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Sample records for central venous catheters

  1. Central venous catheters - ports

    MedlinePlus

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... catheter is attached to a device called a port that will be under your skin. The port ...

  2. Central venous catheter - flushing

    MedlinePlus

    ... To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes ( ... your fingers before washing. Dry with a clean paper towel. Set up your supplies on a clean ...

  3. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  4. Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes

    MedlinePlus

    ... Membership Directory (SIR login) Interventional Radiology Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes People with ... without surgery by an interventional radiologist. Central Venous Access Catheters (CVAC) A CVAC is a tube that ...

  5. Central venous catheter - dressing change

    MedlinePlus

    ... will need: Sterile gloves Cleaning solution A special sponge A special patch, called a Biopatch A clear ... around the catheter. Clean the skin with the sponge and cleaning solution. Air dry after cleaning. Place ...

  6. Central venous catheters: incidence and predictive factors of venous thrombosis

    PubMed Central

    Hammes, Mary; Desai, Amishi; Pasupneti, Shravani; Kress, John; Funaki, Brian; Watson, Sydeaka; Herlitz, Jean; Hines, Jane

    2015-01-01

    Aims: Central venous catheter access in an acute setting can be a challenge given underlying disease and risk for venous thrombosis. Peripherally inserted central venous catheters (PICCs) are commonly placed but limit sites for fistula creation in patients with chronic renal failure (CKD). The aim of this study is to determine the incidence of venous thrombosis from small bore internal jugular (SBIJ) and PICC line placement. This investigation identifies populations of patients who may not be ideal candidates for a PICC and highlights the importance of peripheral vein preservation in patients with renal failure. Materials and methods: A venous Doppler ultrasound was performed at the time of SBIJ insertion and removal to evaluate for thrombosis in the internal jugular vein. Data was collected pre- and post-intervention to ascertain if increased vein preservation knowledge amongst the healthcare team led to less use of PICCs. Demographic factors were collected in the SBIJ and PICC groups and risk factor analysis was completed. Results: 1,122 subjects had PICC placement and 23 had SBIJ placement. The incidence of thrombosis in the PICC group was 10%. One patient with an SBIJ had evidence of central vein thrombosis when the catheter was removed. Univariate and multivariate analysis demonstrated a history of transplant, and the indication of total parenteral nutrition was associated with thrombosis (p < 0.001). The decrease in PICCs placed in patients with CKD 6 months before and after intervention was significant (p < 0.05). Conclusions: There are subsets of patients with high risk for thrombosis who may not be ideal candidates for a PICC. PMID:25997503

  7. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    SciTech Connect

    Gebauer, Bernhard Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-07-15

    Purpose. The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions. We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging.

  8. Central Venous Catheter-related Fungemia Caused by Rhodotorula glutinis.

    PubMed

    Miglietta, Fabio; Letizia Faneschi, Maria; Braione, Adele; Palumbo, Claudio; Rizzo, Adriana; Lobreglio, Giambattista; Pizzolante, Maria

    2015-01-01

    Bloodstream infection due to Rhodotorula glutinis is extremely rare and mostly associated with underlying immunosuppression or cancer. Vascular access devices provide the necessary surfaces for biofilm formation and are currently responsible for a significant percentage of human infections. In this work, we describe a rare case of central venous catheter-related Rhodotorula glutinis fungemia in a female patient with acute myelogenous leukemia in remission. The timely removal of central venous catheter was an essential element for overcoming this CVC-related Rhodotorula fungemia. PMID:26329371

  9. Pneumothorax as a complication of central venous catheter insertion

    PubMed Central

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos

    2015-01-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the “central venous oxygen saturation”), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion. PMID:25815301

  10. Pneumothorax as a complication of central venous catheter insertion.

    PubMed

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion. PMID:25815301

  11. Central venous catheter-related Corynebacterium minutissimum bacteremia.

    PubMed

    Rupp, M E; Stiles, K G; Tarantolo, S; Goering, R V

    1998-10-01

    Although Corynebacterium minutissimum is well-known as the cause of erythrasma, it is noted as the etiologic agent of nondermatologic disease only rarely. We document this organism as a cause of central venous catheter-associated bacteremia and report the use of pulsed-field gel electrophoresis to characterize its molecular epidemiology. PMID:9801290

  12. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

    PubMed Central

    Roldan, Carlos J.; Paniagua, Linda

    2015-01-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition. PMID:26587087

  13. [Venous thrombosis associated with central venous catheter use in patients with cancer].

    PubMed

    Iglesias Rey, Leticia; Fernández Pérez, Isaura; Barbagelata López, Cristina; Rivera Gallego, Alberto

    2015-01-01

    The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment. PMID:25771092

  14. The Malposition of Central Venous Catheters in Children

    PubMed Central

    Dzierzega, Maria; Ossowska, Magdalena; Chmiel, Dariusz; Wieczorek, Aleksandra; Balwierz, Walentyna

    2014-01-01

    Summary Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them. PMID:25177409

  15. Migration of Central Venous Catheters in Neonates: A Radiographic Assessment.

    PubMed

    Gupta, Ruby; Drendel, Amy L; Hoffmann, Raymond G; Quijano, Carla V; Uhing, Michael R

    2016-05-01

    Objective This study aims to determine the frequency that umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs) migrate into the cardiothymic silhouette after initial verification of correct placement. Study Design This is a single-center, retrospective study in neonates in whom a PICC or UVC was placed. The frequency of catheter tip migration into the cardiothymic silhouette requiring catheter manipulation was determined radiographically at 1 and 24 hours, respectively, after insertion. Results At 1 and 24 hours, 36 and 23% of UVCs (n = 41) migrated into the cardiothymic silhouette, respectively. At 1 and 24 hours, 23 and 11% of PICCs (n = 63) migrated into the cardiothymic silhouette, respectively. Migration was not associated with birth weight, weight at insertion, or postnatal age at insertion. Conclusion UVCs and PICCs frequently migrate into the cardiothymic silhouette increase the risk for development of a pericardial effusion. Serial radiographic assessment of catheter tip location is needed to assess catheter migration within the first 24 hours of line placement. PMID:26731179

  16. Important aspects of the colonization of central venous catheter.

    PubMed

    Andreoli-Pinto, T J; Graziano, K U

    1999-01-01

    This study comprises five different kind of venous central catheters, 103 in total, made of Polyurethane Tecoflex, Polyurethane Vialon, PTFE and PVC, and the influence of their raw material on the microbial colonization. Patients age and sex, besides their clinical conditions, were taken into account, and neither considered as a sample vicious, nor associated with colonization. When the tips of the catheters were asseptically inoculated in Tryptic Soy Broth and Tioglicolate, colonization was detected in 15.5% of the catheters. Coagulase negative Staphylococcus, some of which with biofilm, were the predominant organisms found, although some bacillus have also been detected: Enterobacter aerogenes, Hafnia alvei, Pseudomonas cepacia, Xanthomonas maltophilia and Aeromonas sobria. It was not possible to notice any association between the colonization of the catheters and their raw material, probably due to the influence of a previous contact and linking with blood components. This contact causes a thin coating on the surface of the cathether, which makes all the catheters similar in respect of the attachment of a bacterial cell. So, the colonization depends on the virulence of the organism, much more then on the nature of the catheter. PMID:10326311

  17. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (<10s), advection-dominated phase that rapidly depletes the concentration of heparin at the CVC tip, followed by a slow, diffusion-limited phase inside the catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  18. Hemodynamics of Central Venous Catheters: experiments and simulations

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  19. A retrospective study of central venous catheters GCRI experience

    PubMed Central

    Jain, Sachin A.; Shukla, Shilin N.; Talati, Shailesh S.; Parikh, Sonia K.; Bhatt, Shivani J.; Maka, Vinayak

    2013-01-01

    Background: The use of central venous catheters (CVCs) has greatly improved the quality-of-care in cancer patients, yet these catheters may cause serious infectious and thrombotic complications. The aim of this retrospective study was to study the various types of CVCs and their complications. Materials and Methods: We studied retrospectively 213 cases of CVCs in our institute with their indications, type and complications from August 2010 to July 2011. Results: A total of 213 CVCs were inserted in patients with hematological (62%) and solid organ malignancies (38%). Ninety-eight patients (46%) had peripheral inserted central catheter (PICC), 90 (42%) patients had Hickman catheters and 25 (12%) had a port. The median duration of retention of Hickman catheters was 104 days (3-365 days), for the peripherally inserted central catheters was 59 days (3-100 days) and for the port it was 280 days (45-365 days). Non-infective complications were more than infective (12% vs. 7%). The most common complication was non-infective occlusion and thrombophlebitis. In one patient with PICC thrombosis occurred in the cephalic, radial and ulnar vein and in one patient with port thrombosis occurred in the superior vena cava. Organisms were isolated in 60% (12 out of 20) of cultures. Common organisms isolated were Pseudomonas aeruginosa in 5 (42%), Staphylococcus aureus in 2 (16%), Escherichia coli in 2 (16%) and Aspergillus in 3 (25%) patients. 7 out of 12 infected patients had negative blood cultures within 7 days of antibiotic treatment, 5 patients remained positive for more than 7 days with antibiotics. In 155 patients (73%), the desired treatment protocol was completed and at present there are still 28 patients (13%) with catheters. 5 patients (2.3%) died of febrile neutropenia and septicemia with multi-organ failure. In 5 patients (2.3%), the catheters (1 Port, 1 Hickman and 3 PICC) were prematurely removed because of thrombosis. Conclusion: CVCs are better options to facilitate

  20. Central venous catheter vascular erosions. Diagnosis and clinical course.

    PubMed Central

    Ellis, L M; Vogel, S B; Copeland, E M

    1989-01-01

    Central venous catheter (CVC) vascular erosions are difficult to diagnose, and they cause serious complications. From 1985 to 1987, ten patients receiving the surgical services at the University of Florida suffered CVC vascular erosions. By chest roentgenogram, nine CVC tips were in the superior vena cava (SVC), although three catheter tips abutted the lateral wall of the SVC. One catheter tip was in the right atrium. All patients had sudden onset of symptoms, the most common of which was shortness of breath. Initial diagnosis was respiratory insufficiency in five patients, cardiac failure in three patients, pulmonary embolism in one, and sepsis in one. Four patients required intensive care. Two patients suffered pericardial tamponade, and pleural effusions developed in eight patients. One patient died of cardiac arrest. The average time interval from CVC placement to onset of symptoms was 60.2 hours, and from the onset of symptoms to the time of diagnosis, the interval was 16.7 hours. The mean volume obtained at thoracentesis was 1324 ml and at pericardiocentesis was 250 ml. Images Fig. 1. PMID:2930292

  1. A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter.

    PubMed

    Sanderson, P M

    1995-01-01

    The time taken to prime the individual lumina of two multilumen central venous catheters (Viggo-Spectramed 14G 20 cm Hydrocath and Vialon 14G 20 cm Deltacath) and one pulmonary artery catheter (Viggo-Spectramed 110 cm 7.5F Pentacath) at flows between 5 ml.h-1 and 99 ml.h-1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated. PMID:7702147

  2. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    PubMed

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing. PMID:22059378

  3. Malposition of central venous catheter in the jugular venous arch via external jugular vein -a case report-

    PubMed Central

    Ahn, SoWoon; Lee, Ju Ho; Park, Chunghyun; Hong, Yong-woo

    2015-01-01

    The central venous cannulation is commonly performed in the operating rooms and intensive care units for various purposes. Although the central venous catheter (CVC) is used in many ways, the malpositioning of the CVC is often associated with serious complications. We report a case of an unexpected malposition of a CVC in the jugular venous arch via external jugular vein. PMID:25844137

  4. Pacemaker wire central venous stenosis and one more reason to not run central venous catheters for dialysis in reverse flow.

    PubMed

    Ash, Stephen R; Ugianskis, Erika J

    2013-01-01

    A 75-year-old man on chronic peritoneal dialysis had unrecognized stenosis of the superior vena cava (SVC) due to pacemaker wires placed 5 years earlier. The patient was placed on hemodialysis after hernia surgery. When a tunneled central venous catheter for dialysis was placed from the right internal jugular (IJ) vein, the venous lumen extended through the stenotic area but not the arterial lumen. Probably due to a subsequent clot at the arterial lumen port the patient developed SVC syndrome and when the catheter was run in the reversed flow direction he developed hypovolemic shock. The stenosis and SVC syndrome resolved with angioplasty of the SVC stenosis, removal of the IJ catheter and use of a femoral vein catheter. The patient eventually returned to peritoneal dialysis and the femoral catheter was removed. PMID:22860886

  5. Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years.

    PubMed

    Zganjer, Mirko; Cizmić, Ante; Butković, Diana; Matolić, Martina; Karaman-Ilić, Maja; Stepan, Jasminka

    2008-09-01

    Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment. There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155 days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections were more frequent and in PAC group other complications were more frequent than infections. PMID:18982750

  6. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis.

    PubMed

    Ballard, David H; Samra, Navdeep S; Gifford, Karen Mathiesen; Roller, Robert; Wolfe, Bruce M; Owings, John T

    2016-06-01

    Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p < 0.001) and venous thrombosis (p < 0.001). Patients with femoral catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p < 0.01). In conclusion, to reduce catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible. PMID:27112774

  7. Management Of Fever And Suspected Infection In Pediatric Patients With Central Venous Catheters.

    PubMed

    Brennan, Courtney; Wang, Vincent J

    2015-12-01

    The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses. Early resuscitation as well as timely and appropriate antibiotic therapy have been shown to improve outcomes. This issue focuses on the approach to fever in pediatric patients with central venous catheters and the management and disposition of patients with possible catheter-associated bloodstream infections. PMID:26569627

  8. An effective and biocompatible antibiofilm coating for central venous catheter.

    PubMed

    Silva Paes Leme, Annelisa Farah; Ferreira, Aline Siqueira; Alves, Fernanda Aparecida Oliveira; de Azevedo, Bruna Martinho; de Bretas, Liza Porcaro; Farias, Rogerio Estevam; Oliveira, Murilo Gomes; Raposo, Nádia Rezende Barbosa

    2015-05-01

    The aim of this study was to investigate the in vitro and in vivo efficacy and the tissue reaction of an antibiofilm coating composed of xylitol, triclosan, and polyhexamethylene biguanide. The antimicrobial activity was analyzed by a turbidimetric method. Scanning electron microscopy was used to evaluate the antiadherent property of central venous catheter (CVC) fragments impregnated with an antibiofilm coating (I-CVC) in comparison with noncoated CVC (NC-CVC) fragments. Two in vivo assays using subcutaneous implantation of NC-CVC and I-CVC fragments in the dorsal area of rats were performed. The first assay comprised hematological and microbiological analysis. The second assay evaluated tissue response by examining the inflammatory reactions after 7 and 21 days. The formulation displayed antimicrobial activity against all tested strains. A biofilm disaggregation with significant reduction of microorganism's adherence in I-CVC fragments was observed. In vivo antiadherence results demonstrated a reduction of early biofilm formation of Staphylococcus aureus ATCC 25923, mainly in an external surface of the I-CVC, in comparison with the NC-CVC. All animals displayed negative hemoculture. No significant tissue reaction was observed, indicating that the antibiofilm formulation could be considered biocompatible. The use of I-CVC could decrease the probability of development of localized or systemic infections. PMID:25826042

  9. [Procedure adverse events: nursing care in central venous catheter fracture].

    PubMed

    Pérez-Juan, Eva; Maqueda-Palau, Mònica; Romero-Grilo, Cristina; Muñoz-Moles, Yolanda

    2014-01-01

    In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels. PMID:24439203

  10. Repositioning of Misplaced Central Venous Catheter with Saline Injection Under C-Arm Imaging

    PubMed Central

    Gautam, Parshotam Lal; Jain, Krishan; Monga, Hitika

    2015-01-01

    Malposition of central venous catheter is a well known technical complication. Misplaced catheter often requires reinsertion for proper placement of the catheter in the superior vena cava (SVC) to support safe delivery of care and minimize complications. But reinsertion exposes the patient once again to risks of complications related to the procedure including potential of misplacement. Literature describes only a few techniques for repositioning a misplaced central venous catheter (CVC). We tried old simple method of saline injection with force under image intensifier using hydrostatic force of intravenous fluid to straighten the CVC. We could successfully reposition two misplaced CVC’s using this method. PMID:26816974

  11. Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

    SciTech Connect

    Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

    2001-03-15

    Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

  12. [Indications and complications of central venous catheters in hematologic oncology: report of 81 cases].

    PubMed

    Abdelkefi, A; Ladeb, S; Ben Othman, T; Torjman, L; Jeddi, R; Ben Hassen, A; Ben Abdeladhim, A

    2000-11-01

    From february 1998 to july 1999, 81 central venous catheters were placed in 41 patients 28 years old (5 to 51 years). We used the subclavicular anatomic way (Aubaniac) in all cases. The total duration of catheter placement was 2905 days (median of 31 days, range 1 to 165 days). We observed 1 pneumothorax (1.2%), 3 venous thrombosis (3.7%) and 1 arterial puncture (1.2%). Catheter-related infections were seen in 8 catheters (2.7 per 1000 catheter-days). Candida was encountered in 4 cases (50%), Gram-positive cocci in 2 cases (25%), and Gram-negative bacilli in 2 cases (25%). The improvement of preventive ways, diagnosis techniques (simultaneous quantitative cultures, differential positivity time), and therapeutic methods (treatment without removal of the catheter, antibiotic lock technique, catheter exchange by guidewire) should allow a better treatment of catheter-related infections. PMID:11155387

  13. Thrombus on Indwelling Central Venous Catheters: The Histopathology of 'Fibrin Sheaths'

    SciTech Connect

    Suojanen, James Norman; Brophy, David Paul; Nasser, Imad

    2000-03-15

    Purpose: Central venous catheters (CVC) may fail for many reasons, though 'fibrin sheaths' blocking catheter ports are usually implicated. We examined the sheaths removed from dialysis catheters to determine their histopathology.Methods: Ten catheter strippings were performed and the removed material was studied grossly and microscopically.Results: The histologic specimens showed thrombus both with and without a proteinaceous sheath.Conclusion: Dialysis catheters fail because of thrombus formation. This can occur in either the absence or presence of a protein coating on the catheter, the so-called 'fibrin sheath.'.

  14. Automated identification of adverse events related to central venous catheters.

    PubMed

    Penz, Janet F E; Wilcox, Adam B; Hurdle, John F

    2007-04-01

    Methods for surveillance of adverse events (AEs) in clinical settings are limited by cost, technology, and appropriate data availability. In this study, two methods for semi-automated review of text records within the Veterans Administration database are utilized to identify AEs related to the placement of central venous catheters (CVCs): a Natural Language Processing program and a phrase-matching algorithm. A sample of manually reviewed records were then compared to the results of both methods to assess sensitivity and specificity. The phrase-matching algorithm was found to be a sensitive but relatively non-specific method, whereas a natural language processing system was significantly more specific but less sensitive. Positive predictive values for each method estimated the CVC-associated AE rate at this institution to be 6.4 and 6.2%, respectively. Using both methods together results in acceptable sensitivity and specificity (72.0 and 80.1%, respectively). All methods including manual chart review are limited by incomplete or inaccurate clinician documentation. A secondary finding was related to the completeness of administrative data (ICD-9 and CPT codes) used to identify intensive care unit patients in whom a CVC was placed. Administrative data identified less than 11% of patients who had a CVC placed. This suggests that other methods, including automated methods such as phrase matching, may be more sensitive than administrative data in identifying patients with devices. Considerable potential exists for the use of such methods for the identification of patients at risk, AE surveillance, and prevention of AEs through decision support technologies. PMID:16901760

  15. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection.

    PubMed

    Abdelkefi, Abderrahman; Achour, Wafa; Ben Othman, Tarek; Ladeb, Saloua; Torjman, Lamia; Lakhal, Amel; Ben Hassen, Assia; Hsairi, Mohamed; Ben Abdeladhim, Abdeladhim

    2007-06-01

    Bloodstream infections related to the use of central venous catheters are an important cause of patient morbidity, mortality, and increased health care costs. Catheter-related infection may be due to fibrin deposition associated with catheters. Interventions designed to decrease fibrin deposition have the potential to reduce catheter-related infections. This study was a randomized, controlled trial in which 246 patients with nontunneled central venous catheters were randomly assigned to receive a heparin-coated catheter with 50 mL/d of normal saline solution as a continuous infusion (heparin-coated group) or a noncoated catheter with a continuous infusion of low-dose unfractionated heparin (control group: continuous infusion of 100 U/kg/d). Catheter-related bloodstream infection occurred in 2.5% (3/120 catheters) in the heparin-coated group (0.9 events per 1,000 days) and in 9.1% (11/120 catheters) in the control group (3.5 events per 1,000 days; P = 0.027). No other risk factors were found for the development of catheter-related bloodstream infection. Six and seven patients experienced severe bleeding in the heparin-coated and control groups, respectively (P = 1.00). We did not observe heparin-induced thrombocytopenia. The use of heparin-coated catheters can be a safe and effective approach to the prevention of catheter-related bloodstream infection in patients with hematooncologic disease. PMID:17624052

  16. Percutaneous Retrieval of a Central Venous Catheter Sutured to the Wall of the Right Atrium

    SciTech Connect

    Neuerburg, Joerg-M.; Guenther, Rolf W.; Chalabi, Khaled; Hunter, David

    1999-01-15

    A transjugular central venous catheter was inadvertently sutured to the wall of the right atrium in a 63-year-old female during coronary bypass surgery. Using two nitinol Goose Neck snares via a transfemoral and a transjugular approach the catheter was severed into two pieces and retrieved percutaneously.

  17. Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

    PubMed Central

    2013-01-01

    Background Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals’ behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children’s hospital. Methods/design An interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months. Discussion This model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers’ willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635. Trial registration Dutch trials registry (http://www.trialregister.nl), trial # 3635 PMID:24125520

  18. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study

    PubMed Central

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E.; Brennan, Rachel C.; Shook, David R.; Stokes, Dennis C.; Monagle, Paul; Curtis, Nigel; Worth, Leon J.; Allison, Kim; Sun, Yilun; Flynn, Patricia M.

    2015-01-01

    Background Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. Methods We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.” Results Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. Conclusions In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate

  19. [Infections related to central venous catheters in children affected from malignant diseases].

    PubMed

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2011-06-27

    Central venous catheters (CVC) are an essential part of the treatment of children with haematological and oncological diseases. Unfortunately, CVC also represent a major risk factor of bloodstream infections. Catheter-related bloodstream infections (CRBSI) in children are often diagnosed based on blood cultures from the CVC only. Most CRBSI can be treated without catheter removal. On suspicion of CRBSI empirical antibiotic treatment with piperacillin-tazobactam, meropenem or ampicillin in combination with gentamicin is recommended. The systemic treatment can be combined with catheter-lock therapy. PMID:21712011

  20. Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

    PubMed Central

    Son, Jung Tack; Min, Sun Young; Kim, Jae Il; Choi, Pyong Wha; Heo, Tae Gil; Lee, Myung Soo; Kim, Chul-Nam; Kim, Hong-Yong; Yi, Seong Yoon; Lee, Hye Ran; Roh, Young-Nam

    2014-01-01

    Purpose: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. Materials and Methods: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. Results: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. Conclusion: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses. PMID:26217634

  1. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    SciTech Connect

    Teichgraeber, Ulf Karl-Martin Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-15

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  2. Chlorhexidine impregnated central venous catheter inducing an anaphylatic shock in the intensive care unit.

    PubMed

    Khoo, A; Oziemski, P

    2011-10-01

    Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity. Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access. Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters. PMID:21036666

  3. Advances in tunneled central venous catheters for dialysis: design and performance.

    PubMed

    Ash, Stephen R

    2008-01-01

    Over 70% of patients initiating chronic hemodialysis in the United States have a tunneled central venous catheter (CVC) for dialysis as their first blood access device. Tunneled CVC have requirements that are unparalleled by other access devices: high blood flow rates at moderate pressure drops without obstruction, minimal trauma to the vein, resistance to occlusion by fibrous sheathing, prevention of infection, avoidance of clotting, biocompatibility, avoidance of lumen collapse and kinking and breaks, resistance to antiseptic agents, placement with minimal trauma, and radiopaque appearance on X-ray. This publication reviews the numerous designs for tunneled CVC and evaluates the advantages and disadvantages of each design. A catheter that self-centers in the superior vena cava (Centros) is described, along with early clinical results. Current challenges and future directions for tunneled CVC for dialysis are discussed, included means to diminish catheter-related infections, catheter tip clotting, fibrous sheathing, central venous stenosis, and external component bulk. PMID:19000125

  4. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25507120

  5. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25417392

  6. A simulation-based "just in time" and "just in place" central venous catheter education program.

    PubMed

    Lengetti, Evelyn; Monachino, Anne Marie; Scholtz, Amy

    2011-01-01

    The authors describe the Central Venous Catheter Dress Rehearsal simulation program. Teaching is conducted at the bedside, which is efficient and cost effective and allows nurses to practice in a safe environment with no harm to the patient. The educators' challenges and remediation strategies are shared. This simulation program has demonstrated improved consistency of practice and knowledge among pediatric nurses. PMID:22108068

  7. Protocol for Detection of Biofilms on Needleless Connectors Attached to Central Venous Catheters

    PubMed Central

    Donlan, R. M.; Murga, R.; Bell, M.; Toscano, C. M.; Carr, J. H.; Novicki, T. J.; Zuckerman, C.; Corey, L. C.; Miller, J. M.

    2001-01-01

    Central venous catheter needleless connectors (NCs) have been shown to develop microbial contamination. A protocol was developed for the collection, processing, and examination of NCs to detect and measure biofilms on these devices. Sixty-three percent of 24 NCs collected from a bone marrow transplant center contained biofilms comprised primarily of coagulase-negative staphylococci. PMID:11158143

  8. Protocol for detection of biofilms on needleless connectors attached to central venous catheters.

    PubMed

    Donlan, R M; Murga, R; Bell, M; Toscano, C M; Carr, J H; Novicki, T J; Zuckerman, C; Corey, L C; Miller, J M

    2001-02-01

    Central venous catheter needleless connectors (NCs) have been shown to develop microbial contamination. A protocol was developed for the collection, processing, and examination of NCs to detect and measure biofilms on these devices. Sixty-three percent of 24 NCs collected from a bone marrow transplant center contained biofilms comprised primarily of coagulase-negative staphylococci. PMID:11158143

  9. A comparative analysis of radiological and surgical placement of central venous catheters

    SciTech Connect

    McBride, Kieran D.; Fisher, Ross; Warnock, Neil; Winfield, David A.; Reed, Malcolm W.; Gaines, Peter A.

    1997-01-15

    Purpose. To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. Methods.A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access. Results. There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p<0.001). Average catheter life-span was similar for the two placement methods (100{+-}23 days). Conclusion. Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.

  10. Depth of insertion of right internal jugular central venous catheter: Comparison of topographic and formula methods

    PubMed Central

    Vinay, M; Tejesh, CA

    2016-01-01

    Background: Central venous catheters (CVCs) are inserted in many critically ill patients, but there is no gold standard in estimating their approximate depth of insertion. Many techniques have been described in literature. In this study, we compare the topographic method with the standard formula technique. Materials and Methods: 260 patients, in whom central venous catheterization was warranted, were randomly assigned to either topographic method or formula method (130 in each group). The position of the CVC tip in relation to carina was measured on a postprocedure chest X-ray. The primary endpoint was the need for catheter repositioning. Results: The majority of the CVCs tips positioned by the formula method were situated below the carina, and 68% of these catheters required repositioning after obtaining postprocedure chest X-ray (P < 0.001). Conclusion: The topographic method is superior to formula approach in estimating the depth of insertion of right internal jugular CVCs. PMID:27375377

  11. Additional Analgesia for Central Venous Catheter Insertion: A Placebo Controlled Randomized Trial of Dexmedetomidine and Fentanyl.

    PubMed

    Samantaray, Aloka; Hanumantha Rao, Mangu; Sahu, Chitta Ranjan

    2016-01-01

    We aimed to show that a single preprocedural dose of either dexmedetomidine or fentanyl reduces procedural pain and discomfort and provides clinically acceptable sedation. In this prospective, double-blind study, sixty patients scheduled for elective surgery and requiring planned central venous catheter insertion were randomized to receive dexmedetomidine (1 μg/kg), fentanyl (1 μg/kg), or 0.9% normal saline intravenously over ten minutes followed by local anesthetic field infiltration before attempting central venous catheterization. The primary outcome measures are assessment and analysis of pain, discomfort, and sedation level before, during, and after the central venous catheter insertion at five time points. The median (IQR) pain score is worst for normal saline group at local anaesthetic injection [6 (4-6.7)] which was significantly attenuated by addition of fentanyl [3 (2-4)] and dexmedetomidine [4 (3-5)] in the immediate postprocedural period (P = 0.001). However, the procedure related discomfort was significantly lower in dexmedetomidine group compared to fentanyl group in the first 10 min of procedure after local anaesthetic Injection (P = 0.001). Fentanyl is more analgesically efficient for central venous catheter insertion along with local anaesthetic injection. However, dexmedetomidine has the potential to be superior to fentanyl and placebo in terms of providing comfort to the patients during the procedure. PMID:27200187

  12. Additional Analgesia for Central Venous Catheter Insertion: A Placebo Controlled Randomized Trial of Dexmedetomidine and Fentanyl

    PubMed Central

    Samantaray, Aloka; Hanumantha Rao, Mangu; Sahu, Chitta Ranjan

    2016-01-01

    We aimed to show that a single preprocedural dose of either dexmedetomidine or fentanyl reduces procedural pain and discomfort and provides clinically acceptable sedation. In this prospective, double-blind study, sixty patients scheduled for elective surgery and requiring planned central venous catheter insertion were randomized to receive dexmedetomidine (1 μg/kg), fentanyl (1 μg/kg), or 0.9% normal saline intravenously over ten minutes followed by local anesthetic field infiltration before attempting central venous catheterization. The primary outcome measures are assessment and analysis of pain, discomfort, and sedation level before, during, and after the central venous catheter insertion at five time points. The median (IQR) pain score is worst for normal saline group at local anaesthetic injection [6 (4–6.7)] which was significantly attenuated by addition of fentanyl [3 (2–4)] and dexmedetomidine [4 (3–5)] in the immediate postprocedural period (P = 0.001). However, the procedure related discomfort was significantly lower in dexmedetomidine group compared to fentanyl group in the first 10 min of procedure after local anaesthetic Injection (P = 0.001). Fentanyl is more analgesically efficient for central venous catheter insertion along with local anaesthetic injection. However, dexmedetomidine has the potential to be superior to fentanyl and placebo in terms of providing comfort to the patients during the procedure. PMID:27200187

  13. Inadvertent Puncture of the Thoracic Duct During Attempted Central Venous Catheter Placement

    SciTech Connect

    Teichgraber, Ulf K.M. Nibbe, Lutz; Gebauer, Bernhard; Wagner, Hans-Joachim

    2003-11-15

    We report a case of puncture of the thoracic duct during left subclavian vein catheterization on the intensive care unit. Computed tomography and measurement of the triglyceride levels in the aspirated fluid proved the inadvertent penetration of the guidewire into the thoracic duct. Early recognition of central line misplacement avoided serious complications. Inadvertent central venous catheter placement into the thoracic duct may have the potential complications of infusion mediastinum and chylothorax.

  14. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review 1

    PubMed Central

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-01-01

    Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. PMID:27508901

  15. Lights, camera and action in the implementation of central venous catheter dressing1

    PubMed Central

    Ferreira, Maria Verônica Ferrareze; de Godoy, Simone; de Góes, Fernanda dos Santos Nogueira; Rossini, Fernanda de Paula; de Andrade, Denise

    2015-01-01

    Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters. PMID:26626011

  16. Transbrachial Access for Radiologic Manipulation of Problematic Central Venous Catheters in a Pediatric Population

    SciTech Connect

    Rao, Sandeep Hogan, Mark J.

    2010-08-15

    A transfemoral venous approach is the current standard for accessing malpositioned and fractured central venous catheters (CVCs). The purpose of this study was (1) to describe a transbrachial approach for correction and (2) to assess the success and failure of this method in a pediatric population. A 12-year retrospective review of all patients referred for correction of malpositioned, retained, and fractured CVCs was conducted. Based on the performing interventionalist's preference, transbrachial or transfemoral venous sheaths where placed under ultrasonographic guidance. Diagnostic angiographic catheters and snares were used to manipulate the catheters. Patients who underwent the transfemoral approach received postprocedural monitoring for 4 hours, whereas patients who underwent the transbrachial approach were allowed unrestricted activity immediately after hemostasis was obtained. Technical success of malpositioned lines was defined (1) by final position in the superior vena cava or at the cavoatrial junction on postprocedural imaging or (2) by successful removal of retained catheter fragments, if present. Transbrachial approach was used for access in 11 patients. Problematic lines included malpositioned (n = 10) and retained (n = 1) lines. The ipsilateral arm was used for transbrachial entry in 7 patients. Initial use of angiographic catheters was attempted in 7 cases, of which 4 were successful. All 3 unsuccessful cases had tips positioned in the contralateral brachiocephalic vein, and these were successfully repositioned using snares. A combination of snares and angiographic catheters was used in 2 cases. Snares were used for all other cases. Technical success by way of the transbrachial approach was observed in all cases. Periprocedural follow-up demonstrated no immediate complications. We conclude that the transbrachial approach is a suitable alternative to the transfemoral approach for catheter tip position correction. Tip malposition in the contralateral

  17. Factors Influencing Intracavitary Electrocardiographic P-Wave Changes during Central Venous Catheter Placement.

    PubMed

    Wang, Guorong; Guo, Ling; Jiang, Bin; Huang, Min; Zhang, Jian; Qin, Ying

    2015-01-01

    Amplitude changes in the P-wave of intracavitary electrocardiography have been used to assess the tip placement of central venous catheters. The research assessed the sensitivity and specificity of this sign in comparison with standard radiographic techniques for tip location, focusing on factors influencing its clinical utility. Both intracavitary electrocardiography guided tip location and X-ray positioning were used to verify catheter tip locations in patients undergoing central venous catheter insertion. Intracavitary electrocardiograms from 1119 patients (of a total 1160 subjects) showed specific amplitude changes in the P-wave. As the results show, compared with X-ray positioning, the sensitivity of electrocardiography-guided tip location was 97.3%, with false negative rate of 2.7%; the specificity was 1, with false positive rate of zero. Univariate analyses indicated that features including age, gender, height, body weight, and heart rate have no statistically significant influence on P-wave amplitude changes (P > 0.05). Multivariate logistic regression revealed that catheter insertion routes (OR = 2.280, P = 0.003) and basal P-wave amplitude (OR = 0.553, P = 0.003) have statistically significant impacts on P-wave amplitude changes. As a reliable indicator of tip location, amplitude change in the P-wave has proved of good sensitivity and excellent specificity, and the minor, zero, false positive rate supports the clinical utility of this technique in early recognition of malpositioned tips. A better sensitivity was achieved in placement of centrally inserted central catheters (CICCs) than that of peripherally inserted central catheters (PICCs). In clinical practice, a combination of intracavitary electrocardiography, ultrasonic inspection and the anthropometric measurement method would further improve the accuracy. PMID:25915758

  18. Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters

    PubMed Central

    Hamid, Rana S.; Kakaria, Anupam K.; Khan, Saif A.; Mohammed, Saja; Al-Sukaiti, Rashid; Al-Riyami, Dawood; Al-Mula Abed, Yasser W.

    2015-01-01

    Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs) at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis) were collected. Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2%) and 93 were male (57.8%). The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%). A total of 203 procedures were technically successful (99.5%). The right internal jugular vein was the most common site of catheter placement (74.9%). Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%). No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%); of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7%) and catheter-related infection in 29 cases (22.0%). Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature. PMID:26629377

  19. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center

    PubMed Central

    Pektaş, Ayhan; Kara, Ateş; Gurgey, Aytemiz

    2015-01-01

    Objective: This study aims to document and analyze the central venous catheter (CVC)-related complications in children with hematological diseases who were treated within a single institution. Materials and Methods: A retrospective investigation was conducted in 106 pediatric patients in whom 203 CVCs were inserted. A total of 175 catheter-related complications occurred in 5 years. Results: The rates of clinical catheter infections, local catheter infections, venous thromboembolism, bleeding, and mechanical complications were 2.6, 1.1, 0.2, 0.2, and 0.2 per 1000 catheter days. Methicillin-resistant Staphylococcus epidermidis was the predominant infectious organism in blood and catheter cultures. The children with leukemia had a significantly higher frequency of clinical catheter infections (p=0.046). The children who underwent bone marrow transplantation had a significantly lower frequency of clinical catheter infections (p=0.043) and higher frequency of local catheter infections (p=0.003). The children with implanted catheters had a significantly lower frequency of clinical catheter infections (p=0.048). The children with thrombocytopenia had significantly fewer local catheter infections and significantly more clinical catheter infections and catheter-related bleeding (respectively p=0.001, p=0.042, and p=0.024). Conclusion: Leukemia, bone marrow transplantation, and thrombocytopenia are risk factors for CVC-associated complications. The relatively higher number of interventions performed via permanent catheters may be responsible for the significantly increased incidence of systemic infections and mechanical injury. PMID:26316482

  20. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis.

    PubMed

    Chen, Kai; Agarwal, Arnav; Tassone, Maria Cristina; Shahjahan, Nadia; Walton, Mark; Chan, Anthony; Mondal, Tapas

    2016-06-01

    Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children. PMID:26977751

  1. [A Case of Delayed Vascular Injury as a Complication Related to Implanted Central Venous Port Catheter].

    PubMed

    Sumiyoshi, Tetsuya; Kondo, Tomohiro; Fujii, Ryoji; Minagawa, Takeyoshi; Fujie, Shinya; Kimura, Tomohiro; Ihara, Hideyuki; Yoshizaki, Naohito; Kondo, Hitoshi; Kitayama, Hiromitsu; Sugiyama, Junko; Hirayama, Michiaki; Tsuji, Yasushi; Yamamoto, Kazuyuki; Kawarada, You; Okushiba, Shunichi; Nishioka, Noriko; Shimizu, Tadashi

    2015-12-01

    A 74-year-old woman with advanced gastric cancer was admitted to our hospital. A central venous (CV) port catheter was implanted into the right subclavian vein for preoperative chemotherapy and parenteral nutritional management. On the 35th day after implantation, she complained of diarrhea, fever and dyspnea. The chest radiograph showed a right-sided massive pleural effusion. As the patient progressively fell into severe respiratory distress, endotracheal intubation was performed for management of respiration by mechanical ventilation. Initially, given the patient's symptoms, she was diagnosed with septic shock. Therefore, after placement of a CV catheter through the right femoral vein, in consideration of the possibility of a port infection, she was treated with thoracentesis and infusion of antibiotics. The patient gradually recovered, and again received parenteral nutrition through the CV port catheter. After the infusion was administered, she complained of dyspnea. A CT scan of the chest revealed a right pleural effusion and displacement of the tip of the CV port catheter out of the wall of the superior vena cava. We diagnosed delayed vascular injury (DVI), and the CV port catheter was removed. She soon recovered with conservative treatment. We speculated that the initial respiratory symptoms such as the pleural effusion were caused by DVI. DVI should therefore be recognized as a complication related to implanted CV port catheters. PMID:26809313

  2. University HealthSystem Consortium quality performance benchmarking study of the insertion and care of central venous catheters.

    PubMed

    Harting, Brian P; Talbot, Thomas R; Dellit, Timothy H; Hebden, Joan; Cuny, Joanne; Greene, William H; Segreti, John

    2008-05-01

    We report data from an observational benchmarking study of adherence to recommended practices for insertion and maintenance of central venous catheters at a heterogeneous group of academic medical centers. These centers demonstrated a need for significant improvement in implementation and documentation of quality performance measures for the prevention of catheter-related bloodstream infections. PMID:18419367

  3. [The role of the interventional radiologist in central venous catheter dysfunction (pictorial essay)].

    PubMed

    Altunel, Ekrem; Oran, Ismail; Parildar, Mustafa; Memiş, Ahmet

    2004-03-01

    Failure to aspirate blood from the lumen of venous catheters, inadequate blood flow and/or high resistance pressures during hemodialysis were accepted as catheter dysfunction. Other correctable problems such as residual lumen thrombus, external fibrin catheter sheath or malpositioned catheter tip were identified by contrast injection. Catheter malpositions were corrected by snare-mediated catheter repositioning or by exchange of the catheter over a guidewire. Catheters of inadequate length were exchanged over a guidewire to the appropriate position or replaced. Treatment of fibrin sheath formation included fibrin sheath stripping, guidewire catheter exchange, and urokinase infusion. Early catheter dysfunction is frequently due to mechanical problems such as inadequate positioning, kinking, or constriction. Delayed dysfunction usually results from thrombus formation, either within the lumen, around the catheter ("fibrin sleeve"), or in the host vein. In the management of catheter malfunctions and complications, interventional radiological techniques are safe and effective alternatives to standard surgical techniques. PMID:15054708

  4. [Medium- and long-term use of central venous catheters in pediatrics. Personal experience].

    PubMed

    Orfei, P; Pinto, G; Properzi, E; Piccardo, A; Cerroni, A; Prosperi, M; Cozzi, F

    1996-04-01

    From January 1992 to October 1994, 74 central venous catheters were inserted, in the University Hospital of Rome: Polyclinic Umberto I - "La Sapienza", in 62 paediatric patients (15.17 +/- 1.64 years old), admitted to the paediatric surgery division. The authors used a large amount of CVC: totally implanted devices (34 Groshong, 7 Broviac, 2 Hickman, 3 Port) and percutaneous catheters (28 Arrow). The choice of the infusional devices has been influenced by the length of the treatment, the primitive disease, the age and the size of the patient. The authors used totally implanted devices in paediatric patients undergoing chemotherapeutic and nutritional therapies. External central venous access devices were used in patients undergoing central catheterization lasting less than two months. The subclavian vein has been used as venous access in patients weighing > 5 kg, the internal jugular vein in < 5, kg patients. This work reports the early (PNX, hematomas, arterial access) and the long term complications (infections, accidental unthreading, occlusions and dislocations). We can say that the medium and long last term CVC is well tolerated and accepted in paediatric patients too, for antineoplastic, nutritional and infusion therapies. PMID:8984428

  5. The first reported case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens.

    PubMed

    Takemura, Hiromu; Ohno, Hideaki; Miura, Ikuo; Takagi, Taeko; Ohyanagi, Tadatomo; Kunishima, Hiroyuki; Okawara, Akiko; Miyazaki, Yoshitsugu; Nakashima, Hideki

    2015-05-01

    We describe a case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens, a non-neoformans and non-gattii Cryptococcus, in a non-HIV patient. A 71-year-old man with diffuse large B-cell lymphoma receiving antineoplastic chemotherapy was febrile approximately 30 weeks after central venous port insertion, and C. liquefaciens was isolated from all three performed blood cultures as well as a central venous catheter tip culture. In vitro antifungal susceptibility tests showed that this yeast isolate was susceptible to low concentrations of amphotericin B, fluconazole, itraconazole and voriconazole yet was resistant to 5-fluorocytosine (MIC: >64 μg/ml), unlike Cryptococcus neoformans. Treatment of the patient with oral and intravenous voriconazole was effective and consistent with the susceptibility tests. Although non-neoformans and non-gattii Cryptococcus spp. are considered non-pathogenic environmental yeast, they may rarely be the causative agents of serious infections in humans, as in the present case. PMID:25499194

  6. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: A summary and review of peripherally inserted central catheter and venous catheter appropriate use.

    PubMed

    Woller, Scott C; Stevens, Scott M; Evans, R Scott

    2016-04-01

    Peripherally inserted central catheters (PICCs) are being selected for venous access more frequently today than ever before. Often the choice of a PICC, when compared with other vascular access devices (VADs), is attractive because of perceived safety, availability, and ease of insertion. However, complications associated with PICCs exist, and there is a paucity of evidence to guide clinician choice for PICC selection and valid use. An international panel with expertise in the arena of venous access and populations associated with these devices was convened to clarify approaches for the optimal use of PICCs and VADs. Here we present for the busy hospital-based practitioner the methodology, key outcomes, and recommendations of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) panelists for the appropriate use of VADs. Journal of Hospital Medicine 2016;11:306-310. © 2015 Society of Hospital Medicine. PMID:26662622

  7. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service

    PubMed Central

    Barretta, Lidiane Miotto; Beccaria, Lúcia Marinilza; Cesarino, Cláudia Bernardi; Pinto, Maria Helena

    2016-01-01

    Abstract Objective: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications. PMID:27276021

  8. A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric Italian experience.

    PubMed

    Martella, Francesca; Salutari, Vanda; Marchetti, Claudia; Pisano, Carmela; Di Napoli, Marilena; Pietta, Francesca; Centineo, Dina; Caringella, Anna M; Musella, Angela; Fioretto, Luisa

    2015-10-01

    The European Medicines Agency strongly recommends administration of trabectedin through a central venous catheter (CVC) to minimize the risk of extravasation. However, CVCs place patients at risk of catheter-related complications and have a significant budgetary impact for oncology departments. The most frequently used CVCs are subcutaneously implanted PORT-chamber catheters (PORTs); peripherally inserted central venous catheters (PICCs) are relatively new. We reviewed data of trabectedin-treated patients to evaluate the relative cost-effectiveness of the use of PORTs and PICCs in six Italian centres. Data on 102 trabectedin-treated patients (20 with sarcoma, 80 with ovarian cancer and two with cervical cancer) were evaluated. Forty-five patients received trabectedin by a PICC, inserted by trained nurses using an ultrasound-guided technique at the bedside, whereas 57 patients received trabectedin infusion by a PORT, requiring a day surgery procedure in the hospital by a surgeon. Device dislocation and infections were reported in four patients, equally distributed between PORT or PICC users. Thrombosis occurred in a single patient with a PORT. Complications requiring devices removal were not reported during any of the 509 cycles of therapy (median 5; range 1-20). PICC misplacement or early malfunctions were not reported during trabectedin infusion. The cost-efficiency ratio favours PORT over PICC only when the device is used for more than 1 year. Our data suggest that trabectedin infusion by PICC is safe and well accepted, with a preferable cost-efficiency ratio compared with PORT in patients requiring short-term use of the device (≤1 year). PMID:26241804

  9. Use of a Peripherally Inserted Central Catheter as a Conduit for Central Venous Access Across Thrombosed Great Veins

    SciTech Connect

    Guntur Ramkumar, Prasad Chakraverty, Sam Zealley, Ian

    2010-02-15

    This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

  10. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    PubMed

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks. PMID:25501778

  11. Peripherally inserted central catheter - insertion

    MedlinePlus

    ... central catheters and nontunneled central venous catheters. In: Mauro MA, Murphy KPJ, Thomson KR, et al., eds. ... Procedures . 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:chap 4. Mansour JC, Neiderhuber JE. Establishing and ...

  12. Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection.

    PubMed

    Kappers-Klunne, M C; Degener, J E; Stijnen, T; Abels, J

    1989-10-15

    Forty-three evaluable patients with hematologic malignancies, mainly acute leukemia, were prospectively randomized to receive a double lumen central venous catheter or a totally implantable venous access system. The mean catheter stay was 166 days (median, 104 days) for the 23 double lumen catheters and 164 days (median, 65 days) for implanted systems. Exit site infections were not encountered in double lumen catheters, but there were two proven infections around the injection port of implanted devices. Tunnel infections did not occur. Seven double lumen catheters and four implanted systems were removed because of infection. Staphylococcus epidermidis was the predominant microorganism cultured from these catheters. Five of nine patients with double lumen catheters and catheter-related S. epidermidis infection and the two patients with implanted systems in whom S. epidermidis was cultured were on selective gut decontamination. The pattern of infection did not seem to be influenced by this regimen. Totally implantable systems proved to be as safe as double lumen central venous lines. PMID:2790689

  13. Evaluation of a percutaneously placed 27-gauge central venous catheter in neonates weighing less than 1200 grams.

    PubMed

    Nakamura, K T; Sato, Y; Erenberg, A

    1990-01-01

    A percutaneous 27-gauge OD central venous catheter was inserted at 4 +/- 3 (SD) days of age and left in place for up to 2 weeks in 20 neonates with birth weights less than 1200 g and greater than 24 h of age. Parenteral nutritional solutions and medications were administered through these catheters. Twenty neonates matched for birth weight and gestational age served as paired controls. In vitro studies demonstrate that the maximum infusion rate for parenteral nutrition solutions is about 20 ml/hr. Packed red blood cells could not be infused through these catheters. In vivo results demonstrate a significant (p less than 0.05) reduction in number of peripheral iv catheters inserted during study (2 +/- 1 vs 7 +/- 4, SD) with no difference in cost per day of iv access ($79.42 +/- 113.51 vs $43.91 +/- 15.99, SD). Two-dimensional ultrasound assessment of catheter thrombosis was unsuccessful. Moreover, there was no correlation between angiographic and electron microscopic evaluation of catheter tip thrombosis. Electron microscopy of catheter tips revealed 33% with complete, partial and no occlusion, respectively, and 39% with sheath thrombosis. In summary, percutaneous insertion of a 27-gauge OD Vialon central venous catheter is a feasible alternative in providing venous access in very low birth weight infants. PMID:2112646

  14. Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy—Case report

    PubMed Central

    Siordia, Juan A.; Ayers, Georganne R.; Garlish, Amanda; Subramanian, Sreekumar

    2015-01-01

    Introduction Iatrogenic damage of the innominate vein is a possible complication with extracorporeal central venous line catheter insertion techniques. When perforation occurs, the catheter is left in place and surgery is required for careful removal and repair of other possible complications, including hemothorax and cardiac tamponade. The traditional approach for innominate vein repair is via a complete median sternotomy. Presentation of case A 75-year-old female patient with hypertension, diabetes mellitus type two and end stage renal failure, coronary artery disease presenting with iatrogenic innominate vein perforation and pulmonary effusion status post placement of a tunneled hemodialysis catheter through the left subclavian vein. Discussion The patient underwent a partial upper sternotomy into the right fourth intercostal space. Ministernotomy and endovascular techniques provide similar outcomes to those of traditional surgical approaches. However, with minimal access and trauma, these new methods provide better post-operative outcomes for patients. Conclusion The case presented in this report suggests a new approach to replace the traditional complete median sternotomy in attempts to repair the innominate vein. The mini-sternotomy approach provides sufficient visualization of the vessel and surrounding structures with minimal post-operative complications and healing time. PMID:25956040

  15. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

    PubMed

    Zingg, Walter; Cartier, Vanessa; Inan, Cigdem; Touveneau, Sylvie; Theriault, Michel; Gayet-Ageron, Angèle; Clergue, François; Pittet, Didier; Walder, Bernhard

    2014-01-01

    Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI. PMID:24714418

  16. Do Clinicians Know Which of Their Patients Have Central Venous Catheters? A Multicenter Observational Study

    PubMed Central

    Chopra, Vineet; Govindan, Sushant; Kuhn, Latoya; Ratz, David; Sweis, Randy F.; Melin, Natalie; Thompson, Rachel; Tolan, Aaron; Barron, James; Saint, Sanjay

    2016-01-01

    Background Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown. Objective To assess how often clinicians were aware of the presence of triple-lumen or peripherally inserted central catheters (PICCs) in hospitalized patients. Design Multicenter, cross-sectional study. Setting Three academic medical centers in the United States. Patients Hospitalized medical patients in intensive care unit (ICU) and non-ICU settings. Measurements To ascertain awareness of CVCs, we first determined whether a PICC or triple-lumen catheter was present; clinicians were then queried about device presence. Differences in device awareness among clinicians were assessed by chi-square tests. Results 990 patients were evaluated, and 1881 clinician assessments were done. The overall prevalence of CVCs was 21.1% (n = 209), of which 60.3% (126 of 209) were PICCs. A total of 21.2% (90 of 425) of clinicians interviewed were unaware of the presence of a CVC. Unawareness was greatest among patients with PICCs, where 25.1% (60 of 239) of clinicians were unaware of PICC presence. Teaching attendings and hospitalists were more frequently unaware of the presence of CVCs than interns and residents (25.8% and 30.5%, respectively, vs. 16.4%). Critical care physicians were more likely to be aware of CVC presence than general medicine physicians (12.6% vs. 26.2%; P = 0.003). Limitations Awareness was determined at 1 point in time and not linked to outcomes. Patient length of stay and indication for CVC were not recorded. Conclusion Clinicians are frequently unaware of the presence of PICCs and triple-lumen catheters in hospitalized patients. Further study of mechanisms that ensure that clinicians are aware of these devices so that they may assess their necessity seems warranted. Primary Funding Source None. PMID

  17. Computed Tomography-Guided Central Venous Catheter Placement in a Patient with Superior Vena Cava and Inferior Vena Cava Occlusion

    SciTech Connect

    Rivero, Maria A.; Shaw, Dennis W.W.; Schaller, Robert T. Jr.

    1999-01-15

    An 18-year-old man with a gastrointestinal hypomotility syndrome required lifelong parenteral nutrition. Both the superior and inferior vena cava were occluded. Computed tomography guidance was used to place a long-term central venous catheter via a large tributary to the azygos vein.

  18. Thrombotic complications in children from short-term percutaneous central venous catheters: what can we do?

    PubMed

    Latham, Gregory J; Thompson, Douglas R

    2014-09-01

    The reported incidence of venous thromboembolism (VTE) in children has increased dramatically over the past decade, and the primary risk factor for VTE in neonates and infants is the presence of a central venous catheter (CVC). Although the associated morbidity and mortality are significant, very few trials have been conducted in children to guide clinicians in the prophylaxis, diagnosis, and treatment of CVC-related VTE. Furthermore, pediatric guidelines for prophylaxis and management of VTE are largely extrapolated from adult data. How then should the anesthesiologist approach central access in children of different ages to lessen the risk of CVC-related VTE or in children with prior thrombosis and vessel occlusion? A comprehensive review of the pediatric and adult literature is presented with the goal of assisting anesthesiologists with point-of-care decision-making regarding the risk factors, diagnosis, and treatment of CVC-related VTE. Illustrative cases are also provided to highlight decision-making in varying situations. The only risk factor strongly associated with CVC-related VTE formation in children is the duration of the indwelling CVC. Several other factors show a trend toward altering the incidence of CVC-related VTE formation and may be under the control of the anesthesiologist placing and managing the catheter. In particular, because children with VTE may live decades with its sequelae and chronic vein thrombosis, careful consideration of lessening the risk of VTE is warranted in every child. Further studies are needed to form a clearer understanding of the risk factors, prophylaxis, and management of CVC-related VTE in children and to guide the anesthesiologist in lessening the risk of VTE. PMID:24814351

  19. [Two Cases of Retained Guide Wires after Placement of a Central Venous Catheter via the Internal Jugular Vein].

    PubMed

    Kobayashi, Yuki; Masumori, Yasushi; Tanigawa, Saori; Miyakawa, Hidetoshi; Sakamoto, Miki; Tateda, Takeshi

    2015-10-01

    We report two cases of a retained guide wire after perioperative placement of a central venous catheter during a six-month period. Case 1: A 73-year-old male was scheduled for an open cholecystectomy and hepatectomy. After induction of anesthesia, a central venous (CV) catheter was inserted via the right internal jugular vein using an ultrasound guide. Chest radiographs showed a retained guide wire in the inferior vena cava immediately after surgery, which was removed by interventional radiologist before the patient emerged from anesthesia. Case 2: A 77-year-old male was scheduled for colostomy closure. The surgeon inserted a CV catheter in the right internal jugular vein 4 days before the colostomy. Chest radiographs revealed a retained guide wire in the inferior vena cava, which was removed by interventional radiologists before the patient emerged from anesthesia. Although a retained guide wire is a rare complication, awareness of this mishap is necessary to prevent it from happening. PMID:26742416

  20. Association between Peripherally Inserted Central Venous Catheter Insertion Site and Complication Rates in Preterm Infants.

    PubMed

    Bashir, Rani A; Swarnam, Kamala; Vayalthrikkovil, Sakeer; Yee, Wendy; Soraisham, Amuchou S

    2016-08-01

    Objective To examine whether there is an association between peripherally inserted central venous catheter (PICC) insertion site and complication rates among preterm infants. Design We performed a retrospective analysis of the first PICCs placed in preterm infants in a tertiary neonatal intensive care unit between January 2006 and December 2010. The PICC-related complications resulting in catheter removal were compared based on site of insertion. Results Of the 827 PICCs, 593 (72%) were inserted in upper extremity. Lower extremity PICC group infants had higher illness severity (SNAP-II) score and more likely to be inserted later as compared with the upper extremity group. There was no significant difference in the total PICC-related complications between upper and lower extremity PICCs (31.3 vs. 26%; p > 0.05). Logistic regression analysis after adjusting for gestational age, day of line insertion, and SNAP-II score revealed that upper extremity PICCs were associated with increased risk of line infiltration (adjusted odds ratio [aOR], 2.41; 95% confidence interval [CI], 1.36-4.29) but not the total PICC complication (aOR, 1.29; 95% CI, 0.91-1.83). Conclusion There is no difference in total PICC-related complication between upper and lower extremity PICCs; however, the PICC-related mechanical complications vary depending on the site of insertion in preterm infants. PMID:27057766

  1. Characterizing the in vitro biofilm phenotype of Staphylococcus epidermidis isolates from central venous catheters.

    PubMed

    Van Kerckhoven, Marian; Hotterbeekx, An; Lanckacker, Ellen; Moons, Pieter; Lammens, Christine; Kerstens, Monique; Ieven, Margareta; Delputte, Peter; Jorens, Philippe G; Malhotra-Kumar, Surbhi; Goossens, Herman; Maes, Louis; Cos, Paul

    2016-08-01

    Central venous catheter (CVC)-related infections are commonly caused by Staphylococcus epidermidis that is able to form a biofilm on the catheter surface. Many studies involving biofilm formation by Staphylococcus have been published each adopting an own in vitro model. Since the capacity to form a biofilm depends on multiple environmental factors, direct comparison of results obtained in different studies remains challenging. This study characterized the phenotype (strong versus weak biofilm-producers) of S. epidermidis from CVCs in four different in vitro biofilm models, covering differences in material type (glass versus polymer) and nutrient presentation (static versus continuous flow). A good correlation in phenotype was obtained between glass and polymeric surfaces independent of nutrient flow, with 85% correspondence under static growth conditions and 80% under dynamic conditions. A 80% correspondence between static and dynamic conditions on polymeric surfaces could be demonstrated as well. Incubation time had a significant influence on the biofilm phenotype with only 55% correspondence between the dynamic models at different incubation times (48h versus 17h). Screening for the presence of biofilm-related genes only revealed that ica A was correlated with biofilm formation under static but not under dynamic conditions. In conclusion, this study highlights that a high level of standardization is necessary to interpret and compare results of different in vitro biofilm models. PMID:27196636

  2. A corrosive oesophageal burn model in rats: Double-lumen central venous catheter usage

    PubMed Central

    Bakan, Vedat; Çıralık, Harun; Kartal, Seyfi

    2015-01-01

    Background: We aimed to create a new and less invasive experimental corrosive oesophageal burn model using a catheter without a gastric puncture (gastrotomy). Materials and Methods: We conducted the study with two groups composed of 8 male rats. The experimental oesophageal burn was established by the application of 10% sodium hydroxide to the distal oesophagus under a pressure of 20 cmH2O, via 5-F double-lumen central venous catheter without a gastrotomy. The control group was given 0.9% sodium chloride. All rats were killed 24 h after administration of NaOH or 0.9% NaCl. Histologic damage to oesophageal tissue was scored by a single pathologist blind to groups. Results: The rats in the control group were observed to have no pathological changes. Corrosive oesophagitis (tissue congestion, oedema, inflammation, ulcer and necrosis) was observed in rats exposed to NaOH. Conclusion: We believe that an experimental corrosive oesophageal burn can safely be created under same hydrostatic pressure without a gastric puncture using this model. PMID:26712289

  3. Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters.

    PubMed

    Linnemann, Birgit; Lindhoff-Last, Edelgard

    2012-09-01

    An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications. PMID:22915529

  4. Lessons from French National Guidelines on the treatment of venous thrombosis and central venous catheter thrombosis in cancer patients.

    PubMed

    Farge, Dominique; Durant, Cecile; Villiers, Stéphane; Long, Anne; Mahr, Alfred; Marty, Michel; Debourdeau, Philippe

    2010-04-01

    Increased prevalence of Venous thromboembolism (VTE), as defined by deep-vein thrombosis (DVT), central venous catheter (CVC) related thrombosis or pulmonary embolism (PE) in cancer patients has become a major therapeutic issue. Considering the epidemiology and each national recommendations on the treatment of VTE in cancer patients, we analysed guidelines implementation in clinical practice. Thrombosis is the second-leading cause of death in cancer patients and cancer is a major risk factor of VTE, due to activation of coagulation, use of long-term CVC, the thrombogenic effects of chemotherapy and anti-angiogenic drugs. Three pivotal trials (CANTHANOX, LITE and CLOT) and several meta-analysis led to recommend the long term (3 to 6 months) use of LMWH during for treating VTE in cancer patients with a high level of evidence. The Italian Association of Medical Oncology (AIOM), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), the French "Institut National du Cancer" (INCa), the European Society of Medical Oncology (ESMO) and the American College of Chest Physicians (ACCCP) have published specific guidelines for health care providers regarding the prevention and treatment of cancer-associated VTE. Critical appraisal of these guidelines, difficulties in implementation of prophylaxis regimen, tolerance and cost effectiveness of long term use of LMWH may account for large heterogenity in daily clinical practice. Homogenization of these guidelines in international consensus using an adapted independent methodological approach followed by educational and active implementation strategies at each national level would be very valuable to improve the care of VTE in cancer patients. PMID:20433988

  5. Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery.

    PubMed

    Wong, Kevin; Marks, Barry A; Qureshi, Anwer; Stemm, Joseph J

    2016-07-01

    Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein. In such cases, surgical removal of the central venous catheter from perforation sites in the heart and vessel walls poses anesthetic challenges because of the high risk of pneumothorax, hemorrhage, arrhythmias, thrombosis, and death. PMID:27224040

  6. Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Central venous catheters play an important role in patient care. Real-time ultrasound-guided subclavian central venous (SCV) cannulation may reduce the incidence of complications and the time between skin penetration and the aspiration of venous blood into the syringe. Ultrasonic diagnosis of catheter misplacement and pneumothorax related to central venous catheterization is rapid and accurate. It is unclear, however, whether ultrasound real-time guidance and examination can reduce procedure times and complication rates when compared with landmark guidance and radiographic examination for SCV catheterization. Methods/Design The Subclavian Central Venous Catheters Guidance and Examination by UltraSound (SUBGEUS) study is an investigator-initiated single center, randomized, controlled two-arm trial. Three hundred patients undergoing SCV catheter placement will be randomized to ultrasound real-time guidance and examination or landmark guidance and radiographic examination. The primary outcome is the time between the beginning of the procedure and control of the catheter. Secondary outcomes include the times required for the six components of the total procedure, the occurrence of complications (pneumothorax, hemothorax, or misplacement), failure of the technique and occurrence of central venous catheter infections. Discussion The SUBGEUS trial is the first randomized controlled study to investigate whether ultrasound real-time guidance and examination for SCV catheter placement reduces all procedure times and the rate of complications. Trial registration ClinicalTrials.gov Identifier: NCT01888094 PMID:24885789

  7. Skin necrosis after a low-dose vasopressin infusion through a central venous catheter for treating septic shock.

    PubMed

    Kim, Eun Hee; Lee, Sae Hwan; Byun, Seung Woon; Kang, Ho Suk; Koo, Dong Hoe; Park, Hyun-Gu; Hong, Sang Bum

    2006-12-01

    This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter. PMID:17249516

  8. Central venous catheter malposition in the azygos vein and difficult endotracheal intubation in severe ankylosing spondylitis: a case report

    PubMed Central

    Moon, Eunjin; Jeong, Hyungmo; Chung, Junyoung; Yi, Jaewoo

    2015-01-01

    Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devices have been developed to address difficult intubation, in this case, fiberoptic bronchoscopy was the only applicable safe alternative because of the patient’s extremely severe chin on chest deformity and temporomandibular joint disease. We report a successful awake fiberoptic bronchoscopic intubation in a patient with extremely severe AS and recommend that the catheter placement should be confirmed with radiology to ensure proper positioning for severe AS patients. PMID:26885138

  9. Verification of correct central venous catheter placement in the emergency department: comparison between ultrasonography and chest radiography.

    PubMed

    Zanobetti, Maurizio; Coppa, Alessandro; Bulletti, Federico; Piazza, Serena; Nazerian, Peyman; Conti, Alberto; Innocenti, Francesca; Ponchietti, Stefano; Bigiarini, Sofia; Guzzo, Aurelia; Poggioni, Claudio; Taglia, Beatrice Del; Mariannini, Yuri; Pini, Riccardo

    2013-03-01

    In 210 consecutive patients undergoing emergency central venous catheterization, we studied whether an ultrasonography examination performed at the bedside by an emergency physician can be an alternative method to chest X-ray study to verify the correct central venous catheter placement, and to identify mechanical complications. A prospective, blinded, observational study was performed, from January 2009 to December 2011, in the emergency department of a university-affiliated teaching hospital. Ultrasonography interpretation was completed during image acquisition; ultrasound scan was performed in 5 ± 3 min, whereas the time interval between chest radiograph request and its final interpretation was 65 ± 74 min p < 0.0001. We found a high concordance between the two diagnostic modalities in the identification of catheter position (Kappa = 82 %, p < 0.0001), and their ability to identify a possible wrong position showed a high correlation (Pearson's r = 0.76 %, p < 0.0001) with a sensitivity of 94 %, a specificity of 89 % for ultrasonography. Regarding the mechanical complications, three iatrogenic pneumothoraces occurred, all were correctly identified by ultrasonography and confirmed by chest radiography (sensitivity 100 %). Our study showed a high correlation between these two modalities to identify possible malpositioning of a catheter resulting from cannulation of central veins, and its complications. The less time required to perform ultrasonography allows earlier use of the catheter for the administration of acute therapies that can be life-saving for the critically ill patients. PMID:23242559

  10. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type

    PubMed Central

    2013-01-01

    Introduction The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. Methods Critically ill trauma patients needing a SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane SCVC or an aliphatic polyurethane SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics. Results A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age >30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter. Conclusion SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age >30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous. PMID:23718723

  11. Disconnection of chamber and catheter as a complication of central venous catheter type port-a-cath.

    PubMed

    Kostic, S; Kovcin, V; Granić, M; Jevdic, D; Stanisavljevic, N

    2011-12-01

    The use of a central vein catheter (CVC) type port-a-cath (VPS), apart from the comfort it provides to the patient undergoing chemotherapy, also carries certain complications. In this study, our patient was subjected to chemotherapy after a radical breast cancer operation and was given a CVC type VPS. After further care, a rare complication was verified--disconnection of the chamber and catheter, which one was visually identified in the right heart chamber. As the patient was vitally endangered, she was immediately hospitalized and the catheter was removed by catheterization of the right femoral vein, with scopic imaging. Early diagnosis and localization of the problem prevented more severe complications and mortality. PMID:20607455

  12. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience.

    PubMed

    Rus, Rina R; Premru, Vladimir; Novljan, Gregor; Grošelj-Grenc, Mojca; Ponikvar, Rafael

    2016-06-01

    Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications. PMID:27312920

  13. Mechanic and surface properties of central-venous port catheters after removal: A comparison of polyurethane and silicon rubber materials.

    PubMed

    Braun, Ulrike; Lorenz, Edelgard; Weimann, Christiane; Sturm, Heinz; Karimov, Ilham; Ettl, Johannes; Meier, Reinhard; Wohlgemuth, Walter A; Berger, Hermann; Wildgruber, Moritz

    2016-12-01

    Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture. PMID:27552159

  14. Handwashing practice and policy variability when caring for central venous catheters in paediatric intensive care.

    PubMed

    Morritt, Mary Lou; Harrod, Mary Ellen; Crisp, Jackie; Senner, Anne; Galway, Robyn; Petty, Sheila; Maurice, Lucy; Harvey, Alice; Hardy, Jan; Donnellan, Robyn

    2006-02-01

    It has been estimated that there may be as many as 150,000 healthcare associated infections (HCAI) in Australia each year, contributing to 7,000 deaths, many of which could be prevented through the implementation of appropriate infection control practices. Contact with contaminated hands is a primary source of HCAI. Intensive care staff have been identified as one of the least adherent groups of health care professionals with handwashing; they are less likely to practise hand antisepsis before invasive procedures than staff working in other patient care specialties. The study examined the self-reported clean and aseptic handwashing practices of nurses working in paediatric intensive care units (PICUs) across Australia and New Zealand, the patterns in variation between nurses' reported handwashing practices and the local policies, and patterns in the duration of procedural handwashing for specific procedures. A survey was undertaken in 2001 in which participating tertiary paediatric hospitals provided copies of their infection control policies pertaining to central venous catheter (CVC) management; five nurses on each unit were asked to provide information in relation to their handwashing practices. Seven hospitals agreed to participate and 30 nurses completed the survey. The study found an enormous level of variation among and between nurses' reported practices and local policies. This variation extended across all aspects of handwashing practices - duration and extent of handwash, type of solution and drying method used. The rigour of handwashing varied according to the procedure undertaken, with some evidence that nurses made their own risk assessments based on the proximity of the procedure to the patient. In conclusion, this study's findings substantiate the need for standardisation of practice in line with the current Centers for Disease Control and Prevention Guidelines, including the introduction of alcohol handrub. PMID:16544674

  15. Catheter Related Bloodstream Infection (CR-BSI) in ICU Patients: Making the Decision to Remove or Not to Remove the Central Venous Catheter

    PubMed Central

    Deliberato, Rodrigo Octávio; Marra, Alexandre R.; Corrêa, Thiago Domingos; Martino, Marinês Dalla Vale; Correa, Luci; dos Santos, Oscar Fernando Pavão; Edmond, Michael B.

    2012-01-01

    Background Approximately 150 million central venous catheters (CVC) are used each year in the United States. Catheter-related bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs). Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. Methods We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU) from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU) culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1) differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2) simultaneous quantitative blood culture with 5∶1 ratio (CVC versus peripheral). Results 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method) were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208) in ICU patients. Conclusion In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality. PMID:22403696

  16. Two cases of central venous catheter-related thrombosis in living liver donors: how can the risk be minimized?

    PubMed

    Hata, Taigo; Fujimoto, Yasuhiro; Suzuki, Kojiro; Kim, Byeoknyeon; Ishigami, Masatoshi; Ogawa, Hayato; Arikawa, Takashi; Nagai, Shunji; Kamei, Hideya; Nakamura, Taro; Edamoto, Yoshihiro; Kiuchi, Tetsuya

    2009-01-01

    A central venous catheter (CVC) is commonly used for intraoperative management by anesthetists and surgeons during major operations, including donor operations for living donor liver transplantation (LDLT), in which donor safety is of utmost importance. Reasons for use of CVC for donors include measurement of central venous pressure and drug infusion when necessary. A potentially serious complication of a major operation is pulmonary thromboembolism. We report two cases of LDLT donors complicated by catheter related thrombosis (CRT) of the jugular vein, who were eventually discharged without long-term complications. To the best of our knowledge, there has been no report of CRT among LDLT donor population. In this report, in order to minimize the risks related to CRT in LDLT donors, we propose thorough screening for thrombophilic disorders, use of a silicone or polyurethane double-lumen CVC as thin as possible, placement of the tip of the CVC at the superior vena cava via the right jugular vein using ultrasonography as a guide for puncture, and removal of the catheter at the end of the operation based on our experience of CRT among LDLT donors. PMID:19191817

  17. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    PubMed

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting. PMID:26138518

  18. Fluid mechanics and clinical success of central venous catheters for dialysis--answers to simple but persisting problems.

    PubMed

    Ash, Stephen R

    2007-01-01

    Over 60% of patients initiating chronic hemodialysis in the United States have a chronic central venous catheter (CVC) as their first blood access device. Although it would be better if these patients started dialysis with fistulas, the CVC is used because it is a reliable and relatively safe method for obtaining blood access over a period of months. Drawing blood from a vein at 300-400 ml/minute is a relatively delicate and somewhat unpredictable process, and there is always a tendency for the vein wall to draw over the arterial tip and obstruct flow. Several methods have been employed to minimize this problem and maximize blood flow, and differing catheter designs have resulted. With all of the different catheter designs now on the market, it is natural to ask what is the logic of different designs. Moreover, in the absence of many direct comparative studies it is natural to ask whether one design is really better than another. There is some misinformation regarding catheter design and function. The following is a list of 10 frequently asked questions In this review, the hydraulic features of CVC are discussed and explained, and logical answers are provided for the following questions: 1. Why do ''D'' catheters flow better than concentric or side by side catheters? 2. Why are all catheters about the same diameter? Does making them bigger really decrease the resistance to flow? 3. Why might a split tip catheter flow better than a solid body catheter? 4. What happens to injections of lock solution at catheter volume? 5. What's better-numerous side holes or none? 6. Why does blood rise into some internal jugular catheters over time, displacing the lock solution? 7. How can a little kink (or stenosis) decrease flow so much? 8. Where should the tips be placed-superior vena cava or right atrium? 9. Which is really better, splitsheath or over-the-wire placement? 10. Which dialysis access has a lower complication rate--CVC or arteriovenous (AV) graft? There remain

  19. Heparin for clearance of peripherally inserted central venous catheter in newborns: an in vitro study

    PubMed Central

    Balaminut, Talita; Venturini, Danielle; da Silva, Valéria Costa Evangelista; Rossetto, Edilaine Giovanini; Zani, Adriana Valongo

    2015-01-01

    Objective: To compare the efficacy of two concentrations of heparin to clear the lumen of in vitro clotted neonatal peripherally inserted central catheters (PICCs). Methods: This is an in vitro, experimental quantitative study of 76 neonatal 2.0-Fr PICCs coagulated in vitro. The catheters were divided into two groups of 38 PICCs each. In both groups an infusion of low molecular weight heparin was administered with a dose of 25IU/mL for Group 1 and 50IU/mL for Group 2. The negative pressure technique was applied to the catheters of both groups at 5, 15 and 30min and at 4h to test their permeability. Kaplan-Meier survival analysis was used to verify the outcome of the groups according to time intervals. Results: The comparison between both groups in the first 5min showed that more catheters from Group 2 were cleared compared to Group 1 (57.9 vs. 21.1%, respectively). Kaplan-Meier survival analysis showed that less time was needed to clear catheters treated with 50IU/mL of heparin (p<0.001). Conclusions: The use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot, and the use of this concentration is within the safety margin indicated by scientific literature. PMID:26116325

  20. CENTRAL VENOUS CATHETER-RELATED THROMBOSIS AND THROMBOPROPHYLAXIS IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

    PubMed Central

    Vidal, E.; Sharathkumar, A.; Glover, J.; Faustino, E. V. S.

    2014-01-01

    SUMMARY OBJECTIVES In preparation for a pediatric randomized controlled trial on thromboprophylaxis, we determined the frequency of catheter-related thrombosis in children. We also systematically reviewed the pediatric trials on thromboprophylaxis to evaluate its efficacy and to identify possible pitfalls in the conduct of these trials. PATIENTS/METHODS We searched MEDLINE, EMBASE, Web of Science and Cochrane Central Register for Controlled Trials for articles published until December 2013. We included cohort studies and trials on patients 0–18 years old with central venous catheter actively surveilled for thrombosis with radiologic imaging. We estimated the pooled frequency of thrombosis and the pooled risk ratio (RR) with thromboprophylaxis using random effects model. RESULTS Of 2,651 articles identified, we analyzed 37 articles with 3,128 patients. The pooled frequency of thrombosis was 0.20 (95% confidence interval [CI]: 0.16–0.24). Of 10 trials, we did not find evidence that heparin-bonded catheter (RR: 0.34; 95% CI: 0.01–7.68), unfractionated heparin (RR: 0.93; 95% CI: 0.57–1.51), low molecular weight heparin (RR: 1.13; 95% CI: 0.51–2.50), warfarin (RR: 0.85; 95% CI: 0.34–2.17), antithrombin concentrate (RR: 0.76; 95% CI: 0.38–1.55) and nitroglycerin (RR: 1.53; 95% CI: 0.57–4.10) reduced the risk for thrombosis. Most of the trials were either not powered for thrombosis or powered to detect large, likely unachievable, reductions in thrombosis. Missing data on thrombosis also limited these trials. CONCLUSIONS Catheter-related thrombosis is common in children. An adequately powered multicenter trial that can detect a modest, clinically significant, reduction in thrombosis is critically needed. Missing outcome data should be minimized in this trial. PMID:24801495

  1. Evaluation of alternatives for dysfunctional double lumen central venous catheters using a two-compartmental mathematical model for different solutes.

    PubMed

    Van Canneyt, Koen; Van Biesen, Wim; Vanholder, Raymond; Segers, Patrick; Verdonck, Pascal; Eloot, Sunny

    2013-01-01

    Double lumen (DL) central venous catheters (CVC) often suffer from thrombosis, fibrin sheet formation, and/or suction towards the vessel wall, resulting in insufficient blood flow during hemodialysis. Reversing the catheter connection often restores blood flows, but will lead to higher recirculation. Single lumen (SL) CVCs have often fewer flow problems, but they inherently have some degree of recirculation. To assist bedside clinical decision making on optimal catheter application, we investigated mathematically the differences in dialysis adequacy using different modes of access with CVCs.
A mathematical model was developed to calculate reduction ratio (RR) and total solute removal (TSR) of urea, methylguanidine (MG), beta-2-microglobulin (β2M), and phosphate (P) during different dialysis scenarios: 4-h dialysis with a well-functioning DL CVC (DL-normal, blood flow QB 350 ml/min), dysfunctional DL CVC (DL-low flow, QB 250), reversed DL CVC (DL-reversed, QB 350, recirculation 
R = 10%) and 12 Fr SL CVC (effective QB 273). 
With DL-normal as reference, urea RR was decreased by 3.5% (DL-reversed), 13.0% (SL), and 15.6% (DL-low flow), while urea TSR was decreased by 3.3% (DL-reversed), 13.2% (SL), and 13.5% (DL-low flow). The same trend was found for MG and P. However, β2M RR decreased only 1.5% with SL CVC although TSR decrease was 17.2%, while RR decreased 21.1% with DL-low flow although TSR decrease was only 4.9%.
In the case of dysfunctional DL CVCs, reversing the catheter connection and restoring the blood flow did not impair TSR, with 10% recirculation. The SL CVC showed suboptimal TSR results that were similar to those of the dysfunctional DL CVC. PMID:23280082

  2. Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients.

    PubMed

    Abdelkefi, A; Ben Romdhane, N; Kriaa, A; Chelli, M; Torjman, L; Ladeb, S; Ben Othman, T; Lakhal, A; Guermazi, S; Ben Hassen, A; Ladeb, F; Ben Abdeladhim, A

    2005-11-01

    In this prospective study, we assessed the incidence of central venous catheter (CVC)-related thrombosis in haematopoietic stem cell transplant (HSCT) recipients. We determined the contribution of inherited prothrombotic abnormalities in blood coagulation to CVC-related thrombosis in these patients. The study was conducted between May 2002 and September 2004. CVCs were externalized, nontunneled, polyurethane double lumen catheters. Before catheter insertion, laboratory prothrombotic markers included factor V Leiden, the prothrombin gene Gly20210A mutation, plasma antithrombin levels, and protein C and S activity. All patients were systematically examined by ultrasonography just before, or <24 h after, catheter removal, and in case of clinical signs of thrombosis. A total of 171 patients were included during the 28-month study period. Five (2.9%) and three (1.7%) patients had evidence of protein C and protein S deficiency, respectively. Only one patient had an antithrombin deficiency (0.6%). In total, 10 patients (5.8%) were heterozygous for the factor V Leiden mutation, and one patient had heterozygous prothrombin G20210A mutation (0.6%). We observed a CVC-related thrombosis in 13 patients (7.6%). Thrombosis was diagnosed in four out of 20 patients (20%) with a inherited prothrombotic abnormality compared to nine of 151 patients (6%) who did not have a thrombophilic marker (relative risk 3.3 CI 95% 1.1-9.9). Our results suggest that inherited prothrombotic abnormalities contribute substantially to CVC-related thrombosis in HSCT recipients. In view of physicians' reluctance to prescribe prophylactic anticoagulant treatment in these patients, a priori determination of inherited prothrombotic abnormalities may form a basis to guide these treatment decisions. PMID:16151418

  3. Case of recurrent Flavimonas oryzihabitans bacteremia associated with an implanted central venous catheter (Port-A-Cath): assessment of clonality by arbitrarily primed PCR.

    PubMed Central

    Verhasselt, B; Claeys, G; Elaichouni, A; Verschraegen, G; Laureys, G; Vaneechoutte, M

    1995-01-01

    Flavimonas oryzihabitans bacteremias, which occurred immediately after the flushing or use of an implanted central venous catheter (Port-A-Cath) in two patients at the same pediatric ward, were studied by arbitrarily primed PCR. We conclude that the colonization of the Port-A-Cath with F. oryzihabitans described here lasted for several months. PMID:8576374

  4. Peripherally Inserted Central Venous Catheter Complications in Children Receiving Outpatient Parenteral Antibiotic Therapy (OPAT).

    PubMed

    Kovacich, Amanda; Tamma, Pranita D; Advani, Sonali; Popoola, Victor O; Colantuoni, Elizabeth; Gosey, Leslie; Milstone, Aaron M

    2016-04-01

    OBJECTIVE To identify the frequency of and risk factors associated with complications necessitating removal of the peripherally inserted central catheters (PICCs) in patients receiving outpatient parenteral antibiotic therapy (OPAT) and to determine the appropriateness of OPAT in children with OPAT-related complications. METHODS A retrospective cohort of children who had a PICC inserted at the Johns Hopkins Children's Center between January 1, 2003, and December 31, 2013, and were discharged from the hospital on OPAT was assembled. RESULTS A total of 1,465 PICCs were used to provide antibiotic therapy for 955 children after hospital discharge. Among these, 117 PICCs (8%) required removal due to a complication (4.6 of 1,000 catheter days). Children discharged to a long-term care facility were at increased risk of adverse PICC events (incidence risk ratio [IRR], 3.32; 95% confidence interval [CI], 1.79-6.17). For children receiving OPAT, age of the child (adjusted IRR [aIRR], 0.95; 95% CI, 0.92-0.98), noncentral PICC tip location (aIRR, 2.82; 95% CI, 1.66-4.82), and public insurance (aIRR, 1.63; 95% CI, 1.10-2.40) were associated with adverse PICC events. In addition, 34 patients (32%) with adverse events may not have required intravenous antibiotics at the time of hospital discharge. CONCLUSIONS Of children discharged with PICCs on OPAT during the study period, 8% developed a complication necessitating PICC removal. Children discharged to a long-term care facility had an increased rate of complication compared with children who were discharged home. With improved education regarding appropriate duration of antibiotic therapy and situations in which early conversion to enteral therapy should be considered, PICC-related complications may have been avoided in 32% of children. Infect. Control Hosp. Epidemiol. 2016;37(4):420-424. PMID:26961677

  5. Evaluation of cost-effectiveness from the funding body's point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique

    PubMed Central

    Noritomi, Danilo Teixeira; Zigaib, Rogério; Ranzani, Otavio T.; Teich, Vanessa

    2016-01-01

    Objective To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. Methods A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. Results When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Conclusion Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this

  6. Risk factors associated with catheter-related upper extremity deep vein thrombosis in patients with peripherally inserted central venous catheters: a prospective observational cohort study: part 2.

    PubMed

    Maneval, Rhonda E; Clemence, Bonnie J

    2014-01-01

    This is the second part of a 2-part series that reports on the results of a prospective observational cohort study designed to examine risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters (PICCs). Part 1, published in the May/June 2014 issue of the Journal of Infusion Nursing, provided an extensive review and critique of the literature regarding risk factors associated with catheter-related UEDVT and identified 28 suspected risk factors. A study was undertaken to examine each of the risk factors among 203 acute care patients with PICCs, 13 of whom experienced a UEDVT, yielding an incidence of 6.4%. The most common reason for admission was infection (33.5%), and the primary reason for insertion of the PICC was venous access (58.6%). Hypertension (P = .022) and obesity (P = .008), defined as a body mass index ≥30, were associated with UEDVT. The clinical symptoms of edema (P < .001) and a 3-cm or more increase in arm circumference (P < .001) in the PICC arm after PICC placement were associated with UEDVT. All other variables were not statistically significant. The results suggest that patients who are obese and hypertensive may be at greater risk for the development of UEDVT and that the physical finding of edema and increased arm circumference in the PICC arm are possibly suggestive of UEDVT. PMID:24983259

  7. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    PubMed

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.). PMID:27001822

  8. Alginate Dressing Application in Hemostasis After Using Seldinger Peripherally Inserted Central Venous Catheter in Tumor Patients.

    PubMed

    Yang, Qun; Lei, Sanlin

    2015-12-01

    The aim of this study is to observe hemostatic effects of alginate dressing after using seldinger PICC catheter in tumor patients. Sixty tumor patients with PICC receiving chemotherapy were divided into the test group (30 cases) and the control group (30 cases) randomly. The test group was treated with alginate dressing and oppressed by the puncture point, while the control group was treated with gauze of the same size. PICC transparent films were used in both groups. Finally, dressing ooze blood soaked states on the puncture points and dressing change times were observed in the two groups for 1 week. Moreover, local infection rate and incidence of catheter leak were also evaluated. The results showed that the oozing of blood and the changing frequency in the test group were obviously less than that in the control group, and there has a statistical difference (P < 0.05). Infection rate of puncture point and incidence of catheter leak were simultaneously reduced in the test group. Alginate dressing is effective in preventing seldinger PICC catheter-induced hemorrhage. PMID:26306067

  9. Management of catheter-associated upper extremity deep venous thrombosis.

    PubMed

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  10. The management of central venous catheters and infection control: is it time to change our approach?

    PubMed

    Langton, H

    2014-06-01

    Catheter related bloodstream infections (CR-BSIs) can lead to a number of serious conditions for the patient, including death. There is much recent evidence both in the UK and abroad which identifies the sources of CR-BSIs, yet they continue to occur. This article seeks to review some of the current evidence in relation to the prevention of CR-BSIs at insertion point. PMID:25007476

  11. Early and late complications related to central venous catheters in hematological malignancies: a retrospective analysis of 1102 patients.

    PubMed

    Morano, Salvatore Giacomo; Coppola, Lorenzo; Latagliata, Roberto; Berneschi, Paola; Chistolini, Antonio; Micozzi, Alessandra; Girmenia, Corrado; Breccia, Massimo; Brunetti, Gregorio; Massaro, Fulvio; Rosa, Giovanni; Guerrisi, Pietro; Mandelli, Franco; Foà, Roberto; Alimena, Giuliana

    2014-01-01

    Several severe complications may be associated with the use of central venous catheters (CVC). We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with hematological malignancies (142,202 total day number of implanted CVC). Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC). Thirty-nine episodes of early infective complications (<1 week from CVC implant) occurred (3.5% - 0.3/1000 days/CVC): furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC) were recorded. There were 29 episodes (2.6%) of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 - 395). The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature notwithstanding cytopenia often coexisting in hematological patients. PMID:24678388

  12. Early and Late Complications Related to Central Venous Catheters in Hematological Malignancies: a Retrospective Analysis of 1102 Patients

    PubMed Central

    Morano, Salvatore Giacomo; Coppola, Lorenzo; Latagliata, Roberto; Berneschi, Paola; Chistolini, Antonio; Micozzi, Alessandra; Girmenia, Corrado; Breccia, Massimo; Brunetti, Gregorio; Massaro, Fulvio; Rosa, Giovanni; Guerrisi, Pietro; Mandelli, Franco; Foà, Roberto; Alimena, Giuliana

    2014-01-01

    Several severe complications may be associated with the use of central venous catheters (CVC). We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with hematological malignancies (142,202 total day number of implanted CVC). Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC). Thirty-nine episodes of early infective complications (<1 week from CVC implant) occurred (3.5% - 0.3/1000 days/CVC): furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC) were recorded. There were 29 episodes (2.6%) of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 – 395). The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature notwithstanding cytopenia often coexisting in hematological patients. PMID:24678388

  13. Entrapment of J-Tip Guidewires by Venatech and Stainless-Steel Greenfield Vena Cava Filters During Central Venous Catheter Placement: Percutaneous Management in Four Patients

    SciTech Connect

    Andrews, Robert T.; Geschwind, Jean-Francois H.; Savader, Scott J.; Venbrux, Anthony C.

    1998-09-15

    We present four patients in whom bedside placement of a central venous catheter was complicated by entrapment of a J-tip guidewire by a previously placed vena cava (VC) filter. Two Venatech filters were fragmented and displaced into the superior VC or brachiocephalic vein during attempted withdrawal of the entrapped wire. Two stainless-steel Greenfield filters remained in place and intact. Fluoroscopically guided extraction of both wires entrapped by Greenfield filters was successfully performed in the angiography suite.

  14. Duration and Adverse Events of Non-cuffed Catheter in Patients With Hemodialysis

    ClinicalTrials.gov

    2014-10-09

    Renal Failure Chronic Requiring Hemodialysis; Central Venous Catheterization; Inadequate Hemodialysis Blood Flow; Venous Stenosis; Venous Thrombosis; Infection Due to Central Venous Catheter; Central Venous Catheter Thrombosis

  15. Bilateral sternoclavicular joint septic arthritis secondary to indwelling central venous catheter: a case report

    PubMed Central

    Pradhan, Charita; Watson, Nicholas FS; Jagasia, Nitin; Chari, Ray; Patterson, Jane E

    2008-01-01

    Introduction Septic arthritis of the sternoclavicular joint is rare, comprising approximately 0.5% to 1% of all joint infections. Predisposing causes include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. Case presentation We report a rare case of bilateral sternoclavicular joint septic arthritis in an elderly patient secondary to an indwelling right subclavian vein catheter. The insidious nature of the presentation is highlighted. We also review the literature regarding the epidemiology, investigation and methods of treatment of the condition. Conclusion SCJ infections are rare, and require a high degree of clinical suspicion. Vague symptoms of neck and shoulder pain may cloud the initial diagnosis, as was the case in our patient. Surgical intervention is often required; however, our patient avoided major intervention and settled with parenteral antibiotics and washout of the joint. PMID:18445257

  16. "Scrub the hub": cleaning duration and reduction in bacterial load on central venous catheters.

    PubMed

    Simmons, Sarah; Bryson, Celestina; Porter, Susan

    2011-01-01

    This article reports the results of a study on the effect of alcohol disinfection duration on bacterial load on catheter hubs. Three different levels of disinfection (3, 10, and 15 seconds) were analyzed as well as a positive and negative control. All hubs with the exception of the negative controls were contaminated with a 10 bacterial solution and allowed to dry for 24 hours. Through each hub, 1 mL of sterile saline was flushed; a 10-μL calibrated loop was used to plate the flush onto blood agar. Colony counts were performed on the plates after a 24-hour incubation period. Results revealed that the 3 different levels of disinfection duration were not found to differ significantly in reduction in bacterial load. The duration of disinfection did not significantly change the bacterial load on the hub. However, any disinfection duration significantly decreased the bacterial load as compared to the positive control. A larger study would likely detect a significant result among the disinfections. PMID:21160298

  17. Risk factors associated with catheter-related upper extremity deep vein thrombosis in patients with peripherally inserted central venous catheters: literature review: part 1.

    PubMed

    Clemence, Bonnie J; Maneval, Rhonda E

    2014-01-01

    This is part 1 of a 2-part series of articles that report on the results of a prospective observational cohort study designed to examine the risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters. This article provides an extensive review and critique of the literature that serves to explicate what is currently known about risk factors associated with catheter-related UEDVT. Risk factors such as anticoagulant use, cancer, infection, hypertension, catheter tip placement, and catheter size were identified most frequently in the literature as being associated with UEDVT development. Other risk factors--such as obesity, smoking history, surgery, and presence of pain or edema--were examined in a limited number of studies and lacked consistent evidence of their impact on UEDVT development. The subsequent study that evolved from the review of the literature investigates the relationship between identified risk factors and UEDVT development. PMID:24694512

  18. A comparative study of landmark-based topographic method versus the formula method for estimating depth of insertion of right subclavian central venous catheters

    PubMed Central

    Anandaswamy, Tejesh C; Marulasiddappa, Vinay

    2016-01-01

    Background and Aims: Subclavian central venous catheterisation (CVC) is employed in critically ill patients requiring long-term central venous access. There is no gold standard for estimating their depth of insertion. In this study, we compared the landmark topographic method with the formula technique for estimating depth of insertion of right subclavian CVCs. Methods: Two hundred and sixty patients admitted to Intensive Care Unit requiring subclavian CVC were randomly assigned to either topographic method or formula method (130 in each group). Catheter tip position in relation to the carina was measured on a post-procedure chest X-ray. The primary endpoint was the need for catheter repositioning. Mann–Whitney test and Chi-square test was performed for statistical analysis using SPSS for windows version 18.0 (Armonk, NY: IBM Corp). Results: Nearly, half the catheters positioned by both the methods were situated >1 cm below the carina and required repositioning. Conclusion: Both the techniques were not effective in estimating the approximate depth of insertion of right subclavian CVCs. PMID:27512166

  19. Discovering the barriers to spread the usage of peripherally inserted central venous catheters in the neonatal intensive care units: A qualitative research

    PubMed Central

    Zargham-Boroujeni, Ali; Mahdavi-Lenji, Zahra; Hasanpour, Marzieh; Sadeghnia, Alireza

    2013-01-01

    Background: By increasing the survival of immature newborns, intravenous access methods, used to provide intravenous therapy, became more important. More attention has been recently paid on peripherally inserted central venous catheters in newborns, although it is yet unknown in Iran. In this study, we tried to discover the barriers to spread the usage of peripherally inserted central venous catheters (PICC) in the neonatal intensive care units of hospitals affiliated to Isfahan University of Medical Sciences. Materials and Methods: In this descriptive explorative qualitative research, conducted from December 2011 to April 2012 with purposeful sampling and snowball method, participants were selected from nurses and residents of neonatology and neonatal specialists working in Alzahra, Shahid Beheshty, and Amin hospitals, until data saturation occurred. Data were analyzed with thematic analysis proposed by Broun and Clarke in 2006. Results: Data analysis yielded 175 initial codes, 12 sub-themes, and 3 main themes. The main themes included barriers related to procedure and maintenance, barriers related to persons providing care, and barriers related to management and planning. Conclusions: One of the major problems in premature newborns during hospitalization is long-term and safe intravascular access; therefore, more use of PICC is needed. A complete planning is also needed to eliminate barriers and to provide required catheters. Educating the personnel is also necessary. PMID:24403919

  20. Tunnelled Central Venous Catheter-Related Problems in the Early Phase of Haematopoietic Stem Cell Transplantation and Effects on Transplant Outcome

    PubMed Central

    Yeral, Mahmut; Boğa, Can; Oğuzkurt, Levent; Alışkan, Hikmet Eda; Özdoğu, Hakan; Demiroğlu, Yusuf Ziya

    2015-01-01

    Objective: Haematopoietic stem cell recipients need central venous catheters (CVCs) for easy administration of intravenous fluid, medications, apheresis, or dialysis procedures. However, CVCs may lead to infectious or non-infectious complications such as thrombosis. The effect of these complications on transplantation outcome is not clear. This manuscript presents the complication rates of double-lumen tunnelled CVCs and their effect on transplantation outcome. Materials and Methods: Data from 111 consecutive patients, of whom 75 received autologous and 36 received allogeneic peripheral blood stem cell transplantations, were collected retrospectively. The data were validated by the Record Inspection Group of the related JACIE-accredited transplantation centre. Results: Thrombosis developed in 2.7% of recipients (0.9 per 1000 catheter days). Catheter-related infection was identified in 14 (12.6%) patients (3.6 per 1000 catheter days). Coagulase-negative Staphylococcus was the most common causative agent. Engraftment time, rate of 100-day mortality, and development of grade II-IV graft-versus-host disease were not found to be associated with catheter-related complications. Conclusion: These results indicate that adverse events related with tunnelled CVCs are manageable and have no negative effects on transplant outcome. PMID:25805675

  1. Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects

    PubMed Central

    Chmielak, Zbigniew; Dębski, Artur; Kępka, Cezary; Rudziński, Piotr N.; Bujak, Sebastian; Skwarek, Mirosław; Kurowski, Andrzej; Dzielińska, Zofia; Demkow, Marcin

    2016-01-01

    Introduction Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization. Aim To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies. Material and methods Between January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1). Results Foreign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2–3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18–68) vs. 13.5 (11–37) vs. 8 min (8–13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath. Conclusions By using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices. PMID:27279874

  2. Central venous catheter - flushing

    MedlinePlus

    ... and maybe heparin syringes (yellow) Alcohol wipes Sterile gloves Sharps container (special container for used syringes and ... paper towel. Put on a pair of sterile gloves. Remove the cap on the saline syringe and ...

  3. Central vascular catheters and infections.

    PubMed

    Dioni, Elisabetta; Franceschini, Renata; Marzollo, Roberto; Oprandi, Daniela; Chirico, Gaetano

    2014-03-01

    Newborn infants in critical conditions require a permanent intra-venous line to allow for the administration of fluids, parenteral nutrition and drugs. The use of central venous catheters, however, is associated with an increased risk of infections, leading to prolongation of length of stay and higher hospitalization costs, particularly in extremely preterm infants. Dwell time is a significant factor for complications, with a predicted risk of catheter related infections of about 4 per 1000 catheter-days. To reduce the incidence of complications, several requirements must be met, including adequate staff and resources to provide education, training, and quality improvement programs, within a culture of communication and teamwork. Rigorous reporting schedule on line care and the implementation of unique bundle elements, the use of health care failure mode and effect analysis, the judicious use of antibiotics through an antimicrobial stewardship strategy, the application of specific antifungal prophylaxis are among the most effective interventions, while the addition of heparin to parenteral solution, or the use of antibiotic plus heparin lock therapy are under evaluation. Nursing assistance plays a fundamental role in managing central venous lines and in reducing or preventing the incidence of infection, by the application of several complex professional strategies. PMID:24709460

  4. Cerebral Air Embolism Following the Removal of a Central Venous Catheter in the Absence of Intracardiac Right-to-Left Shunting

    PubMed Central

    Eum, Da Hae; Lee, Seung Hwan; Kim, Hyung Won; Jung, Myung Jae; Lee, Jae Gil

    2015-01-01

    Abstract Air embolism following central venous catheter (CVC) removal is a relatively uncommon complication. Despite its rare occurrence, an air embolism can lead to serious outcomes. One of the most fatal complications is cerebral air embolism. We report a case of cerebral air embolism that occurred after the removal of a CVC in a patient with an underlying idiopathic pulmonary fibrosis, subcutaneous emphysema, pneumomediastinum, and a possible intrapulmonary shunt. Although the patient had a brief period of recovery, his condition deteriorated again, and retention of carbon dioxide was sustained due to aggravation of pneumonia. Despite full coverage of antibiotics and maximum care with the ventilator, the patient died about 5 weeks after the removal of the CVC. We suggest that strict compliance to protocols is required even while removing the catheter. Furthermore, additional caution to avoid air embolism is demanded in high-risk patients, such as in this case. PMID:25837752

  5. Malposition of Subclavian Venous Catheter Leading to Chest Complications

    PubMed Central

    Singh, Amarjit; Sidhu, Kuldeep Singh; Kaur, Avleen

    2016-01-01

    Although Central Venous Catheter (CVC) placement is a relatively simple procedure but its insertion and maintenance are associated with significant risks. Malposition (defined as any CVC tip position outside the superior vena cava) may be associated with catheter insertion and may require immediate intervention. It may result in complications like haemothorax, pleural effusions, pneumothorax, sepsis, thrombosis and cardiac tamponade. This case report presents timely detection of the complication after placement of CVC. Everyone should be aware of the complications and monitor consistently appropriate position of catheter tips.

  6. [Central venous lines in children: new trends].

    PubMed

    Desruennes, E

    2006-04-01

    Central venous catheterisation under two-dimensional ultrasound (US) guidance has been proved to be quicker and safer than the classical landmark method in both adults and children. In the literature US guidance with sterile dressing of the probe is the 'gold-standard'. Another way to use US is simple preoperative US location followed either by blind puncture, either by US guided puncture when difficulties are expected: small infants (<15 kg), small diameter or collapses of the vein, multiple unsuccessful attempts during blind technique. Ideal location of the tip of central venous catheters is no more controversial but can depend on age and weight. In 2002 a French agency (Afssaps) study showed that the risk of perforation and tamponade was especially high in small weight prematures with 27 gauge polyurethane catheters when tip was located in the cardiac cavities. In children and adults venous thrombosis and catheter malfunction are closely related to short catheters whose tip is above T3-T4. Excepted polyurethane catheters in small weight prematures, the best location of long-term central venous catheters tip is the superior vena cava-right auricle junction. At this time routine antithrombotic prophylaxis is not recommended for children with long-term central venous catheters. PMID:16414237

  7. A comparative study of two techniques (electrocardiogram- and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery

    PubMed Central

    Barnwal, Neeraj Kumar; Dave, Sona T; Dias, Raylene

    2016-01-01

    Background and Aims: The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG) or landmark as guides, for assessing correct depth of central venous catheter (CVC) placement. Methods: In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark). After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data. Results: In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001). Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056). Conclusion: Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group. PMID:27512162

  8. Two Serious Complications of Peripherally Inserted Central Catheters Indicating the Need to Formalize Training for Placing Central Venous Vascular Access Devices.

    PubMed

    Gerling, Volker; Feenstra, Nico

    2016-02-15

    Peripherally inserted central catheters are being used in increasing numbers. Common (thrombosis, infection, phlebitis, malfunction, or disconnection) and rare complications (pericardial tamponade) have been well explored. We describe 2 serious complications that resolved without sequelae. Both complications occurred in the context of limited provider competence. We conclude that vascular access is more than "just" placing a catheter; it can have serious clinical impact and has evolved into a specialist skill. With increasing use of intravascular catheters, the need for a formalized training becomes urgent. PMID:26517231

  9. [Phlebitogenicity of venous catheters of Vialon].

    PubMed

    Fassolt, A

    1985-12-01

    During three days 132 surgical patients with postoperative infusion treatment were checked on the frequency of venous reactions in the arms when catheters/cannulas of 4 different materials were used and the outcome compared. A significant result was obtained in connection with the I-cath catheter made of vialon (a polyurethanelike resin polymer) and the L-cath of polyurethane. Phlebitis was decreased to 27.3% resp. 24.2% - approximately half of its usual frequency - when I-cath of polyvinyl-chloride and FEP-teflon vasofix cannulas were applied (both 51.5%). The different predisposing factors of infusion phlebitis are under discussion. PMID:4093198

  10. CATheter Infections in CHildren (CATCH): a randomised controlled trial and economic evaluation comparing impregnated and standard central venous catheters in children.

    PubMed Central

    Harron, Katie; Mok, Quen; Dwan, Kerry; Ridyard, Colin H; Moitt, Tracy; Millar, Michael; Ramnarayan, Padmanabhan; Tibby, Shane M; Muller-Pebody, Berit; Hughes, Dyfrig A; Gamble, Carrol; Gilbert, Ruth E

    2016-01-01

    BACKGROUND Impregnated central venous catheters (CVCs) are recommended for adults to reduce bloodstream infection (BSI) but not for children. OBJECTIVE To determine the effectiveness of impregnated compared with standard CVCs for reducing BSI in children admitted for intensive care. DESIGN Multicentre randomised controlled trial, cost-effectiveness analysis from a NHS perspective and a generalisability analysis and cost impact analysis. SETTING 14 English paediatric intensive care units (PICUs) in England. PARTICIPANTS Children aged < 16 years admitted to a PICU and expected to require a CVC for ≥ 3 days. INTERVENTIONS Heparin-bonded, antibiotic-impregnated (rifampicin and minocycline) or standard polyurethane CVCs, allocated randomly (1 : 1 : 1). The intervention was blinded to all but inserting clinicians. MAIN OUTCOME MEASURE Time to first BSI sampled between 48 hours after randomisation and 48 hours after CVC removal. The following data were used in the trial: trial case report forms; hospital administrative data for 6 months pre and post randomisation; and national-linked PICU audit and laboratory data. RESULTS In total, 1859 children were randomised, of whom 501 were randomised prospectively and 1358 were randomised as an emergency; of these, 984 subsequently provided deferred consent for follow-up. Clinical effectiveness - BSIs occurred in 3.59% (18/502) of children randomised to standard CVCs, 1.44% (7/486) of children randomised to antibiotic CVCs and 3.42% (17/497) of children randomised to heparin CVCs. Primary analyses comparing impregnated (antibiotic and heparin CVCs) with standard CVCs showed no effect of impregnated CVCs [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.37 to 1.34]. Secondary analyses showed that antibiotic CVCs were superior to standard CVCs (HR 0.43, 95% CI 0.20 to 0.96) but heparin CVCs were not (HR 1.04, 95% CI 0.53 to 2.03). Time to thrombosis, mortality by 30 days and minocycline/rifampicin resistance did

  11. A right atrial mass, patent foramen ovale, and indwelling central venous catheter in a patient with a malignancy: a diagnostic and therapeutic dilemma.

    PubMed

    Funt, Samuel; Lerakis, Stamatios; McLean, Dalton S; Willis, Patrick; Book, Wendy; Martin, Randolph P

    2010-04-01

    A 33-year-old woman with a history of gestational trophoblastic disease presented for investigation of a right atrial mass. She had been receiving chemotherapy administered via a Port-a-Cath system for 2 months prior to presentation. On transesophageal echocardiography and magnetic resonance imaging, she was found to have a mass attached to the right atrial free wall, with a segment projecting across a patent foramen ovale. Because of the risk for an embolic event, the mass was surgically removed and the patent foramen ovale repaired. Pathology showed an organized thrombus. This case emphasizes the need for high suspicion for thrombus when a right atrial mass is found in a patient with a hypercoagulable state due to underlying malignancy who has a central venous catheter. PMID:19879732

  12. Malassezia furfur: a cause of occlusion of percutaneous central venous catheters in infants in the intensive care nursery.

    PubMed

    Azimi, P H; Levernier, K; Lefrak, L M; Petru, A M; Barrett, T; Schenck, H; Sandhu, A S; Duritz, G; Valesco, M

    1988-02-01

    Growth of Malassezia furfur in the intravascular catheter used for administration of lipid emulsion resulted in occlusion of deep intravascular Silastic catheters in 12 infants in 2 intensive care nurseries. At the time of occlusion visible growth was noted in the clear catheter which was connected to the Silastic intravascular line. Five infants showed clinical signs suggestive of sepsis. The yield of M. furfur from blood cultures and catheter tips was low even when oil enrichment was used. The highest yield of M. furfur was found in the connecting catheter (11 of 11). The source from and the route by which M. furfur entered the catheter remain unclear. The potential portals of entry include the proximal and distal ends of the connecting catheter as well as the colonized skin of the infants and caretakers. PMID:3125516

  13. Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter-related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

    PubMed

    McCann, Margaret; Fitzpatrick, Fidelma; Mellotte, George; Clarke, Michael

    2016-08-01

    A pilot randomized trial in 3 Irish outpatient hemodialysis units compared 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol with routinely used CHG solutions for central venous catheter exit site antisepsis. We found no significant difference between the groups for the prevention of catheter-related bloodstream infections (1/53 vs 2/52; relative risk [RR], 0.49; 95% confidence interval [CI], 0.05-5.25; P = .55) and catheter-associated bloodstream infections (1/53 vs 4/52; RR, 0.25; 95% CI, 0.03-2.12; P = .16). PMID:27079247

  14. Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units

    PubMed Central

    Bernatchez, Stéphanie F.; Ruckly, Stéphane; Timsit, Jean-François

    2015-01-01

    Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. Intervention Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. Results The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. Conclusions According to the base case scenario, the

  15. [Time-delay to avoid: delayed recovery of a percutaneous central venous catheter fractured and embolized in the pulmonary artery].

    PubMed

    Sauro, Luigi; Sauro, Rosario; Manganelli, Fiore; Rotondi, Francesco

    2011-11-01

    We report the case of a 68-year-old man with a fracture of the catheter of a port-a-cath, dislodged into the right atrium. Two days after the diagnosis, the fragment embolized into the lobar artery of the left lower lung lobe. The catheter was removed using a gooseneck snare. PMID:22120781

  16. Time-to-reporting of blood culture positivity and central venous catheter-associated Candida glabrata fungemia in cancer patients.

    PubMed

    Stempel, Jessica M; Farmakiotis, Dimitrios; Tarrand, Jeffrey J; Kontoyiannis, Dimitrios P

    2016-07-01

    Among cancer patients with Candida glabrata (the Candida species with the slowest in-vitro growth) fungemia, time-to-positive blood culture reporting (TTR) was shorter in catheter-associated candidemia (mean±standard deviation: 67±35 h) than in candidemia from other sources (79±31, P<.01). TTR<48 h was 92% specific for catheter-associated C. glabrata fungemia. PMID:27133559

  17. Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

    PubMed Central

    2011-01-01

    Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided. PMID:21864336

  18. Central venous catheter-related bacteremia caused by Kocuria kristinae: case report and review of the literature.

    PubMed

    Dunn, Ryan; Bares, Sara; David, Michael Z

    2011-01-01

    Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided. PMID:21864336

  19. Cerebral air embolism and subsequent transient neurologic abnormalities in a liver transplant recipient following the removal of the pulmonary artery catheter from the central venous access device: a case report

    PubMed Central

    Kim, Sun-Key; Jun, In-Gu; Jang, Dong-Min; Lim, Jinwook; Hwang, Gyu-Sam

    2016-01-01

    Cerebral air embolism is a rare but potentially life-threatening complication. We experienced a living-donor liver transplant recipient who presented with unexpected cerebral air embolism and transient neurologic abnormalities that subsequently developed just after the removal of the pulmonary artery catheter from the central venous access device. One day after the initial event, the patient's neurologic status gradually improved. The patient was discharged 30 days after liver transplantation without neurologic sequelae. PMID:26885308

  20. Tegaderm CHG IV Securement Dressing for Central Venous and Arterial Catheter Insertion Sites: A NICE Medical Technology Guidance.

    PubMed

    Jenks, Michelle; Craig, Joyce; Green, William; Hewitt, Neil; Arber, Mick; Sims, Andrew

    2016-04-01

    Catheters are widely used for vascular access and for the administration of drugs or fluids in critically ill patients. This exposes patients to an infection risk. Tegaderm chlorhexidine gluconate (CHG) (developed by 3M)-a transparent securement dressing-covers and protects catheter sites and secures devices to the skin. It comprises a transparent adhesive dressing to act as a barrier against external contamination and an integrated gel pad containing an antiseptic agent. The Medical Technologies Advisory Committee (MTAC) at the National Institute for Health and Care Excellence (NICE) selected Tegaderm CHG for evaluation. One study was identified by the sponsor as relevant to the decision problem. From this, the sponsor concluded that compared with standard dressings, Tegaderm CHG is associated with lower rates of catheter-related infection, but increased dermatitis incidence. The External Assessment Centre (EAC) identified four paired comparative studies between Tegaderm CHG, other CHG dressings or standard dressings. The EAC agreed with the sponsor's conclusion, finding that CHG dressings reduce infections compared with standard dressings. The sponsor constructed a de novo costing model. Tegaderm CHG generated cost savings of £77.26 per patient compared with standard dressings and was cost saving in 98.5 % of a sample of sets of inputs (2013 prices). The EAC critiqued and updated the model's inputs, yielding similar results to those the sponsor estimate. The MTAC reviewed the evidence and decided to support the case for adoption, issuing a positive draft recommendation. After a public consultation, NICE published this as Medical Technology Guidance 25. PMID:26458938

  1. Microbial biofilms on needleless connectors for central venous catheters: comparison of standard and silver-coated devices collected from patients in an acute care hospital.

    PubMed

    Perez, Elizabeth; Williams, Margaret; Jacob, Jesse T; Reyes, Mary Dent; Chernetsky Tejedor, Sheri; Steinberg, James P; Rowe, Lori; Ganakammal, Satishkumar Ranganathan; Changayil, Shankar; Weil, M Ryan; Donlan, Rodney M

    2014-03-01

    Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs (P=0.11). There were no significant associations (P>0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association (P=0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types (P=0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination. PMID:24371233

  2. Microbial Biofilms on Needleless Connectors for Central Venous Catheters: Comparison of Standard and Silver-Coated Devices Collected from Patients in an Acute Care Hospital

    PubMed Central

    Perez, Elizabeth; Williams, Margaret; Jacob, Jesse T.; Reyes, Mary Dent; Chernetsky Tejedor, Sheri; Steinberg, James P.; Rowe, Lori; Ganakammal, Satishkumar Ranganathan; Changayil, Shankar; Weil, M. Ryan

    2014-01-01

    Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs (P = 0.11). There were no significant associations (P > 0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association (P = 0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types (P = 0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination. PMID:24371233

  3. Pre-treatment of central venous catheters with the cathelicidin BMAP-28 enhances the efficacy of antistaphylococcal agents in the treatment of experimental catheter-related infection.

    PubMed

    Cirioni, Oscar; Giacometti, Andrea; Ghiselli, Roberto; Bergnach, Cristina; Orlando, Fiorenza; Mocchegiani, Federico; Silvestri, Carmela; Licci, Alberto; Skerlavaj, Barbara; Zanetti, Margherita; Saba, Vittorio; Scalise, Giorgio

    2006-09-01

    An in vitro antibiotic susceptibility assay for Staphylococcus aureus biofilms developed on 96-well polystyrene tissue culture plates was performed to elucidate the activity of the 27 residues cathelicidin peptide BMAP-28, quinupristin/dalfopristin (Q/D), linezolid, and vancomycin. Efficacy studies were performed in a rat model of staphylococcal CVC infection. Silastic catheters were implanted into the superior cava. Twenty-four hours after implantation the catheters were filled with BMAP-28. Thirty minutes later rats were challenged via the CVC with 1.0x10(6) CFU of S. aureus strain Smith diffuse. Administration of antibiotics into the CVC at a concentration equal to the MBC observed using adherent cells, or at a much higher concentration (1024 microg/mL) began 24 h later. The inhibition activities of all antibiotics against adherent bacteria were at least two-four-fold lower that against freely growing cells. When antibiotics were used in BMAP-28 pre-treated wells, they showed higher activities. The in vivo studies showed that when CVCs were pre-treated with BMAP-28 or with a high dose of antibiotics, biofilm bacterial load was reduced from 10(7) to 10(3) CFU/mL and bacteremia reduced from 10(3) to 10(1) CFU/mL. When CVCs were treated with both BMAP-28 and antibiotics, biofilm bacterial load was further decreased to 10(1) CFU/mL and bacteremia was not detected. These results suggest that CVC pre-treated with BMAP-28 represents an attractive choice for the treatment of device-related infections caused by staphylococci. PMID:16621147

  4. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    PubMed

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis. PMID:24929256

  5. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  6. Eliminating guidewire retention during ultrasound guided central venous catheter insertion via an educational program, a modified CVC set, and a drape with reminder stickers

    PubMed Central

    Peh, Wee Ming; Loh, Wann Jia; phua, ghee chee; Loo, Chian Min

    2016-01-01

    Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set. The secondary objective was to perform a cost analysis and comparison between the use of the conventional hospital CVC set and drape with our newly modified CVC dressing kit. Root cause analysis of the three cases identified major factors leading to guidewire retention. Interventions were planned and tested using PDSA cycles. Internal medicine trainees rotating through MICU and MICA during the period between February 2012 and June 2013 underwent a multi-modal structured CVC insertion training program with hands on simulation. They also used a newly modified CVC dressing kit and drape. The CVC dressing kit was modified (CVC PLUS) to include a sterile drape with reminder stickers stating “REMOVE the GUIDEWIRE,” as well as a sterile ultrasound sleeve. The total number of CVC insertions performed and guidewire retentions were monitored. During the period of study there were 320 CVC insertions in the MICU and MICA. Since this quality improvement project was initiated, and up to the submission of this article, there have not been any further cases of guidewire retention in the MICU and MICA. The total cost reduction per use of CVC PLUS was S$29.26 (Singaporean Dollars). A multi-modal structured training program, integrated with a modified, pre-packed CVC set, and drapes with reminder stickers (all included in CVC PLUS) were cost effective, and improved patient safety by eliminating guidewire retention during

  7. Eliminating guidewire retention during ultrasound guided central venous catheter insertion via an educational program, a modified CVC set, and a drape with reminder stickers.

    PubMed

    Peh, Wee Ming; Loh, Wann Jia; Phua, Ghee Chee; Loo, Chian Min

    2016-01-01

    Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set. The secondary objective was to perform a cost analysis and comparison between the use of the conventional hospital CVC set and drape with our newly modified CVC dressing kit. Root cause analysis of the three cases identified major factors leading to guidewire retention. Interventions were planned and tested using PDSA cycles. Internal medicine trainees rotating through MICU and MICA during the period between February 2012 and June 2013 underwent a multi-modal structured CVC insertion training program with hands on simulation. They also used a newly modified CVC dressing kit and drape. The CVC dressing kit was modified (CVC PLUS) to include a sterile drape with reminder stickers stating "REMOVE the GUIDEWIRE," as well as a sterile ultrasound sleeve. The total number of CVC insertions performed and guidewire retentions were monitored. During the period of study there were 320 CVC insertions in the MICU and MICA. Since this quality improvement project was initiated, and up to the submission of this article, there have not been any further cases of guidewire retention in the MICU and MICA. The total cost reduction per use of CVC PLUS was S$29.26 (Singaporean Dollars). A multi-modal structured training program, integrated with a modified, pre-packed CVC set, and drapes with reminder stickers (all included in CVC PLUS) were cost effective, and improved patient safety by eliminating guidewire retention during CVC

  8. Percutaneously inserted central catheter - infants

    MedlinePlus

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  9. Rhodococcus equi venous catheter infection: a case report and review of the literature

    PubMed Central

    2011-01-01

    Introduction Rhodococcus equi is an animal pathogen that was initially isolated from horses and is being increasingly reported as a cause of infection in humans with impaired cellular immunity. However, this pathogen is underestimated as a challenging antagonist and is frequently considered to be a mere contaminant despite the potential for life-threatening infections. Most case reports have occurred in immunocompromised patients who have received organ transplants (for example kidney, heart, bone marrow) or those with human immunodeficiency virus infection. Infections often manifest as pulmonary involvement or soft tissue abscesses. Bacteremia related to R. equi infections of tunneled central venous catheters has rarely been described. Case presentation We report the case of a 63-year-old non-transplant recipient, non-HIV infected Caucasian woman with endometrial carcinoma who developed recurrent bloodstream infections and septic shock due to R. equi and ultimately required the removal of her port catheter, a subcutaneous implantable central venous catheter. We also review the medical literature related to human infections with R. equi. Conclusion R. equi should be considered a serious pathogen, not a contaminant, particularly in an immunocompromised patient who presents with a central venous catheter-related bloodstream infection. Counseling patients with central venous catheters who participate in activities involving exposure to domesticated animals is recommended. PMID:21827681

  10. Central venous catheter - dressing change

    MedlinePlus

    ... To change your dressings, you will need: Sterile gloves Cleaning solution A special sponge A special patch, ... paper towel. Put on a pair of clean gloves. Gently peel off the old dressing and Biopatch. ...

  11. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

    PubMed Central

    Bion, Julian; Richardson, Annette; Hibbert, Peter; Beer, Jeanette; Abrusci, Tracy; McCutcheon, Martin; Cassidy, Jane; Eddleston, Jane; Gunning, Kevin; Bellingan, Geoff; Patten, Mark; Harrison, David

    2013-01-01

    Background Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. Methods We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Results Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. Conclusions The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care. PMID:22996571

  12. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients.

    PubMed

    Cesaro, Simone; Cavaliere, Mara; Pegoraro, Anna; Gamba, Piergiorgio; Zadra, Nicola; Tridello, Gloria

    2016-04-01

    We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications. PMID:26961934

  13. [Persistent left superior vena cava. Implications in central venous catheterisation].

    PubMed

    Lacuey Lecumberri, G; Ureña, M; Martínez Basterra, J; Basterra, N

    2009-01-01

    The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC). The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient. PMID:19430517

  14. Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

    PubMed Central

    2013-01-01

    Background Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU. Methods From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. Results Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in

  15. Sagittal vein thrombosis caused by central vein catheter.

    PubMed

    Sabzi, Feridoun; Karim, Hosein; Heydar Pour, Behzad; Faraji, Reza

    2015-01-01

    Cerebral venous thrombosis, including thrombosis of cerebral veins and major dural sinuses, is an uncommon disorder in the general population. However, it has a higher frequency among patients younger than 40 years of age, patients with thrombophilia, pregnant patients or those receiving hormonal contraceptive therapy or has foreign body such as catheter in their veins or arterial system. In this case report, we described clinical and radiological findings in a patient with protein C-S deficiency and malposition of central vein catheter. PMID:25796028

  16. Peripherally Inserted Central Catheters Complicated by Vascular Erosion in Neonates.

    PubMed

    Blackwood, Brian P; Farrow, Kathryn N; Kim, Stan; Hunter, Catherine J

    2016-08-01

    Peripherally inserted central catheters (PICCs) are widely used in the pediatric population, and their use continues to grow in popularity. These catheters provide a reliable source of venous access to neonatal patients but can also be the cause of life-threatening complications. There are several well-documented complications such as infections, catheter thrombosis, vascular extravasations, and fractured catheters. However, the complication of vascular erosion into the pleural space using both small and silicone-based catheters is rarely described. After obtaining institutional review board approval, we identified 4 cases to review of PICCs complicated by vascular erosions in the past 2 years. Herein, we also review the current literature of PICC complications. Getting the catheter tip as close to the atrial-caval junction as possible and confirmation of this placement are of the utmost importance. The thick wall of the vena cava near the atrium seems to be less likely to perforate; in addition, this position provides increased volume and turbulence to help dilute the hyperosmolar fluid, which seems to also be a factor in this complication. A daily screening chest x-ray in patients with upper extremity PICCs and ongoing parenteral nutrition (PN) are not necessary at this time given the overall low rate of vascular erosion and concerns regarding excessive radiation exposure in pediatric populations. However, a low threshold for chest x-ray imaging in patients with even mild respiratory symptoms in the setting of upper extremity PN is recommended. PMID:25700180

  17. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    PubMed Central

    Kampf, Günter; Reise, Gesche; James, Claudia; Gittelbauer, Kirsten; Gosch, Jutta; Alpers, Birgit

    2013-01-01

    Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps. Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention. Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test). Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after). Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68.6% when three of five steps

  18. Peripherally inserted central catheter - flushing

    MedlinePlus

    ... To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes ( ... your fingers before washing. Dry with a clean paper towel. Set up your supplies on a clean ...

  19. Focus on peripherally inserted central catheters in critically ill patients

    PubMed Central

    Cotogni, Paolo; Pittiruti, Mauro

    2014-01-01

    Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks

  20. A Rat Model of Central Venous Catheter to Study Establishment of Long-Term Bacterial Biofilm and Related Acute and Chronic Infections

    PubMed Central

    Chauhan, Ashwini; Lebeaux, David; Decante, Benoit; Kriegel, Irene; Escande, Marie-Christine; Ghigo, Jean-Marc; Beloin, Christophe

    2012-01-01

    Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP) surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections. PMID:22615964

  1. Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

    PubMed Central

    Siddiqui, Adeel M; Harris, Gregory S; Movahed, Assad; Chiang, Karl S; Chelu, Mihail G; Nekkanti, Rajasekhar

    2015-01-01

    The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker. PMID:26380831

  2. Catheter salvage in home infusion patients with central line-associated bloodstream infection.

    PubMed

    Caroff, Daniel A; Norris, Anne H; Keller, Sara; Vinnard, Christopher; Zeitler, Kristen E; Lukaszewicz, Jennifer; Zborowski, Kristine A; Linkin, Darren R

    2014-12-01

    In a retrospective study of home infusion patients with central line-associated bloodstream infection, use of a central venous port, cancer diagnosis, and absence of systemic inflammatory response syndrome were associated with use of catheter salvage. Relapse of infection was uncommon. PMID:25465266

  3. Placement of Hemodialysis Catheters Through Stenotic or Occluded Central Thoracic Veins

    SciTech Connect

    Haller, Claude Deglise, Sebastien; Saucy, Francois; Mathieu, Claudine; Haesler, Erik; Doenz, Francesco; Corpataux, Jean Marc; Qanadli, Salah Dine

    2009-07-15

    A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42-80 years), with central venous stenosis or occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography. Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement. Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8-48 months). Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement, respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion, for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates. This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein.

  4. Pleural effusion with parenteral nutrition solution: an unusual complication of an "appropriately" placed umbilical venous catheter.

    PubMed

    Pabalan, Maria Janina U; Wynn, Ralph J; Reynolds, Anne Marie; Ryan, Rita M; Youssfi, Mostafa; Manja, Veena; Lakshminrusimha, Satyan

    2007-11-01

    Pleural effusion is not an uncommon complication of percutaneous intravenous catheters in neonates. Umbilical venous catheters (UVCs) are associated with pleural effusion following abnormal placement in the left atrium or pulmonary veins due to venous obstruction. We report for the first time a case of right-sided pleural effusion with parenteral nutrition solution following a UVC that appeared to be positioned appropriately in the inferior vena cava. PMID:17972230

  5. Catheter venography and endovascular treatment of chronic cerebrospinal venous insufficiency.

    PubMed

    Mandato, Kenneth; Englander, Meridith; Keating, Lawrence; Vachon, Jason; Siskin, Gary P

    2012-06-01

    Multiple sclerosis (MS) is a disorder characterized by damage to the myelin sheath insulation of nerve cells of the brain and spinal cord affecting nerve impulses which can lead to numerous physical and cognitive disabilities. The disease, which affects over 500,000 people in the United States alone, is widely believed to be an autoimmune condition potentially triggered by an antecedant event such as a viral infection, environmental factors, a genetic defect or a combination of each. Chronic cerebrospinal venous insufficiency (CCSVI) is a condition characterized by abnormal venous drainage from the central nervous system that has been theorized to have a possible role in the pathogenesis and symptomatology of MS (1). A significant amount of attention has been given to this theory as a possible explanation for the etiology of symptoms related to MS patients suffering from this disease. The work of Dr. Zamboni, et al, who reported that treating the venous stenoses causing CCSVI with angioplasty resulting in significant improvement in the symptoms and quality of life of patients with MS (2) has led to further interest in this theory and potential treatment. The article presented describes endovascular techniques employed to diagnose and treat patients with MS and CCSVI. PMID:22640501

  6. Persistent Bloodstream Infection with Kocuria rhizophila Related to a Damaged Central Catheter

    PubMed Central

    Becker, Karsten; Mérens, Audrey; Ferroni, Agnès; Dubern, Béatrice; Vu-Thien, Hoang

    2012-01-01

    A case of persistent bloodstream infection with Kocuria rhizophila related to a damaged central venous catheter in a 3-year-old girl with Hirschsprung's disease is reported. The strain was identified as K. rhizophila by 16S rRNA gene sequencing and matrix-assisted laser desorption ionization–time of flight mass spectrometry. Arbitrarily primed PCR analysis showed a clonal strain. The repeated septic episodes were resolved with the catheter repair. PMID:22259211

  7. Catheter fracture and embolization from totally implanted venous access ports--case reports.

    PubMed

    Vadlamani, P; Dawn, B; Perry, M C

    1998-12-01

    Totally implanted venous access ports are excellent devices for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed. PMID:9855376

  8. [Cardiac tamponade associated with umbilical venous catheter (UVC) placed in inappropriate position].

    PubMed

    Gálvez-Cancino, Franco; de la Luz Sánchez-Tirado, María

    2015-01-01

    Umbilical venous catheter (UVC) is widely used in neonatal intensive care units. Pericardial effusion is an uncommon but life-threatening complication; and tamponade have been reported in 3% of neonates having such catheters. We present a case of cardiac tamponade as a complication of venous catheter in a neonate. The patient was diagnosed at the appropriate time by echocardiography and the pericardiocentesis was performed, and after removal of the complete pericardial effusion,an improvement of the critical condition was achieved. It is important to document the optimal positioning of UVC before the start of infusions. PMID:26089276

  9. Body surface infrared thermometry in patients with central venous cateter-related infections

    PubMed Central

    Silvah, José Henrique; de Lima, Cristiane Maria Mártires; de Unamuno, Maria do Rosário Del Lama; Schetino, Marco Antônio Alves; Schetino, Luana Pereira Leite; Fassini, Priscila Giácomo; Brandão, Camila Fernanda Costa e Cunha Moraes; Basile, Anibal; da Cunha, Selma Freire Carvalho; Marchini, Julio Sergio

    2015-01-01

    Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections. Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject. Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus -0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus -0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus -0.22 - -0.10ºC; p<0.01). Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area. PMID:26466058

  10. Experience of on table modified standard catheters for directed arterial and venous thrombolysis.

    PubMed

    Ram, Bhavin; Baliga, Kapil; Rajesh, S; George, Robbie K

    2016-07-01

    To describe an on-table modification of standard angiography catheters for use in directed arterial and venous thrombolysis. An angiogram is performed and the length of thrombosed vessel (artery or vein) is measured. A 5 or 6 Fr catheter (preferably straight/multi- purpose/vertebral catheter) is modified on table for use by making multiple holes with 23 G needle. After testing ex vivo with saline injection, the on table modified catheter is placed over a wire into the thrombosed segment of the vessel and thrombolytic agent infusion is commenced utilizing a syringe driver after giving a bolus dose of thrombolytic agent. Median duration of thrombolysis was 24 h in our study. We have utilized this method in twenty thrombosed vessels, without any catheter related complications. In our experience, this modification of a standard catheter as a multi-hole catheter is a readily available, simple, cheap, versatile and effective device for directed thrombolysis. PMID:26719163

  11. Washing of gloved hands in antiseptic solution prior to central venous line insertion reduces contamination.

    PubMed

    Kocent, H; Corke, C; Alajeel, A; Graves, S

    2002-06-01

    Glove contamination at the time a central venous catheter is handled is highly undesirable and likely to increase the risk of subsequent line infection. This study was designed to determine how frequently gloves become contaminated during central venous line insertion and to demonstrate the value of glove decontamination immediately prior to handling of the central venous catheter During twenty routine internal jugular catheter insertions the sterility of the operator's gloved fingertips (just prior to handling the intravenous catheter) was assessed by touching the fingertips onto blood agar plates. The gloved hands were then rinsed in chlorhexidine/alcohol and after drying were placed onto a further plate. Contamination was detected in 55% of the prewash plates but in none of the postwash plates. Procedures performed by less experienced resident staff had a higher contamination rate despite there being no evident breach of sterile technique. It is likely that glove contamination results from the persistance of bacteria within the deeper layers of the skin, despite surface disinfection. These bacteria may be released by manipulation of the skin when identifying landmarks. This hypothesis was supported by a subsequent observation that gloves were more highly contaminated after firm touching of the skin rather than light touching. Glove contamination during central line insertion is frequent. Catheter contamination rates could be reduced (without risk or additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%) in alcohol (70%) prior to handling the catheter. PMID:12075642

  12. The Incidence of Central Line–Associated Bacteremia After the Introduction of Midline Catheters in a Ventilator Unit Population

    PubMed Central

    Pathak, Rahul; Patel, Anish; Enuh, Hilary; Adekunle, Oluwaseyi; Shrisgantharajah, Vasanthy; Diaz, Keith

    2015-01-01

    Hypothesis Our objective was to evaluate whether the use of midline venous catheters in place of central line venous catheters, when appropriate, decreased the overall incidence of central line–associated bacteremia in a ventilator unit. Methods The time interval between February 2012 and February 2013 was divided into 2 periods. Group A was the first half of the year, before the introduction of midline catheters, and group B was the second half of the year, 6 months after their introduction. Central line–associated bloodstream infection (CLABSI) was calculated using the equation: (total number of CLABSI/total number of catheter days) × 1000. The Z test was used for proportions between independent groups to compare the significance in the difference in CLABSI between groups A and B. Results There was a significant decrease in the total number of catheter days on the ventilator unit in group A from 2408 catheter days in 1 year (August 1, 2011, to July 31, 2012) before the introduction of midline catheters to 1521 catheter days in group B in the following year (November 1, 2012, to October 31, 2013; P < 0.05 for both groups). Conclusions Midline catheters in place of central lines decrease the rate of CLABSI in a ventilator unit. In addition, no bloodstream infections were associated with midline catheters. PMID:25972725

  13. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

    PubMed Central

    Jalwal, Gopal Krishan; Rajagopalan, Vanitha; Bindra, Ashish; Rath, Girija Prasad; Goyal, Keshav; Kumar, Atin; Gamanagatti, Shivanand

    2014-01-01

    The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described. PMID:24803771

  14. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

    PubMed Central

    2015-01-01

    Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient's condition. PMID:26075094

  15. Mobility therapy and central or peripheral catheter-related adverse events in an ICU in Brazil*

    PubMed Central

    Lima, Natália Pontes; da Silva, Gregório Marques Cardim; Park, Marcelo; Pires-Neto, Ruy Camargo

    2015-01-01

    OBJECTIVE: To determine whether mobility therapy is associated with central or peripheral catheter-related adverse events in critically ill patients in an ICU in Brazil. METHODS: A retrospective analysis of the daily medical records of patients admitted to the Clinical Emergency ICU of the University of São Paulo School of Medicine Hospital das Clínicas Central Institute between December of 2009 and April of 2011. In addition to the demographic and clinical characteristics of the patients, we collected data related to central venous catheters (CVCs), hemodialysis (HD) catheters and indwelling arterial catheters (IACs): insertion site; number of catheter days; and types of adverse events. We also characterized the mobility therapy provided. RESULTS: Among the 275 patients evaluated, CVCs were used in 49%, HD catheters were used in 26%, and IACs were used in 29%. A total of 1,268 mobility therapy sessions were provided to patients while they had a catheter in place. Catheter-related adverse events occurred in 20 patients (a total of 22 adverse events): 32%, infection; 32%, obstruction; and 32%, accidental dislodgement. We found that mobility therapy was not significantly associated with any catheter-related adverse event, regardless of the type of catheter employed: CVC-OR = 0.8; 95% CI: 0.7-1.0; p = 0.14; HD catheter-OR = 1.04; 95% CI: 0.89-1.21; p = 0.56; or IAC-OR = 1.74; 95% CI: 0.94-3.23; p = 0.07. CONCLUSIONS: In critically ill patients, mobility therapy is not associated with the incidence of adverse events involving CVCs, HD catheters, or IACs. PMID:26176520

  16. [A rare complication of permanent venous access: constriction, fracture and embolization of the catheter].

    PubMed

    Groebli, Y; Wuthrich, P; Tschantz, P; Beguelin, P; Piguet, D

    1998-01-01

    The pinch off syndrome due to squeezing of the implanted catheter is a rare complication of permanent venous access devices (0.1 to 1% of the cases). The cause is a mechanical catheter's compression in the costo-clavicular space, when implanted too medially in the subclavian vein. In case of lack of venous reflux or injection difficulties, sometimes complicated by local pain, a radiological control must be obtained to demonstrate signs of compression or beginning of fracture. Significant damage to the system is shown be extravasation of radioopaque contrast medium. The suspicion of catheter damage justifies early replacement of the system to avoid right heart or pulmonary artery embolism. The electron microscopic scanning tends to prove that the catheter's rupture is caused by a fatigue process. PMID:9655009

  17. Development of Needle Insertion Manipulator for Central Venous Catheterization

    NASA Astrophysics Data System (ADS)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  18. Association Between Disruption of Fibrin Sheaths Using Percutaneous Transluminal Angioplasty Balloons and Late Onset of Central Venous Stenosis

    SciTech Connect

    Ni, Nina Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael

    2011-02-15

    To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A {chi}{sup 2} test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P < 0.01, {chi}{sup 2} test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P < 0.01, {chi}{sup 2} test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

  19. [Prevalence of stenosis and thrombosis of central veins in hemodialysis after a tunneled jugular catheter].

    PubMed

    Jean, G; Vanel, T; Chazot, C; Charra, B; Terrat, J C; Hurot, J M

    2001-01-01

    Central venous stenosis (ST) and thrombosis (TB) related to catheter (KT) had been reported mostly for the subclavian vein. We performed a systematic cavographic study to evaluate the prevalence of these complications in 51 hemodialysis patients with present or previous history of tunneled internal jugular catheter. Each of them had used one or several KT (1.8 +/- 1.4 KT) for a mean 28 +/- 26 month cumulative time (i.e. 43,584 days total exposure time). Fifty percent of the KT were PermCath Quinton and 50% were Twincath (uncuffed) or CS 100 (cuffed) Medcomp. Twenty-seven had no ST (53%, group I), 24 had one or several significant ST (47%, group II) of superior Vena Cava (SVC, n = 4), inferior Vena Cava (IVC, n = 1), Brachio-cephalic Vein (BCV, n = 5) and subclavian vein (SC, n = 10), or a TB of SVC (n = 1), IVC (n = 3), BCV (n = 3), SC (n = 2). This accounts for an incidence of 0.55 ST or TB/1000 patient-days. Five of the twelve subclavian ST and TB had no history of previous subclavian catheter. Comparison between the two groups showed no differences according to age, time on dialysis, diabetes, hematocrit, CRP, cumulative time with catheter, catheter-related infections, type of catheter and anticoagulant treatment. IVC catheter tip's position is an important risk factor for TB and ST (4/6). Twelve group II patients had ST or TB-related symptoms, with a functional AV fistula in 9 cases. Eleven patients underwent repeated percutaneous angioplasty with 4 additional Wallstents and in 2 cases an AV fistula need to be closed. Central venous ST and TB after a jugular KT is extremely frequent, mostly without any symptoms. Consequences on peripheral or central vascular access, cost and poor long-term patency rate of angioplasty are of major importance. These results incite us to further reduce the catheter use in dialysis patients. PMID:11811018

  20. Symptomatic Central Venous Stenosis in a Hemodialysis Patient Leading to Loss of Arteriovenous Access: A Case Report and Literature Review

    PubMed Central

    Tatapudi, Vasishta S.; Spinowitz, Noam; Goldfarb, David S.

    2014-01-01

    Central venous stenosis is a well-described sequel to the placement of hemodialysis catheters in the central venous system. The presence of an ipsilateral arteriovenous fistula or graft often leads to severe venous dilatation, arm edema and recurrent infections. Vascular access thrombosis, compromised blood flow and inadequate dialysis delivery are dreaded complications that eventually render the access unusable. We report the case of a 58-year-old male hemodialysis patient who developed symptomatic central venous stenosis to illustrate the problem and review the pertinent literature. This patient developed severe enlargement of upper extremity veins due to central venous stenosis. The symptoms were refractory to multiple endovascular interventions and eventually necessitated ligation of his arteriovenous fistula. Central venous stenosis remains a pervasive problem despite advances in our understanding of its etiology and recognition of the enormity of its consequences. Due to the lack of effective therapeutic options, prevention is better than cure. PMID:24803921

  1. Effect of Ultrasound-Guided Placement of Difficult-to-Place Peripheral Venous Catheters: A Prospective Study of a Training Program for Nurse Anesthetists.

    PubMed

    Partovi-Deilami, Kohyar; Nielsen, Jesper K; Moller, Ann M; Nesheim, Sara-Sophie S; Jorgensen, Vibeke L

    2016-04-01

    Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals. The rate of success, procedure time, number of skin punctures, discomfort, catheter size, location, and incidence of central venous catheter placement are reported before and after implementation of a training program and a mobile service using ultrasound to place difficult-to-place PVCs. The success rate increased from 0% (0 of 33 patients) to 83% (58 of 70 patients) with ultrasound. Procedure time was reduced from 20 to 10 minutes, discomfort was unchanged, and the median number of skin punctures decreased from 3 to 2. The incidence of central venous catheter placement dropped from 34% to 7%. Implementation of a training program and a mobile service in which nurse anesthetists performed ultrasound-guided PVC placement improved the success rate and quality of care in patients with DIVA. PMID:27311149

  2. Noninvasive measurement of central venous pressure

    NASA Technical Reports Server (NTRS)

    Webster, J. G.; Mastenbrook, S. M., Jr.

    1972-01-01

    A technique for the noninvasive measurement of CVP in man was developed. The method involves monitoring venous velocity at a point in the periphery with a transcutaneous Doppler ultrasonic velocity meter while the patient performs a forced expiratory maneuver. The idea is the CVP is related to the value of pressure measured at the mouth which just stops the flow in the vein. Two improvements were made over the original procedure. First, the site of venous velocity measurement was shifted from a vein at the antecubital fossa (elbow) to the right external jugular vein in the neck. This allows for sensing more readily events occurring in the central veins. Secondly, and perhaps most significantly, a procedure for obtaining a curve of relative mean venous velocity vs mouth pressure was developed.

  3. Ventriculoatrial shunt catheter displacement in a child with partial anomalous pulmonary venous return: case report.

    PubMed

    Elhammady, Mohamed Samy A; Benglis, David M; Bhatia, Sanjiv; Sandberg, David I; Ragheb, John

    2008-07-01

    Ventriculoatrial (VA) shunts remain the most used alternative to ventriculoperitoneal shunts in infants with hydrocephalus. The authors report a case of an acute VA shunt malfunction as a result of distal catheter displacement in an 18-month-old girl with partial anomalous pulmonary venous return. The child presented with respiratory compromise, and a chest radiograph revealed a lung infiltrate and normal position of the distal shunt catheter tip. Computed tomography demonstrated stable ventricle size in comparison with previous studies. As the patient's respiratory distress progressed, she required intubation, mechanical ventilation with high airway pressures and inspired oxygen concentrations, muscle relaxants, and sedation. A routine morning chest radiograph several days after admission revealed displacement of the distal catheter into the left innominate vein. Later that day the child's pupils were noted to be large and unreactive and a distal shunt malfunction was diagnosed. Complications of VA shunts and the presumed mechanism by which the catheter became displaced are discussed. PMID:18590399

  4. Neonatal peripherally inserted central catheter team. Evolution and outcomes of a bedside-nurse-designed program.

    PubMed

    Linck, Deborah A; Donze, Ann; Hamvas, Aaron

    2007-02-01

    Percutaneously inserted central venous catheters (PICCs) have been used to provide central venous access for more than 25 years. Although these lines initially were placed by physicians, currently there are many adult, pediatric, and neonatal nurse-based PICC teams. This article describes the inception and growth of 1 team which, during the last 14 years, has placed more than 3400 catheters and trained more than 50 bedside nurses to insert PICCs. It highlights the development of the team, including details of how team members were selected and trained. Management of ongoing issues was handled by a self-directed nurse team organized into a committee structure composed of an oversight committee and education, guideline, qualifications, and quality improvement subcommittees. This team set and achieved the goals of training bedside nurses to place PICCs, providing consistent management of PICCs, and closely monitoring outcomes. PMID:17536330

  5. Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis.

    PubMed

    Zheng, J J; Zhang, Z H; Shan, Z; Wang, W J; Li, X X; Wang, S M; Li, Y-X; Cheng, G-S

    2014-01-01

    We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P < 0.01; OR = 11.78; 95% confidence interval = 6.99-19.87). In conclusion, the meta-analysis indicated that catheter thrombolysis was more effective than superficial venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion. PMID:25078578

  6. Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter

    PubMed Central

    de Almeida, Marcos Moura; Tavares, Wládia Gislaynne de Sousa; Furtado, Maria Mônica Alencar Araripe; Fontenele, Maria Marcia Farias Trajano

    2016-01-01

    Abstract Objective: To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case description: A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. Comments: The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death. PMID:26525686

  7. Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

    PubMed

    Chen, James X; Sudheendra, Deepak; Stavropoulos, S William; Nadolski, Gregory J

    2016-01-01

    The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016. PMID:27618329

  8. Ultrasound-guided central venous catheterization in prone position

    PubMed Central

    Sofi, Khalid; Arab, Samer

    2010-01-01

    Central venous catheterization (CVC) is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV), which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique. PMID:20668564

  9. Proper Angle of Sono-guided Central Venous Line Insertion

    PubMed Central

    Barzegari, Hassan; Forouzan, Arash; Fahimi, Mohammad Ali; Zohrevandi, Behzad; Ghanavati, Mandana

    2016-01-01

    Introduction: Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization. Methods: In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation. Result: 114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09. Conclusion: Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results. PMID:27299146

  10. Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access

    SciTech Connect

    Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio

    2011-12-15

    Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

  11. Catheter-related bloodstream infection.

    PubMed

    Goede, Matthew R; Coopersmith, Craig M

    2009-04-01

    Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. Antiseptic- or antibiotic-impregnated catheters are also an effective tool to prevent infections. The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed. PMID:19281894

  12. A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique.

    PubMed

    Kim, E; Kim, B G; Lim, Y J; Jeon, Y T; Hwang, J W; Kim, H C; Choi, Y H; Park, H P

    2016-09-01

    In clinical practice, both a thin-walled introducer needle and catheter-over-needle technique can be used to allow insertion of a guidewire during central venous catheterisation using the Seldinger technique. We compared the incidence of catheterisation-related complications (arterial puncture, haemothorax, pneumothorax, haematoma and catheter tip malposition) and insertion success rate for these two techniques in patients requiring right-sided subclavian central venous catheterisation. A total of 414 patients requiring infraclavicular subclavian venous catheterisation were randomly allocated to either a thin-walled introducer needle (needle group, n = 208) or catheter-over-needle technique (catheter group, n = 206). The catheterisation-related complication rate was lower in the needle group compared with the catheter group (5.8% vs. 15.5%; p = 0.001). Overall insertion success rates were similar (97.1% and 92.7% in the needle and catheter groups respectively; p = 0.046), although the first-pass success rate was higher in the needle group (62.0% vs. 35.4%; p < 0.001). We recommend the use of a thin-walled introducer needle technique for right-sided infraclavicular subclavian venous catheterisation. PMID:27396474

  13. Peripheral Insertion of a Central Venous Access Device Under Fluoroscopic Guidance Using a Peripherally Accessed System (PAS) Port in the Forearm

    SciTech Connect

    Hata, Yasuhiro; Morita, Sojiro; Morita, Yoshitaka; Awatani, Toshihide; Takasaki, Motohiro; Horimi, Tadashi; Ozawa, Zen

    1998-05-15

    Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

  14. Mediastinal infusion of epirubicin and 5-fluorouracil. A complication of totally implantable central venous systems. Report of a case.

    PubMed

    Rodier, J M; Malbec, L; Lauraine, E P; Batel-Copel, L; Bernadou, A

    1996-01-01

    Perforation of the wall of the superior vena cava by a central venous catheter is reported. The resultant inadvertent infusion of 5-fluorouracil and epirubicin caused a severe acute inflammatory reaction in the right-lobe bronchus, mediastinal infiltration and pleural and pericardial effusions. The patient recovered but has residual mild oesophageal dysfunction. PMID:8781572

  15. Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

    PubMed Central

    Weisz, Dany E.; Poon, Wei Bing; James, Andrew; McNamara, Patrick J.

    2014-01-01

    Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho) is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU), including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU. PMID:25032055

  16. Measurement of Vein Diameter for Peripherally Inserted Central Catheter (PICC) Insertion: An Observational Study.

    PubMed

    Sharp, Rebecca; Cummings, Melita; Childs, Jessie; Fielder, Andrea; Mikocka-Walus, Antonina; Grech, Carol; Esterman, Adrian

    2015-01-01

    Choosing an appropriately sized vein reduces the risk of venous thromboembolism associated with peripherally inserted central catheters. This observational study described the diameters of the brachial, basilic, and cephalic veins and determined the effect of patient factors on vein size. Ultrasound was used to measure the veins of 176 participants. Vein diameter was similar in both arms regardless of hand dominance and side. Patient factors-including greater age, height, and weight, as well as male gender-were associated with increased vein diameter. The basilic vein tended to have the largest diameter statistically. However, this was the case in only 55% of patients. PMID:26339941

  17. Placement of a peripherally inserted central catheter into the azygous vein

    SciTech Connect

    Franklin, Iain Gilmore, Christopher

    2015-06-15

    Peripherally inserted central catheters (PICC) are used for a variety of infusion therapies. They are indicated in patients requiring long-term venous access. Incorrect positioning of the insertion of a PICC line is one of the known complications when inserting the device in clinical practice. Radiographers once performing imaging will commonly check if the tip of a PICC has entered the superior vena cava. This case study will report on a lesser known incorrect placement of a PICC line into the azygous vein and how this can be detected on radiographic imaging. This outcome for the patient can be detrimental as it has an increased risk of perforation, thrombus, and fistula formation.

  18. A Life-Threatening Mediastinal Hematoma After Central Venous Port System Implantation

    PubMed Central

    Sarach, Janine; Zschokke, Irin; Melcher, Gian A.

    2015-01-01

    Patient: Female, 68 Final Diagnosis: Mediastinal hematoma Symptoms: Agitation • severe hemodynamic instability • severe respiratory distress Medication: — Clinical Procedure: Cardiopulmonary resuscitation • reintubation • thoracic drain Specialty: Surgery Objective: Diagnostic/therapeutic accidents Background: We report a case of surgical central venous port system implantation using Seldinger’s technique with a life-threatening mediastinal hematoma due to the perforation of the superior vena cava. Case Report: A 68-year-old woman was admitted to our institution for port implantation. Open access to the cephalic vein and 2 punctures of the right subclavian vein were unsuccessful. Finally, the port catheter could be placed into the superior vena cava using Seldinger’s technique. As blood aspiration via the port catheter was not possible, fluoroscopy was performed, revealing mediastinal contrast extravasation without contrasting the venous system. A new port system could be placed in the correct position without difficulties. After extubation, the patient presented with severe respiratory distress and required consecutive cardiopulmonary resuscitation and reintubation. The CT scan showed a significant hematoma in the lower neck and posterior mediastinum with tracheal compression. We assumed a perforation of the superior vena cava with the tip of the guidewire using Seldinger’s technique. Long-term intensive treatment with prolonged ventilation and tracheotomy was necessary. The port system had to be subsequently explanted due to infection. Conclusions: Mediastinal hematoma is a rare but life-threatening complication associated with central venous catheterization using Seldinger’s technique. Perforation occurs most often during central venous catheterization in critical care. Mediastinal hematoma is an example of a mechanical complication occurring after central venous catheterization, which has been described only a few times in the literature to

  19. Electromagnetically tracked placement of a peripherally inserted central catheter

    NASA Astrophysics Data System (ADS)

    Sacolick, Laura; Patel, Neilesh; Tang, Jonathan; Levy, Elliot; Cleary, Kevin R.

    2004-05-01

    This paper describes a computer program to utilize electromagnetic tracking guidance during insertion of peripherally inserted central catheters. Placement of a Peripherally Inserted Central Catheter (PICC) line is a relatively simple, routine procedure in which a catheter is inserted into the veins of the lower arm and threaded up the arm to the vena cava to sit just above the heart. However, the procedure requires x-ray verification of the catheter position and is usually done under continuous fluoroscopic guidance. The computer program is designed to replace fluoroscopic guidance in this procedure and make PICC line placement a bedside procedure. This would greatly reduce the time and resources dedicated to this procedure. The physician first goes through a quick registration procedure to register the patient space with the computer screen coordinates. Once registration is completed, the program provides a continuous, real-time display of the position of the catheter tip overlaid on an x-ray image of the patient on an adjacent computer screen. Both the position and orientation of the catheter tip is shown. The display is very similar to that shown when using fluoroscopy.

  20. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis

    PubMed Central

    Yang, Bin; Xu, Xiao-dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-ran

    2016-01-01

    Background There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). Material/Methods Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. Results The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all P<0.05). The incidence of postoperative PTS in the CDT group (17.9%) was significantly lower in comparison to the ST group (51.85%) during the follow-up (P=0.007). Conclusions Catheter-directed thrombolysis via the small saphenous veins is an effective, safe, and feasible approach for treating acute deep venous thrombosis. PMID:27552357

  1. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

    PubMed

    Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

    2016-01-01

    BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all P<0.05). The incidence of postoperative PTS in the CDT group (17.9%) was significantly lower in comparison to the ST group (51.85%) during the follow-up (P=0.007). CONCLUSIONS Catheter-directed thrombolysis via the small saphenous veins is an effective, safe, and feasible approach for treating acute deep venous thrombosis. PMID:27552357

  2. Insertion of Totally Implantable Central Venous Access Devices by Surgeons

    PubMed Central

    An, Hyeonjun; Ryu, Chun-Geun; Jung, Eun-Joo; Kang, Hyun Jong; Paik, Jin Hee; Yang, Jung-Hyun

    2015-01-01

    Purpose The aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons. Methods Total 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion. Results The 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case. Conclusion Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications. PMID:25960974

  3. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

    PubMed Central

    Eades, Shannan; Turiy, Yuliya

    2015-01-01

    OBJECTIVES: With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement. METHODS: This was an observational, retrospective, case-control study. Control subjects were patients aged 0 to 18 years who had a central venous line placed. Case subjects had a central line and a radiographically confirmed diagnosis of venous thromboembolism. RESULTS: A total of 150 patients were included in the study. Presence of multiple comorbidities, particularly the presence of a congenital heart defect (34.7% case vs. 14.7% control; p < 0.005), was found to put pediatric patients at increased risk for thrombosis. Additionally, the administration of parenteral nutrition through the central line (34.7% case vs. 18.7% control; p = 0.03) and location of the line increased the risk for clot formation. CONCLUSIONS: With increased awareness of central venous line–related thromboembolism, measures should be taken to reduce the number and duration of central line placements, and further studies addressing the need for thromboprophylaxis should be conducted. PMID:26472949

  4. Venous endothelial injury in central nervous system diseases

    PubMed Central

    2013-01-01

    The role of the venous system in the pathogenesis of inflammatory neurological/neurodegenerative diseases remains largely unknown and underinvestigated. Aside from cerebral venous infarcts, thromboembolic events, and cerebrovascular bleeding, several inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and optic neuritis, appear to be associated with venous vascular dysfunction, and the neuropathologic hallmark of these diseases is a perivenous, rather than arterial, lesion. Such findings raise fundamental questions about the nature of these diseases, such as the reasons why their pathognomonic lesions do not develop around the arteries and what exactly are the roles of cerebral venous inflammation in their pathogenesis. Apart from this inflammatory-based view, a new hypothesis with more focus on the hemodynamic features of the cerebral and extracerebral venous system suggests that MS pathophysiology might be associated with the venous system that drains the CNS. Such a hypothesis, if proven correct, opens new therapeutic windows in MS and other neuroinflammatory diseases. Here, we present a comprehensive review of the pathophysiology of MS, ADEM, pseudotumor cerebri, and optic neuritis, with an emphasis on the roles of venous vascular system programming and dysfunction in their pathogenesis. We consider the fundamental differences between arterial and venous endothelium, their dissimilar responses to inflammation, and the potential theoretical contributions of venous insufficiency in the pathogenesis of neurovascular diseases. PMID:24228622

  5. The use of central venous lines in the treatment of chronically ill children.

    PubMed

    Barczykowska, Ewa; Szwed-Kolińska, Marzena; Wróbel-Bania, Agnieszka; Ślusarz, Robert

    2014-01-01

    Treatment of chronic diseases in children is a special medical problem. Maintaining constant access to the central vascular system is necessary for long-term hemato-oncological and nephrological therapies as well as parenteral nutrition. Providing such access enables chemotherapic treatment, complete parenteral nutrition, long-term antibiotic therapy, hemodialysis, treatment of intensive care unit patients, monitoring blood pressure in the pulmonary artery and stimulation of heart rate in emergency situations as well as treatment of patients suffering from complications, especially when chances of access into peripheral veins are exhausted. Continuous access to the central vascular system is desirable in the treatment of chronically ill children. Insertion of a central venous catheter line eliminates the unnecessary pain and stress to a child patient accompanying injection into peripheral vessels. In order to gain long-term and secure access to the central venous system, respecting the guidelines of the Center for Disease Control and Prevention contained in the updated 'Guidelines for the Prevention of Intravascular Catheter-Related Infections' is necessary. PMID:25618129

  6. Rupture of totally implantable central venous access devices (Intraports) in patients with cancer: report of four cases

    PubMed Central

    Filippou, Dimitrios K; Tsikkinis, Christoforos; Filippou, Georgios K; Nissiotis, Athanasios; Rizos, Spiros

    2004-01-01

    Background Totally implantable central venous access devices (intraports) are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Rupture of intraport is a rare complication. Patients and methods During 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Four of these cases (two colon cancer and one each of pancreas and breast cancer) had rupture of the intraport catheter, these forms the basis of present report. Results Mean time insitu for intraports was 164∀35 days. Median follow-up time was 290 days and total port time in situ was 40180 days. The incidence of port rupture was 1 per 10,000 port days. Three of the 4 cases were managed by successful removal of catheters. In two of these the catheter was removed under fluoroscopic control using femoral route, while in the third patient the catheter (partial rupture) was removed surgically. One of the catheters could not be removed and migrated to right ventricle on manipulations. Conclusion Port catheter rupture is a rare but dreaded complication associated with subcutaneous port catheter device placement for chemotherapy. In case of such an event the patient should be managed by an experienced vascular surgeon and interventional radiologist, as in most cases the ruptured catheter can be retrieved by non operative interventional measures. PMID:15494075

  7. A Comparison of Clinical Outcomes with Regular- and Low-Profile Totally Implanted Central Venous Port Systems

    SciTech Connect

    Teichgraeber, Ulf Karl-Martin Steitparth, Florian; Cho, Chie Hee; Benter, Thomas; Gebauer, Bernhard

    2009-09-15

    The purpose of this study was to evaluate whether low-profile totally implanted central venous port systems can reduce the late complication of skin perforation. Forty patients (age, 57 {+-} 13 years; 22 females, 18 males) were randomized for the implantation of a low-profile port system, and another 40 patients (age, 61 {+-} 14 years; 24 females, 16 males) received a regular port system as control group. Indications for port catheter implantation were malignant disease requiring chemotherapy. All port implantations were performed in the angiography suite using sonographically guided central venous puncture and fluoroscopic guidance of the catheter placement. Procedure time, number of complications (procedure-related immediate, early, and late complications), and number of explantations were assessed. Follow-up was performed for 6 months. All port implantations were successfully completed in both study groups. There were two incidents of skin perforation observed in the control group. One skin perforation occurred 13 weeks and the other 16 weeks after port implantation (incidence, 5%) in patients with regular-profile port systems. Two infections were observed, one port infection in each study group. Both infections were characterized as catheter-related infections (infection rate: 0.15 catheter-related infections per 1000 catheter days). In conclusion, low-profile port systems can be placed as safely as traditional chest ports and reduce the risk of developing skin perforations, which occurs when the port system is too tight within the port pocket.

  8. Congenital anomalies of superior vena cava and their implications in central venous catheterization.

    PubMed

    Rossi, Umberto G; Rigamonti, Paolo; Torcia, Pierluca; Mauri, Giovanni; Brunini, Francesca; Rossi, Michele; Gallieni, Maurizio; Cariati, Maurizio

    2015-01-01

    Congenital anomalies of superior vena cava (SVC) are generally discovered incidentally during central venous catheter (CVC) insertion, pacemaker electrode placement, and cardiopulmonary bypass surgery. Persistent left SVC (PLSVC) is a rare (0.3%) anomaly in healthy subjects, usually asymptomatic, but when present and undiagnosed, it may be associated with difficulties and complications of CVC placement. In individuals with congenital heart anomalies, its prevalence may be up to 10 times higher than in the general population.In this perspective, awareness of the importance of the incidental finding of PLSV during CVC placement is crucial. To improve knowledge of this rare but potentially dangerous condition, we describe the embryological origin of SVC, its normal anatomy, and possible congenital anomalies of the venous system and of the heart, including the presence of a right to left cardiac shunt. Diagnosis of PLSVC as well as the clinical complications and technical impact of SVC congenital anomalies for CVC placement are emphasized. PMID:25768048

  9. Confirmation of endovenous placement of central catheter using the ultrasonographic “bubble test”

    PubMed Central

    Baviskar, Ajit S.; Khatib, Khalid I.; Bhoi, Sanjeev; Galwankar, Sagar C.; Dongare, Harshad C.

    2015-01-01

    Insertion of central venous catheter (CVC) is the most common procedure to be performed in Intensive Care Units. Addition of ultrasonographic guidance to this procedure, which was initially performed blindly, has improved safety of this procedure. Confirmation of endovenous placement of CVC though, is tricky, as methods for confirmation are either operator dependent, time-consuming or not available at bedside. Prospective observational study was carried out to study feasibility of use of sonobubble test to confirm the presence of CVC within central vein. After insertion of CVC in the internal jugular, subclavian or axillary vein, a 10 ml bolus of shaken saline microbubble is injected through port of CVC, and opacification of right atrium is observed in xiphoid view on ultrasonography. The Sonobubble test was helpful for dynamic confirmation of endovenous placement of CVC and prevented complications such as arterial puncture and cannulation. We recommend its use following CVC insertion. PMID:25624649

  10. Septic and technical complications of central venous catheterization. A prospective study of 200 consecutive patients.

    PubMed Central

    Sitzmann, J V; Townsend, T R; Siler, M C; Bartlett, J G

    1985-01-01

    The results of central venous catheterization for total parenteral nutrition were prospectively evaluated in 200 consecutive patients. All catheters were fabricated of polyurethane tubing inserted by the Seldinger technique. Two hundred sixty-three lines were inserted in 200 patients for a total of 4103 days. Major complications occurred in 2.3% patients. Twenty-four per cent of catheters were associated with suspected sepsis; of these, 52% were removed directly and 48% were changed over a guidewire. The total catheter sepsis rate was 5.7%. The incidence of sepsis correlated with the number of attempts to insert the line and with positive skin cultures. These data indicate that: use of the Seldinger technique to insert nonthrombogenic flexible catheters results in lower technical morbidity; the incidence of established infection is much lower than the incidence of suspected sepsis; guidewire change may be performed without risk to the patient or interruption of therapy; sepsis rates can be decreased by reducing the number of attempts to catheterize the subclavian vein; and sepsis rates correlate with positive skin cultures at the insertion site. PMID:3935062

  11. Azygos catheter placement as a cause of failure of dialysis.

    PubMed

    Stewart, G D; Jackson, A; Beards, S C

    1993-11-01

    Common complications of venous dialysis catheters include sepsis and accidental removal. Angiographic demonstration of dialysis lines is only rarely requested usually to confirm the presence of clot or stenosis as a cause for poor dialysis flow. Poor flow can also be due to inadvertent placement of the catheter in the azygos system. The use of dialysis catheters with a long venous limb which extends beyond the arterial port may predispose to such placement as their lumen is lateral to the central axis of the catheter. In those patients with poor venous access catheter placement under angiographic control may be helpful. PMID:8258225

  12. Catheter-Directed Thrombolysis for Treatment of Deep Venous Thrombosis in the Upper Extremities

    SciTech Connect

    Vik, Anders; Holme, Pal Andre; Singh, Kulbir; Dorenberg, Eric; Nordhus, Kare Christian; Kumar, Satish; Hansen, John-Bjarne

    2009-09-15

    Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.

  13. Central Venous Disease in Hemodialysis Patients: An Update

    SciTech Connect

    Modabber, Milad; Kundu, Sanjoy

    2013-08-01

    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.

  14. A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils

    SciTech Connect

    Sonnenschein, Martin J. Anderson, Suzanne E.; Lourens, Steven; Triller, Juergen

    2004-11-15

    Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13-14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included.

  15. Placement of a peripherally inserted central catheter into the azygous vein

    PubMed Central

    Franklin, Iain; Gilmore, Christopher

    2015-01-01

    Peripherally inserted central catheters (PICC) are used for a variety of infusion therapies. They are indicated in patients requiring long-term venous access. Incorrect positioning of the insertion of a PICC line is one of the known complications when inserting the device in clinical practice. Radiographers once performing imaging will commonly check if the tip of a PICC has entered the superior vena cava. This case study will report on a lesser known incorrect placement of a PICC line into the azygous vein and how this can be detected on radiographic imaging. This outcome for the patient can be detrimental as it has an increased risk of perforation, thrombus, and fistula formation. PMID:26229681

  16. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations.

    PubMed

    Moureau, Nancy; Chopra, Vineet

    2016-04-28

    Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access, those requiring multiple attempts, those who are obese, or have diabetes or other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In the clinical setting, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate usage for VADs. This publication summarises the work and recommendations of the panel for the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). PMID:27126759

  17. Placement of a peripherally inserted central catheter into the azygous vein.

    PubMed

    Franklin, Iain; Gilmore, Christopher

    2015-06-01

    Peripherally inserted central catheters (PICC) are used for a variety of infusion therapies. They are indicated in patients requiring long-term venous access. Incorrect positioning of the insertion of a PICC line is one of the known complications when inserting the device in clinical practice. Radiographers once performing imaging will commonly check if the tip of a PICC has entered the superior vena cava. This case study will report on a lesser known incorrect placement of a PICC line into the azygous vein and how this can be detected on radiographic imaging. This outcome for the patient can be detrimental as it has an increased risk of perforation, thrombus, and fistula formation. PMID:26229681

  18. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit.

    PubMed

    Hajjej, Zied; Nasri, Mourad; Sellami, Walid; Gharsallah, Hedi; Labben, Iheb; Ferjani, Mustapha

    2014-03-01

    Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, microbiological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012-30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6 ± 6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more antibiotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant microorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI. PMID:24508422

  19. Can a New Antiseptic Agent Reduce the Bacterial Colonization Rate of Central Venous Lines in Post-Cardiac Surgery Patients?

    PubMed Central

    Yousefshahi, Fardin; Azimpour, Khashayar; Boroumand, Mohammad Ali; Najafi, Mahdi; Barkhordari, Khosro; Vaezi, Mitra; Rouhipour, Nahid

    2013-01-01

    Background: Central venous (CV) catheters play an essential role in the management of critically ill patients in the Intensive Care Unit (ICU). CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil (an antiseptic agent composed of H2O2 and silver) and a control group. Methods: This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgery ICUs of a heart center. The participants were divided into interventional (113 patients) and control (136 patients) groups. Sanosil was added to the routine preparation procedure (Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion). After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts. Results: Catheter colonization occurred in 55 (22.1%) patients: 26 (23%) patients in the Sanosil group and 29 (21.3%) in the control group; there was no significant statistical difference between the two groups (p value = 0.75, RR = 1.05, 95% CI: 0.76–1.45). The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis: 20 cases in the control group and 16 cases in the intervention group. Conclusion: Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization. PMID:23967028

  20. Pulmonary atresia with ventricular septal defect: a case for central venous pressure and oxygen saturation monitoring.

    PubMed Central

    Weiss, B. M.; Atanassoff, P. G.; Jenni, R.; Walder, B.; Wight, E.

    1998-01-01

    A 21-year-old patient with pulmonary atresia and ventricular septal defect (PA-VSD) was admitted to the hospital for tubal ligation. Invasive arterial and central venous (CVP) pressure, pulse oximetric oxygen saturation (SpO2), and (from the tip of oximetric central venous catheter) central venous oxygen saturation (ScvO2) and oxygen extraction rate (ExO2) were continuously monitored. Heart rate (range: 68-75 beat/min), mean arterial pressure (80-90 mmHg), CVP (7-10 mmHg), SpO2 (79-90 percent), ScvO2 (57-70 percent), and ExO2 (21-30 percent) remained stable during epidural anesthesia and transvaginal sterilization. Following an overnight stay (peak SpO2 92 percent; peak ScvO2 71 percent; through ExO2 21 percent), the oxygen data returned to baseline on awakening (SpO2 < 80 percent, ScvO2 < 55 percent, ExO2 > 35 percent), and the patient was discharged. In PA-VSD, a single-outlet double-ventricle anomaly, CVP reflects the preload of systemic ventricle. As the mixed venous oxygen saturation cannot be defined, ScvO2 is the best available indicator of the whole body oxygen consumption. Continuous monitoring of CVP, ScvO2 and ExO2 in the superior vena cava may provide more insight into the response to anesthesia and surgery in patients with PA-VSD. Images Figure 1 PMID:9713951

  1. Modeling of Fungal Biofilms Using a Rat Central-vein Catheter

    PubMed Central

    Nett, Jeniel E.; Marchillo, Karen; Andes, David R.

    2012-01-01

    SUMMARY Candida frequently grows as a biofilm, or an adherent community of cells protected from both the host immune system and antimicrobial therapies. Biofilms represent the predominant mode of growth for many clinical infections, including those associated with placement of a medical device. Here we describe a model for Candida biofilm infection of one important clinical niche, a venous catheter. This animal model system incorporates the anatomical site, immune components, and fluid dynamics of a patient venous catheter infection and can be used for study of biofilm formation, drug resistance, and gene expression. PMID:22328403

  2. Dilemma with the route of venous access for hemodialysis catheter insertion in a patient with dilated ischemic cardiomyopathy treated by cardiac resynchronization therapy

    PubMed Central

    Ashokananda, Devanahalli; Chakravarthy, Murali; Gowda, Mohan; Maddirala, Pavani; Sripar, Sanjay

    2016-01-01

    A 68 year old patient requiring urgent dialysis due to raising potassium was referred to our center. He had 3 indwelling catheters in his heart via right subclavian vein. His left subclavian and interngal jugular veins were thrombosed possibly due to earlier indwelling catheters. The dilemma was if right internal jugular venous route could be used for insertion of dialysis catheter. Under fluoroscopic guidance, right internal jugular vein was cannulated with the dialysis catheter without problems. This case is being presented to highlight the need for imaging both by ultrasound and radiography during the procedure. PMID:27397439

  3. Optoacoustic measurement of central venous oxygenation for assessment of circulatory shock: clinical study in cardiac surgery patients

    NASA Astrophysics Data System (ADS)

    Petrov, Irene Y.; Prough, Donald S.; Kinsky, Michael; Petrov, Yuriy; Petrov, Andrey; Henkel, S. Nan; Seeton, Roger; Salter, Michael G.; Esenaliev, Rinat O.

    2014-03-01

    Circulatory shock is a dangerous medical condition, in which blood flow cannot provide the necessary amount of oxygen to organs and tissues. Currently, its diagnosis and therapy decisions are based on hemodynamic parameters (heart rate, blood pressure, blood gases) and mental status of a patient, which all have low specificity. Measurement of mixed or central venous blood oxygenation via catheters is more reliable, but highly invasive and associated with complications. Our previous studies in healthy volunteers demonstrated that optoacoustic systems provide non-invasive measurement of blood oxygenation in specific vessels, including central veins. Here we report our first results of a clinical study in coronary artery bypass graft (CABG) surgery patients. We used a medical-grade OPO-based optoacoustic system developed in our laboratory to measure in real time blood oxygenation in the internal jugular vein (IJV) of these patients. A clinical ultrasound imaging system (GE Vivid e) was used for IJV localization. Catheters were placed in the IJV as part of routine care and blood samples taken via the catheters were processed with a CO-oximeter. The optoacoustic oxygenation data were compared to the CO-oximeter readings. Good correlation between the noninvasive and invasive measurements was obtained. The results of these studies suggest that the optoacoustic system can provide accurate, noninvasive measurements of central venous oxygenation that can be used for patients with circulatory shock.

  4. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

    PubMed

    Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

    2014-05-01

    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

  5. A new approach of extracting embolized venous catheters using a large-diameter steerable sheath under biplane fluoroscopy.

    PubMed

    Strohmer, Bernhard; Altenberger, Johann; Pichler, Maximilian

    2012-01-01

    To report the efficacy of a new percutaneous technique for extraction of embolized catheters, five female patients (62 ± 14 years) referred to our institution were analyzed. With the combination of a large-diameter steerable sheath with a sizeable snare system, three dislodged Port-A-Cath tubes and two ventriculoatrial shunts were retrieved successfully. Mean procedure time was 51 ± 23 min, biplane fluoroscopy time was 22 ± 21 min, and dose area product was 1188 ± 992 dGy cm(2). Percutaneous extraction of embolized venous catheters is highly effective with the help of this novel, self-assembled system. The presented technique provides major advantages with respect to three-dimensional steerability and should be considered for complex cases. PMID:22920353

  6. Sharp Central Venous Recanalization by Means of a TIPS Needle

    SciTech Connect

    Honnef, Dagmar Wingen, Markus; Guenther, Rolf W.; Haage, Patrick

    2005-06-15

    The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions.

  7. Sharp central venous recanalization by means of a TIPS needle.

    PubMed

    Honnef, Dagmar; Wingen, Markus; Günther, Rolf W; Haage, Patrick

    2005-01-01

    The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21 G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions. PMID:16091988

  8. Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical Intensive Care Unit

    PubMed Central

    Sathish, N.; Singh, Naveen G.; Nagaraja, P. S.; Sarala, B. M.; Prabhushankar, C. G.; Dhananjaya, Manasa; Manjunatha, N.

    2016-01-01

    Introduction: Central venous pressure (CVP) measurement is essential in the management of certain clinical situations, including cardiac failure, volume overload and sepsis. CVP measurement requires catheterization of the central vein which is invasive and may lead to complications. The aim of this study was to evaluate the accuracy of measurement of CVP using a new noninvasive method based on near infrared spectroscopy (NIRS) in a group of cardiac surgical Intensive Care Unit (ICU) patients. Methodology: Thirty patients in cardiac surgical ICU were enrolled in the study who had an in situ central venous catheter (CVC). Sixty measurements were recorded in 1 h for each patient. A total of 1800 values were compared between noninvasive CVP (CVPn) obtained from Mespere VENUS 2000 CVP system and invasive CVP (CVPi) obtained from CVC. Results: Strong positive correlation was found between CVPi and CVPn (R = 0.9272, P < 0.0001). Linear regression equation - CVPi = 0.5404 + 0.8875 × CVPn (r2 = 0.86, P < 0.001), Bland–Altman bias plots showed mean difference ± standard deviation and limits of agreement: −0.31 ± 1.36 and − 2.99 to + 2.37 (CVPi–CVPn). Conclusion: Noninvasive assessment of the CVP based on NIRS yields readings consistently close to those measured invasively. CVPn may be a clinically useful substitute for CVPi measurements with an advantage of being simple and continuous. It is a promising tool for early management of acute state wherein knowledge of CVP is helpful. PMID:27397443

  9. A Case-Control Study to Identify Risk Factors for Totally Implantable Central Venous Port-Related Bloodstream Infection

    PubMed Central

    Lee, Guk Jin; Hong, Sook Hee; Roh, Sang Young; Park, Sa Rah; Lee, Myung Ah; Chun, Hoo Geun; Hong, Young Seon; Kang, Jin Hyoung; Kim, Sang Il; Kim, Youn Jeong; Chun, Ho Jong; Oh, Jung Suk

    2014-01-01

    Purpose To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer. Materials and Methods A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time. Results CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047). Conclusion In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted. PMID:25038760

  10. Central venous port system associated thromboses: outcome in 3498 implantations and literature review

    PubMed Central

    Schumacher, Martina; Wagner, Roland H.

    2007-01-01

    Methods: From 1 July 1995 to 31 June 2006 we implanted 3498 intravenous port systems. In nearly all cases the indication was vascular access for chemotherapy. Results: We registered 199 complications (5.7%), mostly infections (n=85 i.e. 2.4%) and thromboses (n=63 i.e. 1.8%). Conclusions: Permanent central venous catheters have become standard in the management of patients with malignancies. Because of the improvement of material and design during the past twenty years technical complications have been reduced significantly. The most frequent occurring medical complications are infection and thromboses. In order to further minimize these disadvantages we developed a “best practices“ standard for port implantation combining own data with recent studies. PMID:19675714

  11. Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

    PubMed Central

    2013-01-01

    Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children. PMID:24041298

  12. [Peripheral venous catheterization: influence of catheter composition on the occurrence of thrombophlebitis].

    PubMed

    Jacquot, C; Fauvage, B; Bru, J P; Croize, J; Calop, J

    1989-01-01

    Infusion thrombophlebitis is a common troublesome complication of intravenous therapy. This study compared peripheral intravenous Teflon and Vialon catheters. The incidence of phlebitis, bacterial adherence and mechanical resistance (distortion) were assessed on 170 catheters, 85 of each type. The Vialon catheter resulted in less phlebitis than the Teflon one (18 vs. 35; p less than 0.01). During the period 49 to 72 h after the insertion of the catheter, the risk of phlebitis in the Teflon group was twice that in the Vialon group. The study of bacterial adherence using a semi-quantitative culture method demonstrated that 9.0% of the catheters were infected with Staphylococcus epidermidis. There was no statistically significant difference between the two groups (5.7% Vialon group vs. 12.5% Teflon group). The Teflon catheters were much more distorted than vialon catheters: 1.7% vs. 55.7% in the macroscopic study; 1.75% vs. 8.2% in the microscopic study. As Vialon softens at body temperature, it would seem likely that it generates a lesser degree of endothelial injury, explaining the lower rate of phlebitis with Vialon catheters. PMID:2633660

  13. Peripherally inserted central catheter placement using the Sonic Flashlight.

    PubMed

    Amesur, Nikhil B; Wang, David C; Chang, Wilson; Weiser, David; Klatzky, Roberta; Shukla, Gaurav; Stetten, George D

    2009-10-01

    The Sonic Flashlight is an ultrasound (US) device that projects real-time US images into patients with use of a semireflective/transparent mirror. The present study evaluated the feasibility of use of the Sonic Flashlight for clinical peripherally inserted central catheter placements, originally with the mirror located inside a sterile cover (n = 15), then with the mirror outside (n = 11). Successful access was obtained in all cases. Results show that this new design improved visibility, as judged subjectively firsthand and in photographs. The study demonstrated the feasibility of the Sonic Flashlight and the new design to help assure sterility without degrading visibility, allowing further clinical trials involving physicians and nurses. PMID:19699661

  14. Is Long Axis View Superior to Short Axis View in Ultrasound-Guided Central Venous Catheterization?

    PubMed Central

    Vogel, Jody A.; Haukoos, Jason S.; Erickson, Catherine L.; Liao, Michael M.; Theoret, Jonathan; Sanz, Geoffrey E.; Kendall, John

    2014-01-01

    Objective To evaluate whether using long axis (LA) or short axis (SA) view during ultrasound-guided internal jugular (IJ) and subclavian (SC) central venous catheterization (CVC) results in fewer skin breaks, decreased time to cannulation, and fewer posterior wall penetrations (PWP). Design Prospective, randomized crossover study. Setting Urban emergency department with approximate annual census of 60,000. Subjects Emergency medicine resident physicians at the Denver Health Residency in Emergency Medicine, a PGY 1-4 training program. Interventions Resident physicians blinded to the study hypothesis used ultrasound guidance to cannulate the IJ and SC of a human torso mannequin using the LA and SA views at each site. Measurements An ultrasound fellow recorded skin breaks, redirections, and time to cannulation. An experienced ultrasound fellow or attending used a convex 8–4 MHz transducer during cannulation to monitor the needle path and determine PWP. Generalized linear mixed models with a random subject effect were used to compare time to cannulation, number of skin breaks and redirections, and PWP of the LA and SA at each cannulation site. Results 28 resident physicians participated: 8 PGY-1, 8 PGY-2, 5 PGY-3, and 7 PGY-4. The median [interquartile range (IQR)] number of total IJ central venous catheters placed was 27 (IQR 9-42) and SC was 6 (IQR 2-20) catheters. The median number of previous ultrasound-guided IJ catheters was 25 (IQR 9-40), and ultrasound-guided SC catheters was 3 (IQR 0-5). The LA view was associated with a significant decrease in the number of redirections at the IJ and SC sites, relative risk (RR) 0.4 (95% confidence interval [CI] 0.2-0.9), and RR 0.5 (95% CI 0.3-0.7), respectively. There was no significant difference in the number of skin breaks between the LA and SA at the SC and IJ sites. The LA view for SC was associated with decreased time to cannulation; there was no significant difference in time between the SA and LA views at the IJ

  15. Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and postinsertion complications.

    PubMed

    Paulson, Pamela R; Miller, Kellee M

    2008-01-01

    Peripherally inserted central catheters (PICCs) continue to be necessary in neonatal care. They benefit many premature infants and those needing long-term intravenous access. An experienced inserter, early recognition of PICC candidates, early PICC placement, knowledge of anatomy, and correct choice of vein all increase placement success. As with any invasive procedure, there are risks. These include pain, difficulty advancing the catheter, damage to vessels, catheter malposition, and bleeding. Utilizing assessment skills, following the product manufacturer's instructions, and carefully placing the catheter should minimize most of these risks. Additional risks include postinsertion complications such as occlusions, thrombosis, catheter failure, infection, and catheter malposition. Proper nursing care--which includes controlling infection, properly securing the catheter, and changing the dressing as needed--is key to preventing complications and maintaining the PICC until treatment has been completed. PMID:18697655

  16. Mechanical thrombectomy for cerebral venous sinus thrombosis employing a novel combination of Angiojet and Penumbra ACE aspiration catheters: the Triaxial Angiojet technique.

    PubMed

    Bress, Aaron; Hurst, Robert; Pukenas, Bryan; Smith, Michelle; Kung, David

    2016-09-01

    Cerebral venous sinus thrombosis (CVST) can be life threatening. A previously healthy woman in her early forties on oral contraceptives presented with global CVST and rapid clinical deterioration. A novel 'Triaxial Angiojet technique' (KSAW Shuttle [Cook Inc., Bloomington, IN, USA], 5 MAX ACE [Penumbra Inc., Alameda, CA, USA], and Angiojet [Boston Scientific, Marlborough, MA, USA]) was employed to gain access into the superior sagittal sinus. The 5 MAX ACE reperfusion catheter was shortened prior to placing a 4 Fr Angiojet catheter through it. This resulted in markedly improved recanalization with good anterograde flow. The patient was extubated on postoperative day 2 and discharged neurologically intact on postoperative day 10. We report the first case of placing an Angiojet catheter through a larger Penumbra reperfusion catheter when access through a tortuous sigmoid and transverse sinus could not be obtained with a 6 Fr support catheter. PMID:27052259

  17. Recanalization of Acute and Subacute Venous and Synthetic Bypass-Graft Occlusions With a Mechanical Rotational Catheter

    SciTech Connect

    Wissgott, Christian Kamusella, Peter; Andresen, Reimer

    2013-08-01

    PurposePercutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions.Materials and MethodsForty-two patients (average age 65.8 {+-} 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 {+-} 2.9 (24-34) cm. Thirty-four (81 %) patients underwent venous bypass, and 8 (19 %) patients underwent polytetrafluoroethylene bypass.ResultsThe technical success rate was 97.6 % (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 {+-} 2.1 (4-9) min. Ankle-brachial index increased from 0.39 {+-} 0.13 to 0.83 {+-} 0.11 at discharge and to 0.82 {+-} 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8 %) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent.ConclusionPMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.

  18. Right atrial indwelling catheter for patients requiring long-term intravenous therapy.

    PubMed

    Ivey, M F; Adam, S M; Hickman, R O; Gibson, D L

    1978-12-01

    The use of a central venous catheter for long-term intravenous therapy is described. The catheter's history, physical description, and uses are discussed. Also reviewed are complications from use of the catheter, the pharmacist's role in patient teaching, and the procedure for administering medications through the catheter. A listing of drugs administered through the catheter, incompatibility data and patient teaching instructions are also included. PMID:717409

  19. Central venous Access device SeCurement And Dressing Effectiveness (CASCADE) in paediatrics: protocol for pilot randomised controlled trials

    PubMed Central

    Gibson, Victoria; Long, Debbie A; Williams, Tara; Hallahan, Andrew; Mihala, Gabor; Cooke, Marie; Rickard, Claire M

    2016-01-01

    Introduction Paediatric central venous access devices (CVADs) are associated with a 25% incidence of failure. Securement and dressing are strategies used to reduce failure and complication; however, innovative technologies have not been evaluated for their effectiveness across device types. The primary aim of this research is to evaluate the feasibility of launching a full-scale randomised controlled efficacy trial across three CVAD types regarding CVAD securement and dressing, using predefined feasibility criteria. Methods and analysis Three feasibility randomised, controlled trials are to be undertaken at the Royal Children's Hospital and the Lady Cilento Children's Hospital, Brisbane, Australia. CVAD securement and dressing interventions under examination compare current practice with sutureless securement devices, integrated securement dressings and tissue adhesive. In total, 328 paediatric patients requiring a peripherally inserted central catheter (n=100); non-tunnelled CVAD (n=180) and tunnelled CVAD (n=48) to be inserted will be recruited and randomly allocated to CVAD securement and dressing products. Primary outcomes will be study feasibility measured by eligibility, recruitment, retention, attrition, missing data, parent/staff satisfaction and effect size. CVAD failure and complication (catheter-associated bloodstream infection, local infection, venous thrombosis, occlusion, dislodgement and breakage) will be compared between groups. Ethics and dissemination Ethical approval to conduct the research has been obtained. All dissemination will be undertaken using the CONSORT Statement recommendations. Additionally, the results will be sent to the relevant organisations which lead CVAD focused clinical practice guidelines development. Trial registration numbers ACTRN12614001327673; ACTRN12615000977572; ACTRN12614000280606. PMID:27259529

  20. The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value

    PubMed Central

    Citilcioglu, Serenat; Sebe, Ahmet; Oguzhan Ay, Mehmet; Icme, Ferhat; Avci, Akkan; Gulen, Muge; Sahan, Mustafa; Satar, Salim

    2014-01-01

    Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient's intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration. PMID:24772133

  1. Defining the surface anatomy of the central venous system in children.

    PubMed

    Tarr, Gregory P; Pak, Neda; Taghavi, Kiarash; Iwan, Tom; Dumble, Charlotte; Davies-Payne, David; Mirjalili, S Ali

    2016-03-01

    Pediatric emergency physicians, pediatric critical care specialists, and pediatric surgeons perform central venous catheterization in many clinical settings. Complications of the procedure are not uncommon and can be fatal. Despite the frequency of application, the evidence-base describing the surface landmarks involved is missing. The aim of the current study was to critically investigate the surface markings of the central venous system in children. The superior vena cava/right atrial (SVC/RA) junction, superior vena cava (SVC) formation, and brachiocephalic vein (BCV) formation were examined independently by two investigators. Three hundred computed tomography (CT) scans collected across multiple centers were categorized by age group into: 0-3 years, 4-7 years, and 8-11 years. Scans with pathology that distorted or obscured the regional anatomy were excluded. The BCV formation was commonly found behind the ipsilateral medial clavicular head throughout childhood. This contrasts with the variable levels of SVC formation, SVC length, and SVC/RA junction. In the youngest group, SVC formation was most commonly at the second costal cartilage (CC), but moved to the first CC/first intercostal space (ICS) as the child grew. The SVC/RA junction was at the fourth CC in the youngest group and moved to the third CC/third ICS as the child grew. This study demonstrates the variable anatomy of SVC formation and the SVC/RA junction with respect to rib level. This variability underscores the unreliability of surface anatomical landmarks of the SVC/RA junction as a guide to catheter tip position. Clin. Anat. 29:157-164, 2016. © 2015 Wiley Periodicals, Inc. PMID:26518452

  2. Measurement of Cardiac Index by Transpulmonary Thermodilution Using an Implanted Central Venous Access Port: A Prospective Study in Patients Scheduled for Oncologic High-Risk Surgery

    PubMed Central

    Suria, Stéphanie; Wyniecki, Anne; Eghiaian, Alexandre; Monnet, Xavier; Weil, Grégoire

    2014-01-01

    Background Transpulmonary thermodilution allows the measurement of cardiac index for high risk surgical patients. Oncologic patients often have a central venous access (port-a-catheter) for chronic treatment. The validity of the measurement by a port-a-catheter of the absolute cardiac index and the detection of changes in cardiac index induced by fluid challenge are unknown. Methods We conducted a monocentric prospective study. 27 patients were enrolled. 250 ml colloid volume expansions for fluid challenge were performed during ovarian cytoreductive surgery. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution by a central venous access (CIcvc) and by a port-a-catheter (CIport) were recorded. Results 23 patients were analyzed with 123 pairs of measurements. Using a Bland and Altman for repeated measurements, the bias (lower and upper limits of agreement) between CIport and CIcvc was 0.14 (−0.59 to 0.88) L/min/m2. The percentage error was 22%. The concordance between the changes in CIport and CIcvc observed during volume expansion was 92% with an r = 0.7 (with exclusion zone). No complications (included sepsis) were observed during the follow up period. Conclusions The transpulmonary thermodilution by a port-a-catheter is reliable for absolute values estimation of cardiac index and for measurement of the variation after fluid challenge. Trial Registration clinicaltrials.gov NCT02063009 PMID:25136951

  3. Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial.

    PubMed

    Abdelkefi, Abderrahman; Ben Othman, Tarek; Kammoun, Leïla; Chelli, Mouna; Romdhane, Neïla Ben; Kriaa, Azza; Ladeb, Saloua; Torjman, Lamia; Lakhal, Amel; Achour, Wafa; Ben Hassen, Assia; Hsaïri, Mohamed; Ladeb, Fethi; Ben Abdeladhim, Abdeladhim

    2004-09-01

    We have conducted a prospective randomized controlled trial to evaluate the role of low-dose unfractionated heparin prophylaxis in preventing central venous line-related thrombosis in patients with haemato-oncological disease. Patients were randomly assigned to receive either prophylactic intravenous unfractionated heparin (continuous infusion of 100 IU/kg/daily) or 50 ml/daily of normal saline solution as a continuous infusion. CVLs were externalized, non tunneled, double lumen catheters. All CVLs were placed percutaneously by the same physician in the subclavian vein. Upper limb veins were systematically examined by ultrasonography just before, or <24 hours after, catheter removal, and in case of clinical signs of thrombosis. One hundred and twenty-eight CVLs were inserted. Catheter-related thrombosis occurred in 1.5% of the catheters inserted in patients of the heparin group, and in 12.6% in the control group (p = 0.03). No other risk factors were found for the development of catheter-related thrombosis. Two and three patients experienced severe bleeding in the heparin group, and in the control group, respectively (p = 0.18). There were no other side-effects clearly ascribable to the use of unfractionated heparin. This is the first prospective, randomized study, which shows that low-dose of unfractionated heparin is safe and effective to prevent catheter-related thrombosis in patients with haemato-oncological disease. PMID:15351864

  4. The relationship between superior vena cava diameter and collapsibility and central venous pressure.

    PubMed

    Cowie, B S; Kluger, R; Rex, S; Missant, C

    2015-05-01

    The aim of this study was to assess the relationship between superior vena cava (SVC) diameter, collapsibility and central venous pressure (CVP) in cardiac surgical patients. SVC maximum and minimum diameters, plus collapsibility with ventilation, were measured with transoesophageal echocardiography in the mid-oesophageal bicaval view with M-mode. Simultaneously, CVP was measured via the right atrial port of a pulmonary artery catheter. Measurements were possible in 91 out of 92 patients. The median CVP was 10 mmHg with a range of 2 to 19 mmHg. There was a weak, but statistically significant, correlation between CVP and SVC collapsibility index (r=-0.21, P=0.049). There was no statistically significant correlation between maximum SVC diameter and CVP. Maximum SVC diameter was statistically significantly correlated with weight (Pearson's r=0.28, P=0.008). There was no statistically significant correlation between CVP and age or body dimensions. Our findings indicate that SVC diameter and collapsibility are easily measured with transoesophageal echocardiography but do not reliably reflect CVP in anaesthetised cardiac surgical patients. PMID:25943610

  5. Is there resetting of central venous pressure in microgravity?

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.; Ludwig, D. A.; Elliott, J. J.; Wade, C. E.

    2001-01-01

    In the early phase of the Space Shuttle program, NASA flight surgeons implemented a fluid-loading countermeasure in which astronauts were instructed to ingest eight 1-g salt tablets with 960 ml of water approximately 2 hours prior to reentry from space. This fluid loading regimen was intended to enhance orthostatic tolerance by replacing circulating plasma volume reduced during the space mission. Unfortunately, fluid loading failed to replace plasma volume in groundbased experiments and has proven minimally effective as a countermeasure against post-spaceflight orthostatic intolerance. In addition to the reduction of plasma volume, central venous pressure (CVP) is reduced during exposure to actual and groundbased analogs of microgravity. In the present study, we hypothesized that the reduction in CVP due to exposure to microgravity represents a resetting of the CVP operating point to a lower threshold. A lower CVP 'setpoint' might explain the failure of fluid loading to restore plasma volume. In order to test this hypothesis, we conducted an investigation in which we administered an acute volume load (stimulus) and measured responses in CVP, plasma volume and renal functions. If our hypothesis is true, we would expect the elevation in CVP induced by saline infusion to return to its pre-infusion levels in both HDT and upright control conditions despite lower vascular volume during HDT. In contrast to previous experiments, our approach is novel in that it provides information on alterations in CVP and vascular volume during HDT that are necessary for interpretation of the proposed CVP operating point resetting hypothesis.

  6. Pyoderma gangrenosum after totally implanted central venous access device insertion

    PubMed Central

    Inan, Ihsan; Myers, Patrick O; Braun, Rolf; Hagen, Monica E; Morel, Philippe

    2008-01-01

    Background Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25–50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents. Case presentation A 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath®) insertion. Fever and inflammatory skin reaction at the site of insertion developed on the seventh post-operative day, requiring the device's explanation. A rapid progression of the skin lesions evolved into a circular skin necrosis. Intravenous steroid treatment stopped the necrosis' progression. Conclusion Early diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum. PMID:18325095

  7. Potential involvement of the extracranial venous system in central nervous system disorders and aging

    PubMed Central

    2013-01-01

    Background The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. Discussion A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. Summary Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials. Please see related editorial: http://www.biomedcentral.com/1741-7015/11/259. PMID:24344742

  8. Catheter Securement Systems for Peripherally Inserted and Nontunneled Central Vascular Access Devices

    PubMed Central

    Krenik, Karen M.; Smith, Graham E.

    2016-01-01

    Sutureless catheter securement systems are intended to eliminate risks associated with sutures. The clinical acceptability of a novel system was investigated compared with the current method of securement for peripherally inserted central catheters (19 facilities using StatLock or sutures) or nontunneled central vascular access devices (3 facilities using StatLock or sutures or HubGuard + Sorbaview Shield). More than 94% of respondents rated the novel system as same, better, or much better than their current product. More than 82% of respondents were willing to replace their current system with the new one. PMID:27379679

  9. Fracture and atypical migration of an implantable central venous access device.

    PubMed

    Mery, Mirela; Palengat, Stéphanie; Loffroy, Romaric; Vernet, Magali; Matet, Pascal; Cherblanc, Violaine

    2016-06-01

    Distal embolization of a fractured indwelling central catheter is a rare complication. The pinch-off syndrome (POS) should be known, prevented and early detected. We present a case in which further radiological exams were required to find the fragmented catheter with an atypical migration, requiring local surgery for removing. After chest and abdominal CT scan, neck X-ray, and heart echography, the catheter was found on the lower limbs X-ray on the internal side of right knee corresponding to a location of saphenous vein. Implanted catheters should be removed after completion of treatment and the integrity of the system should be monitored. To avoid POS, a catheter must be inserted into the subclavian vein as laterally as possible. PMID:27429915

  10. Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man

    NASA Technical Reports Server (NTRS)

    Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.

    1978-01-01

    Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.