. Two patients underwent manual compressions, three underwent open surgery, three underwent stent-graft repairs, and four underwent Perclose Proglide closure. Clinical success was achieved in all 11 patients. Primary technical success was achieved in 10 patients. In one patient, unsuccessful manual compression was followed by successful stent-graft repair; the manual compression failed to prevent bleeding, possibly because of the long-term oral administration of aspirin for coronary heart disease. The mean follow-up was 5.4 months (range, 1-12 months). The overall mortality rate was zero, and no vascular or neurological events occurred. CONCLUSIONS The existing data show that the current protocol for the treatment of inadvertent cervical arterial catheterization at our center is safe and effective. However, the data are insufficient and require further clinical validation.
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Affiliation(s)
- Liang Wang
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jun Bai
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jie Jin
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Kangkang Zhi
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shaojie Nie
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular & Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Dose-Related Analysis in Percutaneous Central Venous Catheters Insertion: Experience of a Pediatric Interventional Radiology Center. CHILDREN 2022; 9:children9050679. [PMID: 35626856 PMCID: PMC9139661 DOI: 10.3390/children9050679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Background: There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation. Materials and Methods: This retrospective study examined a sample of pediatric patients who received percutaneous long-term CVC positioning in a tertiary care pediatric hospital. Effective dose, dose-area product (DAP) and length of time of exposition during the procedure were determined, using an appropriate technical procedure, exam and program set of the angiograph, and compared with an unpaired t-test analysis. Results: The study included 1410 enrolled patients, with a median age of 10 years (range 0.2–18 years), between 2016 and 2019. In 2016 (318 pts), the mean effective dose was 0.13 mSv and the mean DAP dose was 18.95 µGy/m2 In 2017 (353 pts), the mean effective dose was 0.11 mSv and the mean DAP dose was 17.26 µGy/m2. In 2018 (351 pts), the mean effective dose was 0.05 mSv and the mean DAP dose was 7.23 µGy/m2. In 2019 (388 pts), the mean effective dose was 0.02 mSv and the mean DAP dose was 3.10 µGy/m2. Conclusions: Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors’ hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques.
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Nazir A, Niazi K, Zaidi SMJ, Ali M, Maqsood S, Malik J, Kaneez M, Mehmoodi A. Success Rate and Complications of the Supraclavicular Approach for Central Venous Access: A Systematic Review. Cureus 2022; 14:e23781. [PMID: 35518538 PMCID: PMC9063609 DOI: 10.7759/cureus.23781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/05/2022] Open
Abstract
Central venous catheterization plays a key role in patients that require immediate resuscitation, long-term fluid management, and invasive monitoring. The supraclavicular (SC) and infraclavicular (IC) approaches are utilized for central venous catheterization and both have their benefits and limitations. In this systematic review, we aim to explore the success rate and various complications of the SC technique. A literature review was conducted on the PubMed, EMBASE, Scopus, CINAHL, and Cochrane databases. All relevant original articles that evaluated success rates and complications of SC access were retrieved and included for qualitative synthesis. After screening 1040 articles, 28 studies were included for further analysis. The overall success rate of SC access ranged between 79% and 100%. The overall complication rate in SC access ranged between 0% and 24.24% (Mean: 4.27%). The most prevalent complication was arterial puncture (1.39%) followed by catheter malposition (0.42%). The SC approach can be used as an alternative to the IC technique because of its low access time and high success rate. The SC approach should be more commonly used in day-to-day central venous cannulation. Further studies on the role of ultrasound guidance are warranted for the SC approach.
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Yamamoto M, Yamada K, Horikawa M, Kondo H. Horner Syndrome Caused by Central Venous Port Placement via the Internal Jugular Vein: A Case Report. ACTA ACUST UNITED AC 2020; 5:14-18. [PMID: 36284831 PMCID: PMC9550383 DOI: 10.22575/interventionalradiology.2019-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/22/2019] [Indexed: 11/17/2022]
Abstract
Pneumothorax and unintended arterial puncture are well-known complications of central venous (CV) access via the internal jugular vein (IJV), whereas injury to nerves around the IJV is a relatively rare complication. We describe the case of a male patient in his 60s who developed Horner syndrome after CV port placement via the IJV. We also point out the anatomical nerve structures around the IJV that clinicians should be aware of in order to minimize the risk of nerve injury during CV access. Additionally, with a brief literature review, we describe other nerve injuries that can be caused by CV access.
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Affiliation(s)
| | - Kentaro Yamada
- Department of Radiology, National Defense Medical College
| | - Masahiro Horikawa
- Dotter Department of Interventional Radiology, Oregon Health & Science University
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine
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Lee CS, Yoon SH, Lee SM, Lee IK, Kim JY, Cho HM, Kim MK. Micropuncture Access Set Use During Implantation of Totally Implantable Venous Access Device May Reduce Upper Extremity DVT Incidence Among Patients Undergoing Chemotherapy for Colorectal Cancer. World J Surg 2019; 44:1302-1308. [PMID: 31853590 DOI: 10.1007/s00268-019-05336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to compare the perioperative outcomes when using a micropuncture access set (MS) to those when using a conventional puncture set (CS) for implantation of totally implantable venous access device (TAVID). METHODS A total of 314 patients undergoing chemotherapy for colorectal cancer were included between June 2015 and July 2018. Of these, 123 (39.2%) received TAVID implantation using MS and 191 patients (60.8%) received TAVID using CS. Perioperative outcomes and complications were compared between both groups. RESULTS Baseline characteristics, including body mass index, American Society of Anesthesiologists score, cardiovascular disease, diabetes mellitus, and hyperlipidemia, were not significantly different between the groups. Postoperative complications occurred in 25 patients (8.0%), and the rate and incidence of venous thrombosis were significantly higher in the CS group. There were no significant differences between the groups in other complications such as the rate of port site infection, deep vein thrombosis, obstruction, catheter dislocation, and skin complications (exposure). No incidence of catheter infection, port rotation, intraoperative bleeding, or pneumothorax was observed in this cohort. CONCLUSIONS MS is a safe and feasible procedure and results in less thrombosis. MS may play an important role in improving outcomes for the implantation of TAVID.
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Affiliation(s)
- Chul Seung Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoon Yoon
- Department of Surgery, ST. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Min Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jang Young Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Min Cho
- Department of Surgery, ST. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ki Kim
- Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
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Biffi R, Pittiruti M. Central Venous Long-Term Access Implant in Oncology Patients: Is There a Gold Standard? A Critical Analysis of Available Evidence. J Vasc Access 2018; 3:93-6. [PMID: 17639468 DOI: 10.1177/112972980200300302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R Biffi
- Division of General Surgery, European Institute of Oncology, Milano - Italy
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Yamamoto Y, Orii T, Yoshimura M, Kitahara H, Karasawa Y. Is there any correlation between venipuncture sites and complications of central venous port placement in the chest wall? INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Atypical use of PICC in Infants and Small Children: A Unicentric Experience. J Vasc Access 2017; 18:535-539. [DOI: 10.5301/jva.5000773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or “atypical” approach, first described by Pittiruti. Materials and methods We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area (“atypical” PICC insertion) and then tunneled on the chest. Results Nineteen atypical PICCs were positioned in 18 patients. The median age of patients at the day of implant was 14 months (IQR 3-27 months), and weight 7.5 kg (IQR 4-12 kg). Within this population, 74% of cases scheduled for a typical PICC insertion presented vein caliber too small for this procedure. For this reason, the typical PICC insertion was changed in favor of an atypical PICC procedure. Atypical PICCs were successfully used in 100% of cases without immediate complications. Conclusions Atypical PICC positioning is a safe and useful alternative to the conventional technique when there is need for a central vascular access device (CVAD) for mid- or long-term therapy.
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Fonseca IYI, Krutman M, Nishinari K, Yazbek G, Teivelis MP, Bomfim GAZ, Cavalcante RN, Wolosker N. Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients. EINSTEIN-SAO PAULO 2017; 14:473-479. [PMID: 28076593 PMCID: PMC5221372 DOI: 10.1590/s1679-45082016ao3606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To prospectively evaluate the perioperative safety, early complications and satisfaction of patients who underwent the implantation of central catheters peripherally inserted via basilic vein. Methods Thirty-five consecutive patients with active oncologic disease requiring chemotherapy were prospectively followed up after undergoing peripheral implantation of indwelling venous catheters, between November 2013 and June 2014. The procedures were performed in the operating room by the same team of three vascular surgeons. The primary endpoints assessed were early postoperative complications, occurring within 30 days after implantation. The evaluation of patient satisfaction was based on a specific questionnaire used in previous studies. Results In all cases, ultrasound-guided puncture of the basilic vein was feasible and the procedure successfully completed. Early complications included one case of basilic vein thrombophlebitis and one case of pocket infection that did not require device removal. Out of 35 patients interviewed, 33 (94.3%) would recommend the device to other patients. Conclusion Implanting brachial ports is a feasible option, with low intraoperative risk and similar rates of early postoperative complications when compared to the existing data of the conventional technique. The patients studied were satisfied with the device and would recommend the procedure to others.
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Affiliation(s)
| | | | - Kenji Nishinari
- Fundação Antônio Prudente, Hospital A. C. Camargo, São Paulo, SP, Brazil
| | - Guilherme Yazbek
- Fundação Antônio Prudente, Hospital A. C. Camargo, São Paulo, SP, Brazil
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A new infraclavicular landmark-based approach to the axillary vein as an alternative method of central venous cannulation. J Vasc Access 2016; 17:273-8. [PMID: 26847737 DOI: 10.5301/jva.5000504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We developed the new technique of the axillary vein catheterization, which is connected with the determination of only two anatomical points of reference for puncture site identification. The primary outcome of this study was to determine the rate of successful catheterizations and the assessment of procedure success rate, depending on cannulation side as well as physician experience. The secondary objective was to evaluate the early complication rate and to determine whether this method can be used in clinical practice. METHODS The methodology of this prospective, cohort study included catheterization of the axillary vein via the infraclavicular approach. All procedures were performed by the first two authors, each of whom had different levels of experience with the technique. The choice of the cannulation side was based on clinical factors, and the technique was identical on the right and left sides. RESULTS The cannulation success rate reached 85.6% (N = 153). The correlation between physician experience and the procedure success rate as well as between cannulation side and procedure success rate were not significant. A common early complication was a puncture of axillary artery (14.4%) with the following proper cannulation in the majority of patients (77.3%, p<0.01, exact test). CONCLUSIONS The procedure success rate, 85.6% (95% CI [80.0, 91.2%]), is comparable to other landmark-based techniques of the central vein cannulation. The moderately high percentage of axillary artery puncture points out that the approach should be used only as an alternative method to the central vein catheterization.
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Mori Y, Nagayama S, Kawamura JI, Hasegawa S, Tanaka E, Okabe H, Takeuchi M, Sonobe M, Matsumoto S, Kanai M, Muto M, Chiba T, Sakai Y. A retrospective analysis on the utility and complications of upper arm ports in 433 cases at a single institute. Int J Clin Oncol 2015; 21:474-82. [PMID: 26507141 PMCID: PMC4901144 DOI: 10.1007/s10147-015-0917-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
Background We have employed upper arm central venous ports (UACVPs) since 2006 for long-term intravenous chemotherapy (CTx) or fluid supplementation. We evaluated the long-term availability of CVPs implanted in the upper arm to determine whether UACVPs could be one of the treatment options besides chest CVPs in terms of CVP-related complications. Methods We reviewed the medical records of all patients who underwent subcutaneous implantation of UACVPs at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009. We assessed the indwelling duration of the UACVPs and the incidences of early and late UACVP-related complications. Results A total of 433 patients underwent subcutaneous implantation of UACVPs during this time period. The cumulative follow-up period was 251,538 catheter days, and the median duration of UACVP indwelling was 439.0 days (1–2, 24). There was no UACVP-related mortality throughout the study period. A total of 83 UACVP-related complications occurred (19.2 %), including 43 cases of infection (9.9 %, 0.17/1000 catheter days), ten cases of catheter-related thrombosis (2.3 %, 0.040/1000 catheter days), ten cases of occlusion (2.3 %, 0.040/1000 catheter days), nine cases of catheter dislocation (2.0 %, 0.036/1000 catheter days), five cases of port leakage (1.2 %, 0.019/1000 catheter days), four cases of skin dehiscence (0.9 %, 0.015/1000 catheter days) and two cases of port chamber twist (0.5 %, 0.008/1000 catheter days). The removal-free one-year port availability was estimated at 87.8 %. Conclusions UACVPs were of long-term utility, with complication rates comparable to those of chest CVPs previously reported.
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Affiliation(s)
- Yukiko Mori
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoshi Nagayama
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Jun-Ichiro Kawamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Suguru Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Eiji Tanaka
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Okabe
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Megumi Takeuchi
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto University, Yoshidahonmachi, Sakyo Ward, Kyoto, Kyoto, 606-8501, Japan
| | - Shigemi Matsumoto
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masashi Kanai
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsutomu Chiba
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Gastroenterology and Hepatology, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Boddi M, Villa G, Chiostri M, De Antoniis F, De Fanti I, Spinelli A, Savino A, Gensini GF, Pelagatti C. Incidence of ultrasound-detected asymptomatic long-term central vein catheter-related thrombosis and fibrin sheath in cancer patients. Eur J Haematol 2015; 95:472-9. [PMID: 25598286 DOI: 10.1111/ejh.12519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most central venous catheter (CVC)-related deep vein thromboses (DVT) are asymptomatic and their incidence and clinical relevance are still under debate. Data on CVC-related fibrin sheaths are scarce. We investigated the incidence of asymptomatic DVT and fibrin sheaths in cancer patients with long-term CVC implantation who underwent Doppler ultrasound surveillance at 1, 6, and 12 months after implantation. Effects of low-weight molecular heparin (LWMH) therapy on DVT and fibrin sheaths were also analyzed. MATERIAL AND METHODS This prospective study was performed on a large cohort (n = 400) of patients with cancer aged >18 requiring long-term CVC implantation for chemotherapy infusion. CVC was implanted by a trained qualified staff, according to standardized protocol in a specific surgery. Patients underwent ultrasound examination at 1 and 6 months after CVC implantation to detect 'early' (1 month) and 'late' (6 months) asymptomatic DVT or fibrin sheaths incidence. Sixty-nine patients underwent US examination also 12 months after CVC implantation. RESULTS The incidence of CVC-related thrombosis was 0.10 events per 1000 catheter days. Anticoagulation therapy with LWMH resolved 50% of DVT, but no CVC needed removing. Incidence of new onset fibrin sheaths was 0.71 events per 1000 catheter days. Fibrin sheaths resolution occurred independently of LWMH therapy. DISCUSSION The incidence of asymptomatic DVT in our patients with long-term CVC is very low and does not represent per se an indication for removal of functioning CVC in patients with cancer. Fibrin sheaths are frequent (13%) and never associated with CVC dysfunction. CONCLUSION Asymptomatic DVT and fibrin sheaths do not represent per se an indication for removal of functioning CVC in cancer patients who need central vein access.
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Affiliation(s)
- Maria Boddi
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy
| | - Gianluca Villa
- Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy
| | - Marco Chiostri
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy
| | - Francesco De Antoniis
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy
| | - Ilaria De Fanti
- Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy
| | - Alessandra Spinelli
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy
| | - Andrea Savino
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy
| | - Gian Franco Gensini
- Department of Experimental and Clinical Medicine, Careggi Teaching Hospital, Florence, Italy.,Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy
| | - Cecilia Pelagatti
- Section of Anesthesia and Intensive Care, Department of Human Health Science, Careggi Teaching Hospital, Florence, Italy
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Błasiak R, Ławiński M, Majewska K, Gradowska A. Damage of Central Catheters in Home Parenteral Nutrition Patients. POLISH JOURNAL OF SURGERY 2015; 87:579-86. [DOI: 10.1515/pjs-2016-0006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Indexed: 11/15/2022]
Abstract
AbstractAccording to the ESPEN and ASPEN guidelines, in the case of a long-term (>3-month) parenteral nutrition should be administered via a subcutaneous central venous catheter (CVC). There are three types of mechanical complications of tunnelled central catheter: catheter rupture, occlusion by TPN depositing and thrombofibrotic occlusion.was to analyse the incidence of complications central catheter in a group of patients receiving HPN.Between January 2010 and June 2014, HPN was conducted in 584 patients (306 women and 278 men), ninety-nine patients were enrolled in the study: 67 women and 32 men in whom mechanical complications of central catheters were found.Among 99 patients, 71 used the tunnelled Broviac catheter. Groshong catheters were placed only in patients receiving parenteral nutrition due to cancer. Analyses have shown differences between the older and younger in the number of mechanical complications. Younger patients were found to have a larger number of catheter complications (1.6 ± 1.1) in comparison with older patients (1.3 ± 0.7). The catheter that was most commonly damaged was the Broviac catheter 76.8%. The most frequent type of mechanical complications was catheter rupture 64.81%.Mechanical complications of tunnelled central catheters in HPN patients can be repaired in an outpatient setting in half of the cases, which enables continuation of parenteral nutrition without the need to hospitalise the patient. The centres that conduct HPN should offer 24-hour care and help in case of problems with the central venous line to the patients.
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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.
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Affiliation(s)
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
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15
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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: 18] [Impact Index Per Article: 1.8] [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.
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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
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Central vascular catheters versus peripherally inserted central catheters in nurse anesthesia. A perspective within the Greek health system. J Vasc Access 2013; 14:373-8. [PMID: 23817954 DOI: 10.5301/jva.5000160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2013] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We present a study comparing the insertion of central vascular catheter (CVC) and peripherally inserted central catheter (PICC) by an anesthesia nurse at 2 Greek University Hospitals. METHODS Eighty patients, aged 20-80 years, were enrolled in the study. Patients were divided into 2 groups. In group A (41 patients), a CVC was inserted in the internal jugular vein. In group B (39 patients), a pressure-injectable PICC was inserted in the basilica vein. RESULTS Correlations between the methods applied, the patients' characteristics, the procedures' characteristics and the overall satisfaction scores for each procedure were examined. The final results show that the patients of group B (PICC method) were more satisfied with the procedure than the patients of group A (CVC method), at the statistical significance level of a=0.01. Also, according to the results of the analysis, the PICC method offers significantly more comfort and relative satisfaction than the CVC method, at the statistical significance level of a=0.01. The satisfaction scores of "physicians" were statistically more significant, at a=0.01, for the patients of group A (classic CVCs) mainly because of the insufficient flow rate of the PICCs when compared with the CVCs and especially if one considers the fact that the physicians did not have any experience with the PICC method at all. CONCLUSIONS PICCs under ultrasound guidance constitute the solution of choice for patients and they definitely surpass the CVCs focusing mainly on the improvement of the quality of life and the satisfaction of patients.
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Ultrasound guided supraclavicular central vein cannulation in adults: a technical report. J Vasc Access 2012; 14:89-93. [PMID: 22865526 DOI: 10.5301/jva.5000088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Ultrasound-guided (USG) central vein cannulation has become very popular among anesthesiologists and critical care physicians in the last decade and it has been advocated as the gold standard practice for internal jugular vein (IJV) catheterization. METHODS We report a technique used at our second level hospital for cannulating either subclavian vein or innominate vein using a supraclavicular (SCV) approach under real time ultrasound guidance for elective positioning of long, medium or short-term central venous catheters (CVC). We report one year of practice. RESULTS A total of 347 intravascular devices were positioned; successful USG SCV cannulation with no complication, failure or malposition was reported in 119 cases. CONCLUSIONS The SCV approach under ultrasound guidance is feasible and safe.
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Yeh CH, Wu YM, Toh CH, Chen YL, Wong HF. A safe and efficacious alternative: sonographically guided internal jugular vein puncture for intracranial endovascular intervention. AJNR Am J Neuroradiol 2012; 33:E7-E12. [PMID: 22158929 DOI: 10.3174/ajnr.a2416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.
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Affiliation(s)
- C-H Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
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A Comparison between Blood Flow Outcomes of Tunneled External Jugular and Internal Jugular Hemodialysis Catheters. J Vasc Access 2011; 13:51-4. [DOI: 10.5301/jva.2011.8444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose The right internal jugular (RIJ) vein is preferred for placement of long-term venous catheters (CVC) for hemodialysis (HD). Use of left IJ vein potentially depletes the access site for arteriovenous fistula (AVF) or arteriovenous graft (AVF) placement because of the high rates of central venous stenosis. The right external jugular (EJ) vein is a viable alternative to the LIJ. The purpose of this study is to compare blood flow outcomes in a series of percutaneously placed external jugular (EJ), LIJ and RIJ HD catheters. Methods Using a prospectively collected database, we identified 46 hemodialysis patients who received a tunneled catheter during a 4-year period. Blood flow outcomes of RIJ, LIJ, and EJ catheters that were date-matched over the study period were compared. Using ANOVA, the blood flow outcomes of the 3 tunneled catheter techniques at 30-d and 90-d were compared. Results The 90-d blood flow outcomes of the 3 groups did not differ significantly. The 30-d blood flow was found to be 348.5± 56.62, 341± 22.42, and 365.7± 71.76 mL/min for RIJ, LIJ, and EJ respectively (P<.05). Using multiple regression analysis, no covariates (age, sex, race, diabetes) were found to be associated with blood flow outcomes at 30-d or 90-d. No identifiable factors were found to be associated with the difference in blood flow between 30-d and 90-d either. Conclusions EJ blood flow outcomes at 30-d and 90-d were comparable to both LIJ and RIJ historic data. Further prospective investigation is required to define the role of EJ CVC placement as another potential long-term access modality.
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Letter to the Editor re: "Outcome analysis in 3160 implantations of radiologically guided placements of totally implantable central venous port systems": observations about right internal jugular access. Eur Radiol 2011; 21:2166-7; author reply 2168. [PMID: 21626361 DOI: 10.1007/s00330-011-2163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Paul C, Knopf H, Böttiger BW, Gawenda M, Bovenschulte H. [Sticking guide wire. Problems with a high-flow catheter]. Anaesthesist 2011; 60:641-6. [PMID: 21424310 DOI: 10.1007/s00101-011-1870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/25/2022]
Abstract
In the case presented an intravenous line for large volume infusion rates was to be placed in a patient with an aortic aneurysm during clinical preoperative care. After a high-flow catheter had been placed without any problems retraction of the guide wire was found to be impossible. Computer tomography revealed that the reason was a kink in the catheter resulting in the guide wire being nipped off. Fortunately both catheter and guide wire could be removed completely without any further complications.
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Affiliation(s)
- C Paul
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik Köln, Kerpener Strasse 62, Köln, Germany.
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol 2010; 21:470-6. [PMID: 20171903 DOI: 10.1016/j.jvir.2009.12.392] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/23/2009] [Accepted: 12/23/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. MATERIALS AND METHODS From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4). RESULTS Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%. CONCLUSIONS Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.
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Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M. ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009; 28:365-77. [DOI: 10.1016/j.clnu.2009.03.015] [Citation(s) in RCA: 345] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Biffi R, Orsi F, Pozzi S, Pace U, Bonomo G, Monfardini L, Della Vigna P, Rotmensz N, Radice D, Zampino MG, Fazio N, de Braud F, Andreoni B, Goldhirsch A. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol 2009; 20:935-40. [PMID: 19179550 DOI: 10.1093/annonc/mdn701] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Central venous access is extensively used in oncology, though practical information from randomized trials on the most convenient insertion modality and site is unavailable. METHODS Four hundred and three patients eligible for receiving i.v. chemotherapy for solid tumors were randomly assigned to implantation of a single type of port (Bard Port, Bard Inc., Salt Lake City, UT), through a percutaneous landmark access to the internal jugular, a ultrasound (US)-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Early and late complications were prospectively recorded until removal of the device, patient's death or ending of the study. RESULTS Four hundred and one patients (99.9%) were assessable: 132 with the internal jugular, 136 with the subclavian and 133 with the cephalic vein access. The median follow-up was 356.5 days (range 0-1087). No differences were found for early complication rate in the three groups {internal jugular: 0% [95% confidence interval (CI) 0.0% to 2.7%], subclavian: 0% (95% CI 0.0% to 2.7%), cephalic: 1.5% (95% CI 0.1% to 5.3%)}. US-guided subclavian insertion site had significantly lower failures (e.g. failed attempts to place the catheter in agreement with the original arm of randomization, P = 0.001). Infections occurred in one, three and one patients (internal jugular, subclavian and cephalic access, respectively, P = 0.464), whereas venous thrombosis was observed in 15, 8 and 11 patients (P = 0.272). CONCLUSIONS Central venous insertion modality and sites had no impact on either early or late complication rates, but US-guided subclavian insertion showed the lowest proportion of failures.
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Affiliation(s)
- R Biffi
- Division of Abdomino-Pelvic Surgery, European Institute of Oncology, via Ripamonti 435, I-20141 Milan, Italy.
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Yevzlin AS, Chan M, Gimelli G. How I Do It: Preferential Use of the Right External Jugular Vein for Tunneled Catheter Placement. Semin Dial 2008; 21:183-5. [DOI: 10.1111/j.1525-139x.2007.00415.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tellioglu G, Kara M, Berber I, Yigit B, Cavdar F, Bugan U, Titiz I. Ultrasonography-Guided Jugular Venous Catheter Insertion for Renal Transplant Recipients Before Renal Transplantation: A Prospective Study. Transplant Proc 2008; 40:90-1. [DOI: 10.1016/j.transproceed.2007.11.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cicconi S, Pittiruti M, Buononato M, Piccirillo N, Sorà F, Chiusolo P, Laurenti L, Leone G, Sica S. Non-tunneled central venous catheters in adult stem cell transplantation recipients: An effective option. J Vasc Access 2007; 2:168-74. [PMID: 17638282 DOI: 10.1177/112972980100200407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stem cell transplantation (SCT) recipients require central venous catheter (CVC) insertion for the administration of chemotherapy, antibiotics and total parenteral nutrition. Traditionally, tunneled CVC have been considered as the golden standard although they require surgery for both insertion and removal. We prospectively evaluated the use of a non-tunneled CVC in 182 consecutive patients who had undergone allogenic or autologous SCT. The median duration of CVC was 4 weeks (range 1-24) with a significant difference between allogenic (8 weeks, range 2-24) and autologous SCT (4 weeks, range 1-24) (p<0.0001). The life expectancy of the CVC was significantly influenced by spontaneous removal, which occurred in 26 patients (13.8%). There was a significant increase of this complication in allogenic SCT (p=0.039). The overall incidence of sepsis was 24.5%, although catheter-related sepsis was microbiologically documented by positive culture of the tip only in 17 cases (9%). Non-tunneled CVC in adult SCT recipients allowed (a) bedside insertion and removal, (b) guidewire replacement for diagnostic or therapeutic purposes (dialysis or pheresis procedures) thus reducing the need for repeated venipunctures. (The Journal of Vascular Access 2001; 2: 168-174).
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Affiliation(s)
- S Cicconi
- Department of Hematology, Istituto di Semeiotica Medica, Rome - Italy
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Iovino F, Pittiruti M, Buononato M, Lo Schiavo F. [Central venous catheterization: complications of different placements]. ANNALES DE CHIRURGIE 2001; 126:1001-6. [PMID: 11803622 DOI: 10.1016/s0003-3944(01)00653-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY AIM The aim of this prospective multicentric non-randomised trial was to report the complications of the central venous catheter insertion with different techniques and to assess the advantages of the low lateral approach to the internal jugular vein, according to the technique originally described by Jernigan et al, with our own modifications. PATIENTS AND METHOD From January 1993 to August 1997, 2,290 CVC (2,286 by percutaneous puncture and 4 by surgical approach) were placed. The following complications were analysed prospectively: pneumothorax, accidental arterial puncture, more than two punctures of the same vein, necessity to shift to another venous approach, complete failure, malposition of catheter. RESULTS The veins the most frequently used were internal jugular vein (48.7%), femoral vein (27%) and subclavian vein (24.2%). Internal jugular vein was punctured especially by low lateral approach (75%) and subclavian vein by infraclavicular approach (92%). With these two placements, the rate of pneumothorax was 0% and 3.1% respectively (p < 0.001), the rate of accidental arterial puncture was 1% and 2.7% respectively (p < 0.03) and the rate of more than two consecutive punctures was 3.1% and 6.3% respectively (p < 0.008). CONCLUSION On our experience, we advocate the low lateral approach to the internal jugular vein as first choice technique for venipuncture in both adults and children for both short and long-term central venous approach, because it is associated to high rate of outcome and to low rate of complications in comparison with other techniques.
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Affiliation(s)
- F Iovino
- III Divisione di Chirurgia Generale e Oncologica, Seconda Università degli Studi di Napoli, Piazza Miraglia 2, 80122 Napoli, Italie.
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