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Rodriguez Perez C, Pezzotti E, Risso FM. Chest-to-arm tunneling technique for central venous access devices in neonates. J Vasc Access 2024; 25:988-994. [PMID: 37151028 DOI: 10.1177/11297298231174064] [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] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Chest-to-arm (CTA) tunneling technique has been described recently as an alternative option to exit site of the catheter in the infraclavicular area. METHOD We report our experience with ultrasound-guided centrally inserted central catheters (CICCs) placed using CTA tunneling in six neonates. All central venous catheters were positioned with ultrasound guidance and real-time tip location. RESULTS There were no insertion-related complications; all devices were correctly positioned at the first attempt. During the follow-up, we found no catheter-related thrombosis, infections, or catheter malfunction. No tip position-related complications. Only one case of secondary malposition was reported. CONCLUSION In our experience, the CTA tunneling technique is reliable, safe, and feasible in the neonate even from the first hours of life, as well as for preterm newborns; it could be a valid alternative to the usual exit site.
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Affiliation(s)
| | - Elena Pezzotti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
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Annetta MG, Ostroff M, Marche B, Emoli A, Musarò A, Celentano D, Taraschi C, Dolcetti L, Greca AL, Scoppettuolo G, Pittiruti M. Chest-to-arm tunneling: A novel technique for medium/long term venous access devices. J Vasc Access 2023; 24:92-98. [PMID: 34148390 DOI: 10.1177/11297298211026825] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chest-to-arm (CTA) tunneling has been described recently as a technique that allows an optimal exit site at mid-arm even in chronically ill patients with complex clinical issues and challenging problems of vascular access. METHOD We adopted CTA tunneling in oncologic and in non-oncologic patients, in totally implanted and in external devices, for both medium and long-term intravenous treatments. We report our experience with 60 cases of CTA tunneling: 19 patients requiring a totally implantable device, who had bilateral contraindication to venous access at the arm and bilateral contraindication to placement of the pocket in the infra-clavicular area; 41 patients requiring an external central venous catheter, who had bilateral contraindication to insertion of peripherally inserted central catheters or femoral catheters, as well as contraindication to an exit site in the infraclavicular area. All venous access devices were inserted with ultrasound guidance and tip location by intracavitary electrocardiography, under local anesthesia. RESULTS There were no immediate or early complications. Patients with CTA-ports had no late complications. In patients with CTA-tunneled external catheters, there were two dislodgments, four episodes of central line associated blood stream infections, and one local infection. There were no episodes of venous thrombosis or catheter malfunction. CONCLUSION Our experience suggests that CTA tunneling is a safe maneuver, with very low risk of complications, and should be considered as an option in patients with complex venous access.
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Affiliation(s)
| | - Matt Ostroff
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Bruno Marche
- Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | | | - Andrea Musarò
- Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | | | | | - Laura Dolcetti
- Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | | | | | - Mauro Pittiruti
- Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
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Retrospective outcome analysis of rates and types of complications after 8654 minimally invasive radiological port implantations via the subclavian vein without ultrasound guidance. Radiol Med 2019; 124:926-933. [DOI: 10.1007/s11547-019-01048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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Kehagias E, Tsetis D. The “Arm-to-Chest Tunneling” technique: A modified technique for arm placement of implantable ports or central catheters. J Vasc Access 2019; 20:771-777. [DOI: 10.1177/1129729819826039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Central venous catheters or “venous access devices” include totally implantable venous access devices or “ports,” peripherally inserted central catheters, and tunneled lines. Venous access devices are now the standard of care in patients requiring long-term intravenous drug administration. Arm venous access device placement is a valuable option for vascular access yet often complicated or rendered practically impossible by the condition and size of peripheral veins. We describe a modification of the arm venous access device implantation technique that we use in our department in order to offer this option to our patients, regardless of their peripheral veins condition. Methods: After ultrasound guided venous access of a suitable neck vein, we create a port pouch—in case of a totally implantable vascular access device—or a skin nick—in case of a venous access device—in the inner aspect of the mid-arm. Using a straight metal tunneler, we tunnel the line from the neck to the arm in two stages, externalizing and re-inserting the line into a skin nick made on the deltopectoral groove. We call this technique “Arm-to-Chest Tunneling” and use it to place venous access devices in the arm using a neck venous access. Results: The Arm-to-Chest Tunneling technique allows us to use larger arm venous access device catheters irrespective of the arm veins condition. Thus, this technique has the advantages of arm venous access device placement, with the added benefit of saving the arm veins. Conclusion: The “Arm-to-Chest Tunneling” method offers the alternative to place a venous access device in a more discreet site in the arm, even in cases in which arm veins are inadequate.
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Affiliation(s)
- Elias Kehagias
- Interventional Radiology Unit, Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Radiology, School of Medicine, University of Crete, Heraklion, Greece
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Zerati AE, Wolosker N, de Luccia N, Puech-Leão P. Cateteres venosos totalmente implantáveis: histórico, técnica de implante e complicações. J Vasc Bras 2017; 16:128-139. [PMID: 29930637 PMCID: PMC5915861 DOI: 10.1590/1677-5449.008216] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
O acesso ao sistema venoso, seja para coleta de amostras de sangue ou para infusão de soluções, é de vital importância para o diagnóstico e tratamento de pacientes com as mais variadas condições clínicas. Desde que Harvey, em 1616, descreveu o sistema circulatório a partir de estudos em animais e que Sir Christopher Wren, 4 décadas depois, realizou a primeira infusão endovenosa em seres vivos, a evolução na técnica de acesso e nos dispositivos para infusão tem sido constante. Merece destaque a criação dos cateteres de longa duração na década de 1970, em especial os totalmente implantáveis, que revolucionaram o tratamento do câncer, aumentando a segurança e o conforto dos pacientes oncológicos. Este artigo tem como objetivo a revisão de dados históricos relativos ao acesso vascular e a discussão da técnica de implante e das principais complicações associadas ao procedimento de colocação e ao uso dos cateteres totalmente implantáveis.
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Affiliation(s)
- Antonio Eduardo Zerati
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Nelson Wolosker
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Nelson de Luccia
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Pedro Puech-Leão
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
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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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Zerati AE, Figueredo TR, de Moraes RD, da Cruz AM, da Motta-Leal Filho JM, Freire MP, Wolosker N, de Luccia N. Risk factors for infectious and noninfectious complications of totally implantable venous catheters in cancer patients. J Vasc Surg Venous Lymphat Disord 2016; 4:200-5. [DOI: 10.1016/j.jvsv.2015.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/11/2015] [Indexed: 12/21/2022]
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Zottele Bomfim GA, Wolosker N, Yazbek G, Bernardi CV, Valentim LA, De Castro TM, Pignataro BS, Benitti DA, Nishinari K. Comparative Study of Valved and Nonvalved Fully Implantable Catheters Inserted Via Ultrasound-Guided Puncture for Chemotherapy. Ann Vasc Surg 2014; 28:351-7. [DOI: 10.1016/j.avsg.2013.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/12/2013] [Accepted: 01/15/2013] [Indexed: 10/26/2022]
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