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1

Central Venous Catheter Access  

Microsoft Academic Search

Central venous access for the purpose of supplying parenteral nutrition to the pediatric age group requires a careful definition of the patient’s caloric need, estimated duration of therapy, and an assessment of available sites. Peripheral vein parenteral nutrition is limited by caloric density of the nutrient fluids, while peripherally inserted central catheters (PICC) offers a new technology for accessing central

Dai H Chung; Moritz M Ziegler

1998-01-01

2

Central venous catheter - flushing  

MedlinePLUS

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

3

Thrombolytic therapy for central venous catheter occlusion  

PubMed Central

Background Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and Methods This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms “central venous catheter”, “central venous access device” OR “central venous line” associated with the terms “obstruction”, “occlusion” OR “thrombolytic” was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. Results Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67–74% within 30–40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16–68% in the control group to 4–23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. Conclusions Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID:22180420

Baskin, Jacquelyn L.; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Pui, Ching-Hon; Howard, Scott C.

2012-01-01

4

Spontaneous migration of central venous catheter tip following extubation  

PubMed Central

Migration of the tip of central venous catheters is not an uncommon event and the mechanism for this is not clear. Increased intrathoracic pressure due to coughing, sneezing or weight lifting, changing the body position or physical movements such as abduction or adduction of the arms is thought to be the cause of such migration. We present here a case of a patient with a port catheter tip that migrated from the left subclavian to the superior vene cava following extubation. PMID:24665255

Prabaharan, Balaji; Thomas, Sara

2014-01-01

5

Preventing central venous catheter-related bloodstream infection.  

PubMed

Nurses should be able to apply evidence-based practice in a way that is appropriate for the individual patient. This article discusses one area, the incidence of central venous catheter-related bloodstream infection in acute care, to examine the available evidence and identify ways in which this evidence can be applied to practice. Research indicates that implementing best practice at the time of insertion is a principal determinant in minimising the risk of catheter-related bloodstream infection. PMID:25563126

Wilson, Charlotte

2015-01-01

6

Diagnosis of central venous catheter-related bloodstream infection without catheter removal: A prospective observational study  

PubMed Central

Background Catheter-related bloodstream infections (CRBSI) resulting from bacterial colonisation of an intravascular catheter are the leading cause of nosocomially acquired sepsis contributing significantly towards in-hospital morbidity and mortality. Suspicion of central venous CRBSI leads frequently to catheter withdrawal but not all infection requires the catheter to be withdrawn; therefore, diagnosis of central venous CRBSI without catheter withdrawal is a necessity. Methods The study was prospectively performed in a cohort of adult patients who had short term central venous catheter use. The samples collected from each patients included, skin swab from insertion site, swab from catheter hub, paired blood samples from catheter and from the peripheral vein for quantitative blood culture collected within 15 min of each other and catheter-tip sample by cutting off the tip (distal 5-cm segment). All samples were processed immediately. Results 50 episodes of clinical sepsis involving 100 patients occurred in the study population. 28 of the episodes were confirmed as CR-BSI (56%). Blood culture from the central venous catheter had the highest sensitivity (71.43%) and the greatest negative predictive value (86.67%). However, the peripheral blood culture was most specific and had the highest positive predictive value (specificity75%; positive predictive value 50%). The most accurate technique was differential quantitative blood cultures (accuracy 72%), followed by semiquantitative superficial cultures (accuracy 68%), although there were no statistically significant differences between values. Conclusion We recommend combining semiquantitative cultures and peripheral blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique. PMID:24623941

Kumar, Alok; Sharma, R.M.; Jaideep, C.N.; Hazra, Nandita

2013-01-01

7

Cost/benefit analysis of chlorhexidine-silver sulfadiazine-impregnated venous catheters for femoral access.  

PubMed

Sixty-four patients with chlorhexidine-silver sulfadiazine-impregnated catheters had a lower rate of catheter-related bloodstream infection and lower central venous catheter-related costs per catheter day than 190 patients with a standard catheter. PMID:25278411

Lorente, Leonardo; Lecuona, María; Jiménez, Alejandro; Lorenzo, Lisset; Diosdado, Sara; Marca, Lucía; Mora, María L

2014-10-01

8

Neonatal central venous catheter thrombosis: diagnosis, management and outcome.  

PubMed

Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. There is no guideline that systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC-related thrombosis. A comprehensive search of the scientific literature was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged below 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for over 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products and malpositioned UVCs were identified as risk factors. The commonest diagnostic investigations to confirm thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis, but this warrants close monitoring. Thrombolysis with urokinase alone or combined with low-molecular-weight heparin might be effective and well tolerated as treatment strategies. Prophylactic heparin increases the duration of catheter usability (P?catheter occlusion, but may not uniformly prevent thrombosis. CVL-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC-related thrombosis and to institute safe therapeutic modalities. PMID:24477225

Park, Christina K; Paes, Bosco A; Nagel, Kim; Chan, Anthony K; Murthy, Prashanth

2014-03-01

9

Intensivist supervision of resident-placed central venous catheters decreases the incidence of catheter-related blood stream infections  

Microsoft Academic Search

Catheter-related blood stream infections (CRBSI) cause significant morbidity and mortality. A retrospective study of a performance improvement project in our teaching hospital's surgical intensive care unit (SICU) showed that intensivist supervision was important in reinforcing maximal sterile barriers (MSB) use during the placement of a central venous catheter (CVC) in the prevention of CRBSI. A historical control period, 1 January

Thomas J Papadimos; Sandra J Hensely; Joan M Duggan; James P Hofmann; Sadik A Khuder; Marilyn J Borst; John J Fath

2008-01-01

10

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

PubMed

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

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

2000-11-01

11

Accidental migration of ASH-split catheter during central venous catheter replacement: retrieval using an interventional radiology approach.  

PubMed

Catheter fracture and embolization of the distal fragment are well-known complications of subclavian central venous long-term cannulation. In hemodialysis it is an exceptional event. We report a case of accidental rupture of a cuffed hemodialysis catheter with distal migration of a fragment during a procedure of catheter exchange via guide-wire. According to most reported cases, intravascular catheter separation usually occurs completely asymptomatically; our report confirms that catheter embolization itself is usually asymptomatic. Less than one third of the literature-reported cases have associated symptoms, such as palpitations or chest discomfort. Once diagnosed, treatment is an interventional radiological approach, which has a very high success rate. The replacement of permanent cuffed hemodialysis catheters via guide-wire is a delicate procedure and if catheter embolization is diagnosed, the patient must be referred to a center with specific experience in the retrieval of intravascular objects. PMID:17638263

Galli, S; Zollo, A; Cavatorta, F; Gazzo, P

2001-01-01

12

Cost-effective supply use in permanent central venous catheter operations.  

PubMed

A prospective, randomized trial was designed to determine whether a streamlined operating room supply pack was cost-effective in the placement of permanent central venous catheters. Over a 12-month period, 139 consecutive patients were randomized and evaluated. There were no differences found between the mean ages, sex, indication for catheter placement, mean operative time, or surgeon and nurse satisfaction between treatment groups. In addition, 30-day catheter infection rate, 30-day catheter malfunction rate, and 30-day catheter removal rate were similar between groups. Supply costs were $411.32 per patient operation in the control group and only $180.34 per patient operation in the study group, resulting in an average cost-effectiveness ratio of $230.98 per catheter placed. Based on these data, a streamlined operating room supply setup is cost-effective in the operative placement of permanent central venous catheters. PMID:9128234

Howard, T J; Stines, C P; O'Connor, J A; Schuster, W S; Wiebke, E A

1997-05-01

13

Extravasation from venous catheter: a serious complication potentially missed by lung imaging  

SciTech Connect

Three patients were referred for lung ventiliation and perfusion (V/Q) imaging with symptoms strongly suggestive of pulmonary embolus (PE). Chest roentgenograms and xenon ventilation studies on all three were normal, save for prominent mediastinal silhouettes and effusions. Technetium-99m macroaggregated albumin(Tc-99m MAA), when injected through the central venous catheter (CVP), revealed mediastinal localization, whereas antecubital injections showed normal pulmonary perfusion. Contrast fluoroscopy introduced through the venous catheter in the first patient defined the extravasation. For patients under strong suspicion of PE, with a venous catheter whose distal tip is seen about the level of the heart on chest radiograph, the authors recommend administering the perfusion agent slowly through the central catheter to exclude catheter-induced complications. When extravasation is detected, injection of Tc-99m MAA by peripheral vein should be used to exclude PE.

Spicer, K.M.; Gordon, L.

1983-11-01

14

The carina as a landmark for central venous catheter placement in small children  

Microsoft Academic Search

Central venous devices are frequently used in children to monitor haemodynamic status, to administer fluids, medication, parenteral\\u000a nutrition and for blood sampling. Life-threatening complications that may occur on insertion if the central venous catheter\\u000a (CVC) is misplaced, are cardiac tamponade or a hydro-\\/haemopericardium. There is still controversy over the optimum catheter\\u000a tip position in paediatric patients, whether to place the

Knut Albrecht; Dirk Breitmeier; Bernhard Panning; Hans Dieter Tröger; Heike Nave

2006-01-01

15

In-vitro efficacy of a central venous catheter complexed with iodine to prevent bacterial colonization.  

PubMed

Infections of central venous lines are still a problem in daily medicine. Despite adequate antibiotic therapy, removal of an infected catheter often becomes necessary. A simple procedure has been developed by which a special hydrophilic central venous catheter (Secalon-Hydrocath) can be loaded with iodine. Iodine is complexed in the hydrophilic polyvinylpyrrolidone surface coating of the Hydrocath catheter and is released during contact with an aqueous medium. The amount of complexed iodine depends on the incubation time in Lugol's solution. Antimicrobial activity of the loaded catheters was assessed with Staphylococcus epidermidis, showing complete inhibition of bacterial adherence to the catheters for the duration of iodine release. Depending on the experimental conditions, iodine released from the catheter is also active on bacteria in the surrounding medium. PMID:1399922

Jansen, B; Kristinsson, K G; Jansen, S; Peters, G; Pulverer, G

1992-08-01

16

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

SciTech Connect

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.

Neuerburg, Joerg-M.; Guenther, Rolf W. [Department of Diagnostic Radiology, University of Technology Aachen, Pauwelsstrasse 30, D-52057 Aachen (Germany); Chalabi, Khaled [Department of Vascular and Thoracic Surgery, University of Technology Aachen, Pauwelsstrasse 30, D-52057 Aachen (Germany); Hunter, David [Department of Radiology, Fairview-University Medical Center, 420 Delaware Street S.E., Box 292, Minneapolis, MN 55455 (United States)

1999-01-15

17

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

PubMed

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

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

2014-01-01

18

Successful Use of Central Venous Catheter as Permanent Hemodialysis Access: 84Month Follow-Up in Lucania  

Microsoft Academic Search

Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an essential role in providing permanent access in subjects in whom all other access options have been exhausted. The predominant complications are catheter thrombosis, catheter fibrin sheating and infection. The aim of this study was to evaluate long-term survival and

B. Di Iorio; T. Lopez; M. Procida; P. Marino; V. Valente; F. Iannuzziello; A. Bombini; V. Bellizzi; V. Terracciano; C. Bagnato; F. Casino; V. Gaudiano; D. Mostacci; G. Santarsia; R. Biscione; A. Caputo; G. Ferlan; M. A. Lauria; G. Marinaro; R. Molinari; D. Sanicandro; M. A. Lotito; G. Plastino; P. Carretta

2001-01-01

19

Central venous catheter infection-induced Henoch-Schönlein purpura in a patient on hemodialysis.  

PubMed

A 69-year-old man, who had been dialyzed using a permanent central venous catheter for 2 years, presented with Henoch-Schönlein purpura and positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA). He was diagnosed with catheter-related infection by Staphylococcus aureus. After administration of antibiotic and steroid therapy, purpura disappeared and p-ANCA gradually became negative. This case supports the conclusion that infection can be pathogenesis of the vasculitis, including ANCA-positive HSP. Additionally, impregnation of catheters with antibiotics can be an effective treatment for catheter infections. PMID:24845224

Gao, Jian Jun; Wei, Jia Mei; Gao, Yue Hua; Li, Shuang; Na, Yu

2014-08-01

20

Creating and Evaluating a Data-Driven Curriculum for Central Venous Catheter Placement  

PubMed Central

Background Central venous catheter placement is a common procedure with a high incidence of error. Other fields requiring high reliability have used Failure Mode and Effects Analysis (FMEA) to prioritize quality and safety improvement efforts. Objective To use FMEA in the development of a formal, standardized curriculum for central venous catheter training. Methods We surveyed interns regarding their prior experience with central venous catheter placement. A multidisciplinary team used FMEA to identify high-priority failure modes and to develop online and hands-on training modules to decrease the frequency, diminish the severity, and improve the early detection of these failure modes. We required new interns to complete the modules and tracked their progress using multiple assessments. Results Survey results showed new interns had little prior experience with central venous catheter placement. Using FMEA, we created a curriculum that focused on planning and execution skills and identified 3 priority topics: (1) retained guidewires, which led to training on handling catheters and guidewires; (2) improved needle access, which prompted the development of an ultrasound training module; and (3) catheter-associated bloodstream infections, which were addressed through training on maximum sterile barriers. Each module included assessments that measured progress toward recognition and avoidance of common failure modes. Since introducing this curriculum, the number of retained guidewires has fallen more than 4-fold. Rates of catheter-associated infections have not yet declined, and it will take time before ultrasound training will have a measurable effect. Conclusion The FMEA provided a process for curriculum development. Precise definitions of failure modes for retained guidewires facilitated development of a curriculum that contributed to a dramatic decrease in the frequency of this complication. Although infections and access complications have not yet declined, failure mode identification, curriculum development, and monitored implementation show substantial promise for improving patient safety during placement of central venous catheters. PMID:21976088

Duncan, James R.; Henderson, Katherine; Street, Mandie; Richmond, Amy; Klingensmith, Mary; Beta, Elio; Vannucci, Andrea; Murray, David

2010-01-01

21

Bacteriophage K for reduction of Staphylococcus aureusbiofilm on central venous catheter material  

PubMed Central

The purpose of this project was to determine whether bacteriophage can reduce bacterial colonization and biofilm formation on central venous catheter material. Twenty silicone discs were inoculated for 24 h with broth culture of Methicillin sensitive staphylococcus aureus (0.5 McFarland standard). The inoculate was aspirated and discs placed into two equal groups for 24 h: (1) untreated controls; (2) bacteriophage treatment (staphylococcal bacteriophage K, propagated titer > 108). At the completion of the experiment discs were processed for quantitative culture. Statistical testing was performed using the rank sum test. Mean colony forming units (CFU) were significantly decreased in experimental compared with controls (control 6.3 × 105 CFU, experimental 6.7 × 101, P ? 0.0001). Application of bacteriophage to biofilm infected central venous catheter material significantly reduced bacterial colonization and biofilm presence. Our data suggests that bacteriophage treatment may be a feasible strategy for addressing central venous catheter staph aureus biofilm infections. PMID:24265979

Lungren, Matthew P; Christensen, Diana; Kankotia, Ravi; Falk, Irene; Paxton, Ben E; Kim, Charles Y

2013-01-01

22

Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients  

Microsoft Academic Search

Objective To compare the incidence of catheter colonization and catheter-related bloodstream infections between heparin-coated catheters and those coated with a synergistic combination of chlorhexidine and silver sulfadiazine. Design Randomized, controlled clinical trial. Setting A 20-bed medical-surgical intensive care unit. Patients A total of 180 patients requiring the insertion of a trilumen central venous catheter. Interventions Patients were randomized to receive

M. N. Carrasco; A. Bueno; C. de las Cuevas; S. Jimenez; I. Salinas; A. Sartorius; T. Recio; M. Generelo; F. Ruiz-Ocaña

2004-01-01

23

Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter  

Microsoft Academic Search

Antiseptic coating of intravascular catheters may be an effective means of decreasing catheter-related colonization and subsequent infection. The purpose of this study was to assess the efficacy of chlorhexidine and silver sulfadiazine (CH-SS)-impregnated central venous catheters (CVCs) to prevent catheter-related colonization and infection in patients with hematological malignancies who were subjected to intensive chemotherapy and suffered from severe and sustained

K. Jaeger; S. Zenz; B. Jüttner; H. Ruschulte; E. Kuse; J. Heine; S. Piepenbrock; A. Ganser; M. Karthaus

2005-01-01

24

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

PubMed

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

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

2014-10-01

25

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

PubMed

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

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

2014-10-01

26

Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters  

Microsoft Academic Search

Simultaneously drawn quantitative blood cultures are used to diagnose catheter-related bloodstream infections. We conducted\\u000a this study to determine the frequency with which central venous catheters were the source of bloodstream infections detected\\u000a through paired positive blood cultures drawn from cancer patients and the potential for quantitative blood cultures to help\\u000a predict outcome in neutropenic and non-neutropenic patients. From September 1999

I. Raad; R. Hachem; H. Hanna; P. Bahna; I. Chatzinikolaou; X. Fang; Y. Jiang; R. F. Chemaly; K. Rolston

2007-01-01

27

Clearance of Cellulosimicrobium cellulans bacteremia in a child without central venous catheter removal.  

PubMed

Cellulosimicrobium cellulans (formerly known as Oerskovia xanthineolytica) rarely causes human infection. Infections have been reported in immunocompromised hosts or in patients with foreign bodies, such as catheters, where treatment has generally involved removal of the foreign body. We report on a case in which the organism was isolated in multiple blood cultures from a 13-year-old male. After initial therapy failed, treatment with vancomycin and rifampin resulted in infection clearance without removal of the central venous catheter. PMID:16825406

Rowlinson, Marie-Claire; Bruckner, David A; Hinnebusch, Claudia; Nielsen, Karin; Deville, Jaime G

2006-07-01

28

Clearance of Cellulosimicrobium cellulans Bacteremia in a Child without Central Venous Catheter Removal  

PubMed Central

Cellulosimicrobium cellulans (formerly known as Oerskovia xanthineolytica) rarely causes human infection. Infections have been reported in immunocompromised hosts or in patients with foreign bodies, such as catheters, where treatment has generally involved removal of the foreign body. We report on a case in which the organism was isolated in multiple blood cultures from a 13-year-old male. After initial therapy failed, treatment with vancomycin and rifampin resulted in infection clearance without removal of the central venous catheter. PMID:16825406

Rowlinson, Marie-Claire; Bruckner, David A.; Hinnebusch, Claudia; Nielsen, Karin; Deville, Jaime G.

2006-01-01

29

Life-threatening anaphylactic shock due to chlorhexidine on the central venous catheter: a case series  

PubMed Central

In this article, we report two life-threatening anaphylactic shocks by an antiseptic coated central venous catheter (CVC) within a 6-month period in our cancer center. Anaphylactic shock was preceded immediately after insertion of a central venous catheter (CVC) coated with silver sulphadiazine and chlorhexidine acetate (Blue FlexTip® ARROWg+ard Blue®, 14Ga, Arrow International, Inc. USA). Though antiseptic coated CVC anaphylaxis has been reported in Japan, Europe and America, to our knowledge, this is first reported in China. We present these rare cases to remind clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. PMID:25664137

Weng, Meilin; Zhu, Minmin; Chen, Wankun; Miao, Changhong

2014-01-01

30

[Venous lesions in relation to injections and the use of catheters].  

PubMed

The point of this study is to draw attention to the many complications which are likely to arise when the venous network is injected or cathetered. The main complications affecting the peripheral veins are lesions at the puncture point, cutaneous necroses in the case of paravenous injections, accidental intra-arterial injection, and chemical and bacterial thrombophlebites. The catheterism of intrathoracic veins can cause lesions at the puncture point (pneumothorax, lesion of the carotid), wrong positioning of the catheter and of the vascular or cardiac perforations, and central venous thromboses responsible for septicemic conditions and/or pulmonary embolism. PMID:4095145

Otteni, J C; Gaudias, J; Mayer, J F

1985-01-01

31

Comparison of NHSN-Defined Central Venous Catheter Day Counts with a Method that Accounts for Concurrent Catheters.  

PubMed

Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates. Infect Control Hosp Epidemiol 2015;36(1): 107-109. PMID:25627768

Talbot, Thomas R; Johnson, James G; Anders, Theodore; Hayes, Rachel M

2015-01-01

32

Factors influencing the prevalence of central venous catheter use in a Canadian haemodialysis centre  

Microsoft Academic Search

Background. The arteriovenous (AV) fistula is the opti- mal vascular access for chronic haemodialysis (HD) pa- tients. The Dialysis Outcomes and Practice Patterns Study (DOPPS II) reported a high use of central venous (CV) catheters for HD in Canadian centres. We studied factors influencing the choice of access in a prevalent HD popula- tion at a Canadian centre. Methods. This

Janet Graham; Swapnil Hiremath; Peter O. Magner; Greg A. Knoll; Kevin D. Burns

2008-01-01

33

Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children  

Microsoft Academic Search

Background  Peripherally inserted central venous catheters (PICCs) have been increasingly used in pediatric patients. However, little is known about the incidence and risk of complications when using this device in children with cancer. The purposes of this study are to assess the feasibility of PICCs and to determine the risk factors for PICC-related complications in pediatric patients with various types of

Akinobu Matsuzaki; Aiko Suminoe; Yuhki Koga; Miho Hatano; Sagano Hattori; Toshiro Hara

2006-01-01

34

Comparative In Vitro Efficacies and Antimicrobial Durabilities of Novel Antimicrobial Central Venous Catheters  

Microsoft Academic Search

We investigated the efficacies and durability of novel antimicrobial central venous catheters (CVCs) in preventing the adherence of microbial organisms to the surfaces of the CVCs. Novel antimicrobial CVCs investigated in this in vitro study were impregnated with antibiotics (minocycline and rifampin), with Oligon agent (silver, platinum, and carbon black), with approved antiseptics (chlorhexidine and silver sulfadiazine), or with a

Hend Hanna; Paul Bahna; Ruth Reitzel; Tanya Dvorak; Gassan Chaiban; Ray Hachem; Issam Raad

2006-01-01

35

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

SciTech Connect

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.

Teichgraeber, Ulf Karl-Martin, E-mail: ulf.teichgraeber@charite.de; Streitparth, Florian, E-mail: florian.streitparth@charite.d [Charite Universitaetsmedizin Berlin, Institut fuer Diagnostische und Interventionelle Radiologie (Germany); Gebauer, Bernhard, E-mail: bernhard.gebauer@charite.d [Charite Universitaetsmedizin Berlin, Klinik fuer Strahlenheilkunde (Germany); Benter, Thomas, E-mail: Thomas.Benter@klinikum-rg.d [Elblandkliniken Riesa-Grossenhain gGmbH, Klinik fuer Innere Medizin II Haematologie/Onkologie und Gastroenterologie (Germany)

2010-04-15

36

Successful treatment of central venous catheter induced superior vena cava syndrome with ultrasound accelerated catheter-directed thrombolysis.  

PubMed

Superior vena cava (SVC) syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology, especially lung cancer and lymphoma. Thrombosis is becoming increasingly common due to the use of indwelling catheters and implantable central venous access devices. Most patients are unresponsive to anticoagulation alone which appears to be effective only in the mildest cases. However, recent advances in catheter-based interventions have led to the development of a variety of minimally invasive endovascular strategies to remove venous thrombus and accepted as an important first-line treatment given its high overall success rate and low morbidity as compared with medical and surgical treatments. Ultrasound accelerated catheter-directed thrombolysis (UACDT) has been developed to rapidly and completely resolve the existing thrombus. This technique integrates high frequency, low intensity ultrasound (US) with standard CDT in order to accelerate clot dissolution, reducing treatment time and the incidence of thrombolysis-related complications. An US wave enhances drug permeation through thrombus by disaggregating the fibrin matrix, exposing additional plasminogen receptor sites to the thrombolytic agent. The US energy affects thrombus in the entire venous segment, increasing the probability of complete thrombus clearing. We report the case of a 56-year-old man who presented with a 5 days history of SVC syndrome symptoms who had been receiving chemotherapy for colon cancer through a right subclavian vein port catheter. The patient successfully treated with UACDT with EkoSonic(®) Mach4e Endovascular device with an overnight infusion. © 2013 Wiley Periodicals, Inc. PMID:23404752

Dumantepe, Mert; Tarhan, Arif; Ozler, Azmi

2013-06-01

37

Sonication for diagnosis of catheter-related infection is not better than traditional roll-plate culture: a prospective cohort study with 975 central venous catheters.  

PubMed

This prospective randomized controlled study with 975 nontunneled central venous catheters (CVCs) showed that the semiquantitative roll-plate culture technique (SQC) was as accurate as the sonication method for diagnosis of catheter-related infections. Sonication is difficult to standardize, whereas SQC is simpler, faster, and as reliable as the sonication method for culturing CVCs. PMID:24825872

Erb, Stefan; Frei, Reno; Schregenberger, Katharina; Dangel, Marc; Nogarth, Danica; Widmer, Andreas F

2014-08-15

38

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

SciTech Connect

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

Rao, Sandeep, E-mail: sandeep.rao@osumc.edu; Hogan, Mark J. [Ohio State University Medical Center, Department of Radiology (United States)

2010-08-15

39

Central Venous Catheter Salvage in Home Parenteral Nutrition Catheter-Related Bloodstream Infections: Long-Term Safety and Efficacy Data.  

PubMed

Background: Catheter-related bloodstream infections (CRBSIs) are a serious complication in the provision of home parenteral nutrition (HPN). Antibiotic salvage of central venous catheters (CVCs) in CRBSI is recommended; however, this is based on limited reports. We assessed the efficacy of antibiotic salvage of CRBSIs in HPN patients. Materials and Methods: All confirmed CRBSIs occurring in patients receiving HPN in a national intestinal failure unit (IFU), between 1993 and 2011, were analyzed. A standardized protocol involving antibiotic and urokinase CVC locks and systemic antibiotics was used. Results: In total, 588 patients were identified with a total of 2134 HPN years, and 297 CRBSIs occurred in 137 patients (65 single and 72 multiple CRBSIs). The overall rate of CRBSI in all patients was 0.38 per 1000 catheter days. Most (87.9%) infections were attributable to a single microorganism. In total, 72.5% (180/248) of CRBSIs were salvaged when attempted (coagulase-negative staphylococcus, 79.8% [103/129], Staphylococcus aureus, 56.7% [17/30]; polymicrobial infections, 67.7% [21/30]; and miscellaneous, 66.1% [39/59]). CVC salvage was not attempted in 49 episodes because of life-threatening sepsis (n = 18), fungal infection (n = 7), catheter problems (n = 20), and CVC tunnel infection (n = 4). Overall, the CVC was removed in 33.7% (100/297) of cases. There were 5 deaths in patients admitted to the IFU for management of the CRBSI (2 severe sepsis at presentation, 3 metastatic infection). Conclusions: This is the largest reported series of catheter salvage in CRBSIs and demonstrates successful catheter salvage in most cases when using a standardized protocol. PMID:25224728

Dibb, Martyn J; Abraham, Arun; Chadwick, Paul R; Shaffer, Jon L; Teubner, Antje; Carlson, Gordon L; Lal, Simon

2014-09-15

40

Do central venous catheters have advantages over arteriovenous fistulas or grafts?  

PubMed

Central venous accesses have become an integral component of vascular access procedures for hemodialysis. Although the DOQI guidelines recommend that less than 10% of chronic hemodialysis patients should be maintained on catheters, in some countries higher prevalences are reported, as in the United States and the United Kingdom (18% and 24%, respectively, according to the DOPPS). The native arteriovenous fistulas are still the best suited accesses for hemodialysis. However, this option is impractical in many situations, so that several justifiable reasons exist for protracted dialysis catheter use; these include the catheter as a bridge angioaccess device, while the patient is awaiting living-related kidney donor transplantation or maturation of an autologous fistula or graft or, increasingly, as the permanent vascular access for patients with unsuitable vascular anatomy who have exhausted all other options. Moreover, the surgical creation of an AVF is felt to be impossible or at least seems to entail significant risks in situations of high output cardiac failure, myocardial ischaemic events and steal syndrome. In these cases, the dialysis access catheter brings considerable advantages, but it also carries tremendous drawbacks. In addition to the increased risk of luminal thrombosis, infection, unreliable blood flows, central venous stenosis, shorter use life and patient cosmetic concern, tunneled catheters are associated with an increased risk of death. Tunnellization, exit site protection, antibiotic-coated or antiseptic-impregnated hemodialysis catheters, antibiotic lock solutions could be helpful in preventing and treating catheter-related bacteremias. Moreover, the development of a subcutaneous port, that is durable, offers a high blood flow and is fully implantable subcutaneously, may become an alternative for chronic use. In our 10-year experience we implanted in our center over 450 central venous catheters with a satisfactory survival (86% at 1 year and 79% at 2 years for the subcutaneous port). In a matched comparison between Tesio twin catheters and Dialock ports (37 vs. 35, respectively), followed for a 2 year period, no significant differences emerged as regards bacteremia incidence, 0.58/1,000 catheter-days in the Tesio catheter group vs. 0.9/1000 catheter-days in the subcutaneous port group, p=0.12; thrombolytic agents needed, 4.5% vs 4.3% of dialysis sessions; or access failure with removal of the device, 8.1% vs 14.2%, p=0.4. The longer duration of antibiotic therapy in the Tesio group (24.6 vs 14.3 days, p=0.006) was due to the higher incidence of cutaneous infectious episodes (3.8 vs 0.16/1,000 catheter-days). In conclusion, although central venous catheter is the vascular access of last choice, in particular cases it can be a useful alternative, provided that strict protocols for nursing care and proper catheter management are implemented in every center. PMID:16874685

Quarello, Francesco; Forneris, Giacomo; Borca, Marco; Pozzato, Marco

2006-01-01

41

Fatal cardiac tamponade associated with central venous catheter: a report of 2 cases diagnosed in autopsy.  

PubMed

The authors present 2 cases of fatal cardiac tamponade associated with the insertion of a central venous catheter. The first case occurred soon after the insertion of the catheter (early complication), and the second case, 4 days after (late complication). In both cases, the post-catheter insertion check chest x-ray film showed the tip of the catheter located within the heart silhouette. The diagnosis of cardiac tamponade was made only during the cadaverous examination. In the first case, the catheter was found to be in the right internal jugular vein at autopsy. The postmortem examination showed a clear liquid inside the pericardial cavity and the inferior vena cava injury. In the second case, the catheter had been inserted via the right subclavian vein puncture and there was a perforation of the right atrium at autopsy. The child was using total parenteral nutrition, and the intrapericardial liquid was milky. The incorrect placement of the catheter tip and unrecognized complications led the 2 children to death. PMID:24457580

dos Santos Modelli, Manoel Eugenio; Cavalcanti, Felipe Barbosa

2014-03-01

42

Catheter venography and endovascular treatment of chronic cerebrospinal venous insufficiency.  

PubMed

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

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

2012-06-01

43

Complications Related to Insertion and Use of Central Venous Catheters (CVC)  

PubMed Central

ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion. PMID:25568558

Hodzic, Samir; Golic, Darko; Smajic, Jasmina; Sijercic, Selma; Umihanic, Sekib; Umihanic, Sefika

2014-01-01

44

Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature  

PubMed Central

Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur. PMID:24826318

Khasawneh, Faisal A.; Smalligan, Roger D.

2011-01-01

45

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

SciTech Connect

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.

Teichgraber, Ulf K.M. [Charite Campus Virchow-Klinikum Humboldt-Universitaet zu, Berlin, Augusten berger Platz 1, 13353 Berlin, Department of Radiology (Germany)], E-mail: ulf.teichgraeber@charite.de; Nibbe, Lutz [Charite Campus Virchow-Klinikum Humboldt-Universitaet zu Berlin, Berlin, Department of Internal Medicine and Nephrology (Germany); Gebauer, Bernhard; Wagner, Hans-Joachim [Charite Campus Virchow-Klinikum Humboldt-Universitaet zu, Berlin, Augusten berger Platz 1, 13353 Berlin, Department of Radiology (Germany)

2003-11-15

46

Etiology and retrieval of retained central venous catheter fragments within the heart and great vessels of infants and children  

Microsoft Academic Search

Background: The use of centrally positioned venous catheters plays an indispensable role in the care of infants and children.Methods: Since 1992 the authors have seen nine patients who experienced fragmentation and migration of catheter fragments into the central circulation. The patients ranged in age from 6 days to 15 years.Results: Sites of migration included pulmonary artery (five patients), superior vena

Michael M Fuenfer; Keith E Georgeson; Walter S Cain; Edward V Colvin; Walter H Johnson; F. Bennett Pearce; William S McMahon

1998-01-01

47

Preventing biofilm formation and associated occlusion by biomimetic glycocalyxlike polymer in central venous catheters.  

PubMed

The use of catheters and other implanted devices is constantly increasing in modern medicine. Although catheters improve patients' healthcare, the hydrophobic nature of their surface material promotes protein adsorption and cell adhesion. Catheters are therefore prone to complications, such as colonization by bacterial and fungal biofilms, associated infections, and thrombosis. Here we describe the in vivo efficacy of biologically inspired glycocalyxlike antiadhesive coatings to inhibit Staphylococcus aureus and Pseudomonas aeruginosa colonization on commercial totally implantable venous access ports (TIVAPs) in a clinically relevant rat model of biofilm infection. Although noncoated TIVAPs implanted in rats were heavily colonized by the 2 biofilm-forming pathogens with a high percentage of occlusion, coating TIVAPs reduced their initial adherence and subsequently led to 4-log reduction in biofilm formation and reduced occlusion. Our antiadhesive approach is a simple and generalizable strategy that could be used to minimize clinical complications associated with the use of implantable medical devices. PMID:24795479

Chauhan, Ashwini; Bernardin, Aude; Mussard, Windy; Kriegel, Irène; Estève, Marc; Ghigo, Jean-Marc; Beloin, Christophe; Semetey, Vincent

2014-11-01

48

In Vitro Evaluation of the Antibacterial Activity of Three Different Central Venous Catheters Against Gram-Positive Bacteria  

Microsoft Academic Search

.   The aim of this study was to evaluate the activity of three different catheters against Staphylococcus aureus ATCC 29213 and the slime-producing Staphylococcus epidermidis ATCC 35984 (RP62A). Three central venous catheters were evaluated: one impregnated with silver sulfadiazine–chlorhexidine,\\u000a one to which minocycline\\/rifampin is bonded and a novel one into which silver, platinum and carbon are incorporated. A nonantiseptic\\u000a catheter

K. Yorganci; C. Krepel; J. Weigelt; C. Edmiston

2002-01-01

49

[Sterile film as a barrier method in central venous catheter placement].  

PubMed

Sepsis related to central venous catheter (CVC) is an important reason of nosocomial infection in which most of the causal microorganisms are originated in the patient's skin. This study aims to evaluate the efficiency of a sterile film as a method of antimicrobial barrier in the placement of CVC. We have studied the infection incidence and the number of days of the catheter placement in two groups, one experimental group in which the CVC was inserted through a sterile adherent film and another group in which the CVC was inserted according to the current hospital protocol. This is a randomized experimental quantitative study in the setting of an Intensive Care Unit (ICU) of the Bellvitge University Hospital. Our study sample was made up of 100 critical patients. The effectiveness of this film was measured by controlling the infection incidence in the different groups, using a point of insertion smear, culture of the catheter tip and blood cultures after withdrawal. The results were interpreted according to the criteria of the ICACC (Interscience Conference on Antimicrobial Agents and Chemotherapy). A decrease of the percentage of positive smears (12.3%), positive tops of catheter (6.1%) and bacteriemia related to the catheter (8.9%) with the use of the barrier method has been demonstrated. We conclude that using the polyethylene hypoallergenic sterile adherent film is an effective antimicrobial barrier method in insertion of the CVC. PMID:18358117

Izquierdo Fuentes, M T; Justel García, R; Moral Quintana, C; García Pastor, E; Mora Muñiz, V; Martínez Estalella, G

2008-01-01

50

Approach to prophylactic measures for central venous catheter-related infections in hemodialysis: a critical review.  

PubMed

Vascular access is the major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. The type of vascular access most associated with bloodstream infection is central venous catheter (CVC). The incidence of catheter-related bacteremia ranges between 0.6 and 6.5 episodes per 1000 catheter days and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC-related infections have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted in order to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. In the following article, prophylactic measures against CVC-related infections in HD patients and their possible advantages and limitations will be discussed, and the more recent literature on clinical experience with prophylactic antimicrobial lock therapy in HD CVCs will be reviewed. PMID:23944971

Silva, Tricya N V; de Marchi, Daniel; Mendes, Marcela L; Barretti, Pasqual; Ponce, Daniela

2014-01-01

51

Complications of central venous catheters in children undergoing hematopoietic stem cell transplantation in Turkey.  

PubMed

Although central venous catheters (CVCs) have become an integral element of the care of patients undergoing hematopoietic stem cell transplantation (HSCT), the associated complications can lead to treatment delays and negatively affect the child and family's quality of life. The aim of this study was to identify the types, rate of, and risk factors for the complications relating to CVCs used in children undergoing HSCT in Turkey. One hundred children were followed prospectively to track catheter-related complications in the transplantation unit. Overall, 186 complications were documented. The most frequent complications were catheter-related infections and malfunctions. Children who had nonhematological disease had a higher rate of complications than those with hematological disease. HSCT nurses should follow and apply evidence-based clinical practice guidelines to support the management of catheters. Nurse staffing ratios and workload may be an issue in developing countries. The authors believe that proper maintenance of CVCs contributes to the reduction of catheter-related complications despite these issues and that problems can be overcome by hiring experienced staff, appropriate nursing education, and by organizing and improving home care programs for HSCT patients. PMID:22797681

Yilmaz, Medine C; Aksoylar, Serap; Erdogan, Durdane; Demirag, Bengu

2012-01-01

52

Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial  

Microsoft Academic Search

It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater sisk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the

C. Logghe; Ch. Van Ossel; W. D'Hoore; H. Ezzedine; G. Wauters; J. J. Haxhe

1997-01-01

53

The impact of increased blood flow rates on recirculation in central venous hemodialysis catheters.  

PubMed

A recent practice change in our unit from Quinton dual lumen PermCaths to Vas-Cath Optiflow central venous catheters resulted in the routine achievement of bloodflow rates (BFR) of 500 ml/min. Previously BFRs of 300-400 ml/min were the norm. The increased BFR was achieved without any apparent increase in venous pressure, prompting us to consider the possibility that increased recirculation was occurring. This paper presents the results of a study designed to answer the following questions: (a) What is the difference in recirculation rates between Quinton dual lumen PermCaths and Vas-Cath Optiflow dual lumen catheters? and (b) What is the impact of increased BFR on recirculation rates in Optiflow hemodialysis catheters? The study documented recirculation rates in two groups of patients. In Group 1, the Optiflow group, recirculation rates were calculated for 10 subjects, first at 350 ml/min and then at 500 ml/min. In Group 2, the PermCath Group, recirculation rates were calculated for 10 subjects at 300 ml/min. Paired t-tests were performed to compare Group 1 at 350 ml/min with Group 2. No significant differences were found within or between groups suggesting that recirculation rates were not affected by increased BFR. PMID:12143473

Szabo, J; Locking-Cusolito, H

2001-12-01

54

Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis.  

PubMed

Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9 F (range 8-16 F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2 %). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1 %) hematoma and 1 (1 %) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9 %) cases of thrombosis and 1 (2.2 %) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P = 0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD. PMID:23504572

Yeral, Mahmut; Boga, Can; Oguzkurt, Levent; Asma, Suheyl; Kasar, Mutlu; Kozanoglu, Ilknur

2014-01-01

55

The role of routine chest radiography for detecting complications after central venous catheter insertion.  

PubMed

Chest radiographs are obtained routinely after central venous catheter (CVC) insertion in many institutions, although it consumes time and money. The purpose of this study was to evaluate the role of post-procedural chest X-ray in detecting complications of CVC insertion; we performed CVC insertion without using ultrasonography guidance. A total of 454 patients who required an emergency vascular access for hemodialysis between February 2008 and March 2010 were included in this study. In cases where three to five unsuccessful attempts were encountered to place the CVC or pierce the artery, we used another site for CVC placement or we placed the CVC under ultrasonographic guidance. Both the internal jugular and the subclavian veins were used as routes for catheter insertion. All the catheters were dual lumen and were inserted by the same vascular access surgeon. All the catheters were inserted using the same protocol. This protocol consists of five stages including position, percutaneous anesthesia, puncture, pull out and placement. Chest radiography was obtained after the procedure and patients were interviewed for the presence of any unusual symptoms. The X-rays were reviewed by a radiologist who was unaware of the patients' symptoms. Complications occurred in two patients who had unusual symptoms after the placement of the catheter. Although immediate postprocedural chest radiography is recommended for tip position confirmation, it should not be considered a reliable procedure for detecting complications in the absence of clinical symptoms. It is recommended to monitor patients after catheter insertion and perform delayed chest X-ray in the presence of any unusual symptoms. PMID:25193899

Zadeh, Morteza Kavanin; Shirvani, Amir

2014-09-01

56

Ultrasound-accelerated catheter-directed thrombolysis for the management of postpartum deep venous thrombosis.  

PubMed

Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism, which remains an important cause of maternal morbidity and mortality. Although oral or systemic anticoagulation therapy may minimize thrombus propagation, it remains ineffective in removing thrombus burden and consequently does not prevent post-thrombotic syndrome. A novel technique, ultrasound accelerated catheter directed thrombolysis (UACDT), has been developed to rapidly and completely resolve thrombus. While pregnancy and the postpartum period are generally considered as contraindications for thrombolysis, we demonstrate in this case study the safety and effectiveness of using UACDT to treat symptomatic, postpartum, iliofemoral deep vein thrombosis after only an overnight infusion. PMID:23379969

Dumantepe, Mert; Tarhan, Ibrah?m Arif; Yurdakul, Ilhan; Ozler, Azmi

2013-05-01

57

Clinical significance of isolated Staphylococcus aureus central venous catheter tip cultures.  

PubMed

This retrospective cohort study examined the clinical significance of isolated Staphylococcus aureus central venous catheter (CVC) tip cultures (i.e., positive tip cultures without concomitant positive blood cultures). Subsequent S. aureus bacteraemia was found in nine (12%) of 77 patients at a median time of 4 days after CVC removal. A high co-morbidity score and no effective antibiotic treatment within 48 h of CVC removal were independent risk-factors for septic complications following multivariate analysis. A matched case-control study that compared the above cohort with patients with CVC tip cultures negative for S. aureus supported the significance of these findings. PMID:16882304

Ruhe, J J; Menon, A

2006-09-01

58

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial  

Microsoft Academic Search

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related\\u000a infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open,\\u000a controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units\\u000a at a university hospital undergoing chemotherapy for haematological or oncological malignancies

Heiner Ruschulte; Matthias Franke; Petra Gastmeier; Sebastian Zenz; Karl H. Mahr; Stefanie Buchholz; Bernd Hertenstein; Hartmut Hecker; Siegfried Piepenbrock

2009-01-01

59

Hospital-Wide Multidisciplinary, Multimodal Intervention Programme to Reduce Central Venous Catheter-Associated Bloodstream Infection  

PubMed Central

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

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

2014-01-01

60

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

ClinicalTrials.gov

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

2014-10-09

61

A cross-sectional study to compare two blood collection methods: direct venous puncture and peripheral venous catheter  

PubMed Central

Objectives To demonstrate the equivalence between blood collection methods using direct venous puncture (DVP) and a peripheral venous catheter or cannula (PVC). Design and setting A cross-sectional study of simple crossover design with within-subject measures carried out between October 2011 and May 2012 at a regional hospital in Spain. Participants 272 patients aged 18 or older hospitalised or admitted to the short-stay unit (SSU) who required laboratory testing and PVC to administer saline solution, intravenous fluid therapy and/or intravenous medication. Excluded were those with PVC collection time exceeding 20?s, difficulty of venoclysis, or who presented with arteriovenous fistula, language difficulties, in critical condition or altered consciousness with no family to consent. Primary and secondary outcome measures 18 variables were recorded for DVP and PVC, along with age, sex, diagnosis, vein location for DVP, location of the PVC, PVC calibre, saline syringe, intravenous fluid therapy, medication, haemolysis and clotted blood during DVP or PVC collection. Univariate analysis, Pearson's product-moment correlation coefficient (r), Lin's concordance correlation coefficient (rc) and Bland-Altman's 95% agreement interval were provided. Results Included in the study were 272 patients, primarily aged 65 or older (80.9%), males (52.6%) and receiving intermittent medication (43.4%). Values obtained with both methods showed a positive linear association, being moderate for pO2 (r=0.405) and very high for all others (r>0.86). Levels were concordant (rc?0.9), except for calcium (rc=0.860), pH (rc=0.853), pCO2 (rc=0.843) and pO2 (rc=0.336) and equivalent for all determinations except pCO2 and pO2, where clinically significant differences were found in more than 9% of cases (21.2%, 95% CI 16.6% to 26.5% and 73.1%, 95% CI 67.4% to 78.1%). Conclusions Blood collection methods using DVP and PVC can be used interchangeably for most routine laboratory tests. PMID:24578539

Ortells-Abuye, Nativitat; Busquets-Puigdevall, Teresa; Díaz-Bergara, Maribel; Paguina-Marcos, Marta; Sánchez-Pérez, Inma

2014-01-01

62

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

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

2014-01-01

63

Impact of Chlorhexidine-Silver Sulfadiazine-Impregnated Central Venous Catheters on In Vitro Quantitation of Catheter-Associated Bacteria  

Microsoft Academic Search

tion of 10 3 CFU ofStaphylococcus epidermidisper ml, aliquots of catheter-exposed broth were subcultured onto blood agar at 15-min intervals. Decreased mean colony counts were noted at 45 min for broth exposed to antiseptic-impregnated catheters compared with the colony counts for broth exposed to non-antiseptic-im- pregnated catheters (170 versus 540 CFU\\/ml). These effects, which were also demonstrated by the roll-plate

STEVEN K. SCHMITT; CYNTHIA KNAPP; GERALDINE S. HALL; DAVID L. LONGWORTH; JAMES T. MCMAHON

1996-01-01

64

Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.  

PubMed

The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ?60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion. PMID:25407386

Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

2014-12-01

65

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

SciTech Connect

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.

Guntur Ramkumar, Prasad, E-mail: prasad.guntur@nhs.net; Chakraverty, Sam, E-mail: schakraverty@nhs.net; Zealley, Ian, E-mail: ian.zealley@nhs.ne [Ninewells Hospital and Medical School, Department of Clinical Radiology, NHS Tayside (United Kingdom)

2010-02-15

66

Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme  

Microsoft Academic Search

Risk factors for central venous catheter (CVC)-related bacteraemia among infants admitted to a neonatal intensive care unit (NICU) were analysed and the impact of surveillance and continuing education on the incidence of this complication investigated. Among patients admitted to a NICU, CVC-related bacteraemia increased from 115 (7%) in 1987 to 1126 (42%) in 1988 (P = 0·01). Coagulase-negative staphylococci isolated

A. Maas; P. Flament; A. Pardou; A. Deplano; M. Dramaix; M. J. Struelens

1998-01-01

67

Candida parapsilosis Fungemia Associated with Implantable and Semi-Implantable Central Venous Catheters and the Hands of Healthcare Workers  

Microsoft Academic Search

A cluster of six cases of fungemia among hematology, bone marrow transplant, and oncology patients was investigated in a case-control study (18 controls). The use of implantable and semi-implantable central venous catheters was significantly associated with cases (p = 0.016). The hands of three healthcare workers (HCWs) were positive for Candida parapsilosis. Electrophoretic karyotyping showed two profiles among patients and

A. S Levin; S. F Costa; N. S Mussi; M Basso; S. I Sinto; C Machado; D. C Geiger; M. C. B Villares; A. Z Schreiber; A. A Barone; M. L. M Branchini

1998-01-01

68

Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging  

PubMed Central

The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC), indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins) yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi. PMID:23935636

Colombo, Alberto; Maccari, Giuseppe; Congiu, Terenzio; Basso, Petra; Baj, Andreina; Toniolo, Antonio

2013-01-01

69

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial.  

PubMed

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days. Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006. Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under standardized conditions and were randomized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a standard sterile dressing. Daily routine included clinical assessment of the insertion site (swelling, pain, redness), temperature, white blood count and C-reactive protein. Catheters remained in place until they were no longer needed or when a CVC-related infection was suspected. Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method. Six hundred and one patients were included. The groups were comparable with respect to demographic and clinical data. The incidence of CVC-related infections were 11.3% (34 of 301) and 6.3% (19 of 300) in the control and chlorhexidine-impregnated wound dressing groups, respectively (p=0.016, relative risk 0.54; confidence interval 0.31-0.94). Especially, catheter-related infections at internal jugular vein insertions could be reduced (p=0.018). No adverse effects related to the intervention were observed. The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy. PMID:18679683

Ruschulte, Heiner; Franke, Matthias; Gastmeier, Petra; Zenz, Sebastian; Mahr, Karl H; Buchholz, Stefanie; Hertenstein, Bernd; Hecker, Hartmut; Piepenbrock, Siegfried

2009-03-01

70

Misinsertion of central venous catheter into the suspected vertebral vein: a case report  

PubMed Central

We experienced a case in which a central venous catheter (CVC) was misplaced into the wrong vein, which was mistaken for the internal jugular vein (IJV), identified by chest x-ray and ultrasound. The vertebral vein passes through the transverse foramina from the atlas to the 6th cervical vertebra. After exiting the transverse foramen of the 6th vertebra, the vein subsequently runs anterolateral to the vertebral artery and posterior to the IJV and drains the innominate vein. In this case, chest x-ray and ultrasound revealed that the inserted CVC had a course very similar to the vertebral vein. The misplacement of a CVC into the vertebral vein might occur from excessive rotation of the patient's head, which leads to alterations in the cervical vascular anatomy, and from deep insertion of the puncture needle. Therefore, it is advised, for safe CVC insertion, to minimize a patient's head rotation and to make use of ultrasound when the anatomical structures cannot be clearly identified. PMID:25473464

Yang, So-Hee; Jung, Sung-Mee

2014-01-01

71

Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion  

PubMed Central

Background and Aim: Central venous catheter (CVC) insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA) field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Methods: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 ?g/kg) or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points. Results: The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7]) and at the end of procedure (5 [4-5]), which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively). The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008). Conclusions: Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose. PMID:25024470

Samantaray, Aloka

2014-01-01

72

The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection.  

PubMed

Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections. PMID:24006027

Arora, Navneet; Patel, Killol; Engell, Christian A; LaRosa, Jennifer A

2013-09-01

73

Recirculation in double lumen catheter veno-venous extracorporeal membrane oxygenation measured by an ultrasound dilution technique.  

PubMed

Recirculation is a limiting factor for oxygen delivery in double lumen catheter veno-venous extracorporeal membrane oxygenation (DLVV-ECMO). This study compares three different methods for the determination of the recirculation fraction during double lumen catheter veno-venous ECMO at ECMO flow rates of 150, 125, 100, 75, and 50 ml/kg.min in nine lambs: (1) an ultrasound dilution method, in which the change in ultrasound velocity in blood after injection of a saline bolus as a marker is used for determination of recirculation; (2) an SvO2 method using real mixed venous blood oxygen saturation, the gold standard, for determination of recirculation fraction; and (3) the CVL method, in which oxygen saturation of a blood sample of the inferior vena cava is considered to represent mixed venous oxygen saturation. In all methods, the recirculation fraction increased with increasing ECMO flow rate. The correlation coefficient between the ultrasound dilution method and the SvO2 method was 0.68 (p < 0.01); mean difference was -2.4% (p = 0.6). Correlation coefficient between the ultrasound dilution method and the CVL method was 0.48 (p < 0.01); mean difference was -18.1% (p < 0.01). The correlation coefficient between the SvO2 method and the CVL method was 0.51 (p < 0.01); mean difference was -15.7% (p < 0.01). The ultrasound dilution method is a useful method for measurement of the recirculation fraction in DLVV-ECMO and is easier to use than the other methods. PMID:11482489

van Heijst, A F; van der Staak, F H; de Haan, A F; Liem, K D; Festen, C; Geven, W B; van de Bor, M

2001-01-01

74

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

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

Maneval, Rhonda E; Clemence, Bonnie J

2014-01-01

75

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

SciTech Connect

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.

Wissgott, Christian, E-mail: cwissgott@wkk-hei.de; Kamusella, Peter; Andresen, Reimer [Westkuestenklinikum Heide-Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Institute of Diagnostic and Interventional Radiology/Neuroradiology (Germany)

2013-08-01

76

Costoclavicular pinching: a complication of long-term central venous catheters. A report of three cases.  

PubMed

In the course of 1994-1995 we found three nearly identical cases involving fracture of polyurethane catheters from subcutaneous implantable vascular ports. This resulted in complications: leakage of drugs and infusions and thereby soft tissue damage. The leakage occurred in the costoclavicular space in all instances. We assume that the catheters have been subjected to repeated pinching, resulting in material fatigue. In order to eliminate the risk of this serious complication, the subclavian route should be avoided and preference given to the approach via the internal jugular vein. PMID:9698968

Nøstdahl, T; Waagsbø, N A

1998-08-01

77

[Less pain during puncture by a peripheral venous catheter; a bibliographical review on adults].  

PubMed

Canalizing veins is a habitual technique carried out by nurses. Inserting a catheter in a peripheral vein causes pain. The importance of fine quality in nursing treatment implicitly bears on a person's well-being. In daily practice, health professionals do not use any method to reduce pain when inserting a catheter. The authors observations led them to believe in the need to carry out a bibliographical review whose objective was to discover all the methods used to reduce pain caused by puncturing a peripheral vein. Six randomly assigned clinical tests and a meta-analysis evaluate the effectiveness of: The use of Valsalva, an analgesic cream which contains two local amino-amide anesthetics; lidocaine and prylocaine (EMLA) compared to another analgesic cream, Myolaxin; a meta-analysis of twenty studies evaluates the degree by which pain is diminished by one such method: an EMLA cream; an anti-inflammatory skin dressing (diclofenaco), a diclofenaco dressing versus an EMLA anesthetic dressing, 0.25 ml subcutaneous injection of 1% mepivaína, an amida type local anesthetic; and direct photography moments before puncture occurs to use the effects of a flash of light. All these methods studied proved effective in reducing pain. Creams and dressing prove to be unaggressive methods but require some time for application prior to puncture. Using a camera flash, subcutaneous injection of mepivacaine and the application of Valsalva can be effective alternatives to reduce pain when puncturing veins in patients who require emergency care. PMID:20672715

Prat González, Irene; Fuentes i Pumarola, Concepció; Bertran Noguer, Carme; Ballester Ferrando, David; Juvinyà Canal, Dolors; Vila Vidal, Dalmau

2010-06-01

78

Catheter-Related Thrombosis  

Microsoft Academic Search

The use of central venous catheters (CVC) has greatly facilitated the delivery of chemotherapeutic agents and is one of the\\u000a most important aspects of the supportive care of patients with cancer. The most frequently utilized central venous catheters\\u000a in cancer care include totally implanted catheter systems and single or multilumen tunneled catheters. Despite the convenience\\u000a of use of CVC, thrombosis

César O. Freytes

79

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

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

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

80

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

PubMed

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

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

81

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

PubMed Central

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

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

82

Infusion of noradrenaline through the proximal line of a migrated central venous catheter.  

PubMed

A 41-year-old, obese, patient was admitted to Accident and Emergency with a history of leg cellulitis. A central line was inserted. Documented aspiration of blood from all lines, central venous pressure trace obtained and correct position noted on the chest X-ray (CXR). The patient became increasingly septic despite antibiotic therapy. He was subsequently commenced on a noradrenaline infusion; however, the blood pressure was unresponsive. On admission to the intensive care unit (ICU), it was noted he had an area of white skin over the right clavicle. The infusions were stopped and a CXR confirmed proximal migration of the line. The central line was re-sited and his noradrenaline recommenced with an improvement in his blood pressure. Acute renal failure developed which required haemofiltration for 24 hours. The condition improved and the patient was discharged from ICU. It took several weeks for his renal function to return to normal, but he was discharged home with no permanent damage. PMID:22859814

Freer, M; Noble, S

2012-08-01

83

Efficacy of 1.0% chlorhexidine-gluconate ethanol compared with 10% povidone-iodine for long-term central venous catheter care in hematology departments: a prospective study.  

PubMed

The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration. PMID:24655901

Yamamoto, Natsuo; Kimura, Hideo; Misao, Hanako; Matsumoto, Hayato; Imafuku, Yuji; Watanabe, Akemi; Mori, Hiroko; Yoshida, Akiko; Miura, Saori; Abe, Yoshinobu; Toba, Mamoru; Suzuki, Hiromi; Ogawa, Kazuei; Kanemitsu, Keiji

2014-05-01

84

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

PubMed Central

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

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

2013-01-01

85

Successful catheter directed thrombolysis in postpartum deep venous thrombosis complicated by nicoumalone-induced skin necrosis and failure in retrieval of inferior vena caval filter.  

PubMed

Venous thromboembolism is an important cause for maternal morbidity and mortality in postpartum period. Though catheter-directed thrombolysis (CDT) is now considered as a safe and effective therapy for the management of deep venous thrombosis (DVT) but still it is not indicated in postpartum DVT. We are presenting a case of 22-year-old female patient who presented with post-partum lower limb DVT and managed successfully with CDT by using injection streptokinase and temporary inferior vena caval filter was inserted as prophylactic for pulmonary embolism as she had extensive DVT extending into inferior vena cava (IVC). During follow-up, she developed large skin necrosis in left lower limb which was managed by adding injection low-molecular-weight heparin. IVC filter also could not be retrieved even after trying all manoeuvres during follow-up after 2 weeks. PMID:23887994

Srinivas, B C; Patra, Soumya; Agrawal, Navin; Manjunath, C N

2013-01-01

86

Management of a small bowel transplant with complicated central venous access in a patient with asymptomatic superior and inferior vena cava obstruction.  

PubMed

During the past few years, small bowel transplantation (SBT) has become a realistic alternative for patients with irreversible intestinal failure who have or will develop severe complications from total parenteral nutrition (TPN). Transplantation can be associated with large fluid shifts and massive blood loss necessitating rapid infusions of large quantities of crystalloid and/or blood products. Invasive monitoring and large-bore venous access are necessary in order to manage these patients intraoperatively. Because patients with irreversible intestinal failure are often managed with total parenteral nutrition via a central venous catheter, thrombotic intraluminal obstruction of major vessels may develop over time. Additionally, this may lead to superior vena cava (SVC) syndrome as well as challenging problems with vascular access. We present a 34-year-old woman with a past medical history for long-standing Crohn's disease with multiple small bowel resections and short gut syndrome who presented for an SBT. The patient had a long history of TPN use, complicated by SVC syndrome and inferior vena cava (IVC) obstruction. She was presently asymptomatic from her SVC obstruction. Central venous access was obtained by an interventional radiologist. A 7-French double-lumen Hickman minicatheter was placed in the left femoral vein with the tip of the catheter positioned just distal to the IVC narrowing. A left radial 20-gauge arterial line was placed for hemodynamic monitoring and frequent blood sampling. The patient's left and right dorsal-saphenous veins were cannulated with 16-guage catheters and adequate flow was observed. Lower extremity pressure was measured via the Hickman catheter in the left femoral vein. A multiplane transesophageal echo was used to assess ventricular volume. The options and intraoperative management of such patients are discussed. PMID:15050169

Mims, T T; Fishbein, T M; Feierman, D E

2004-03-01

87

Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.  

PubMed

Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up. PMID:25480759

Jahromi, Alireza Hamidian; Coulter, Amy H; Bass, Patrick; Zhang, Wayne W; Tan, Tze-Woei

2014-12-01

88

Central Venous Catheter Repair is Associated with an Increased Risk of Bacteremia and Central Line Associated Bloodstream Infection in Pediatric Patients  

PubMed Central

Background Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and CVC-associated bloodstream infections (CLABSI). Methods We conducted a retrospective case-crossover study of pediatric patients aged 1 month to 21 years with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days pre-repair (control period) and the 30 days post-repair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression. Results The mean pre-repair rate of bacteremia was 9.9 per 1000 catheter days, which increased to 24.5 post-repair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI 1.05 – 3.33, p = 0.034). Risk of CLABSI demonstrated a greater than two-fold increase (IRR 2.15, 95% CI 1.02 – 4.53, p = 0.045) when all catheter days were included, and a four-fold increase when days on antibiotics were excluded (IRR 4.07, 95% CI 1.43 – 11.57, p = 0.008). Conclusions We found that repair of a broken CVC was associated with a two to four-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations. PMID:22146741

LUNDGREN, INGRID S.; ZHOU, CHUAN; MALONE, FRANCES R.; MCAFEE, NANCY G.; GANTT, SOREN; ZERR, DANIELLE M.

2011-01-01

89

The impact of an “acute dialysis start” on the mortality attributed to the use of central venous catheters: a retrospective cohort study  

PubMed Central

Background Central venous catheters (CVCs) are associated with early mortality in dialysis patients. However, some patients progress to end stage renal disease after an acute illness, prior to reaching an estimated glomerular filtration rate (eGFR) at which one would expect to establish alternative access (fistula/peritoneal dialysis catheter). The purpose of this study was to determine if exclusion of this “acute start” patient group alters the association between CVCs and mortality. Methods We conducted a retrospective cohort study of 406 incident dialysis patients from 1 Jan 2006 to 31 Dec 2009. Patients were classified as acute starts if 1) the eGFR was >25?ml/min/1.73?m2, ?3?months prior to dialysis initiation and declined after an acute event (n?=?45), or 2) in those without prior eGFR measurements, there was no supporting evidence of chronic kidney disease on history or imaging (n?=?12). Remaining patients were classified as chronic start (n?=?349). Results 98?% and 52?% of acute and chronic starts initiated dialysis with a CVC. There were 148 deaths. The adjusted mortality hazard ratio (HR) for acute vs. chronic start patients was 1.84, (95?% CI [1.19-2.85]). The adjusted mortality HR for patients dialyzing with a CVC compared to alternative access was 1.19 (95?% CI [0.80-1.77]). After excluding acute start patients, the adjusted HR fell to 1.03 (95?% CI [0.67-1.57]). Conclusions A significant proportion of early dialysis mortality occurs after an acute start. Exclusion of this population attenuates the mortality risk associated with CVCs. PMID:22846341

2012-01-01

90

Effects of fentanyl on procedural pain and discomfort associated with central venous catheter insertion: A prospective, randomized, double-blind, placebo controlled trial  

PubMed Central

Context: Central venous catheter (CVC) insertion induces pain and discomfort to a conscious patient despite application of a local anesthetic (LA) field block and this pain can be greatly lessened by using additional analgesics. Aim: The aim of this study is to evaluate the efficacy of fentanyl along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Settings and Design: A prospective, randomized, double-blind, placebo-controlled trial was conducted at tertiary referral center. Materials and Methods: Fifty-four patients scheduled for planned CVC were randomly assigned to receive either fentanyl (2 ?g/kg) or 0.9% normal saline. Pain and discomfort using a verbal numeric rating pain scale at 5 times points during CVC insertion were assessed and analyzed. Results: The median interquartile range pain score is worst for placebo group after LAI (5 [3-6]) and in the immediate postprocedure period (5 [4-5]) which was significantly attenuated by addition of fentanyl (3.5 [2-5] and 3 [2-4]) (P = 0.009 and 0.001 respectively). Overall, fentanyl and placebo group were not statistically different with median discomfort score except at T10 (P = 0.047). Conclusions: Preprocedural bolus fentanyl infusion provides adequate analgesia and can be safely used for alleviating pain during CVC insertion in conscious patients. PMID:25097353

Samantaray, Aloka; Rao, Mangu Hanumantha

2014-01-01

91

Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis.  

PubMed

Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P?=?0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P?=?0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD. PMID:25330826

Paglialonga, Fabio; Consolo, Silvia; Biasuzzi, Antonietta; Assomou, Jolanda; Gattarello, Elisabetta; Patricelli, Maria Grazia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Edefonti, Alberto

2014-10-01

92

Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: a randomized controlled trial  

PubMed Central

Introduction Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for CRBSI. The aim of this study was to assess the efficacy of medical-grade honey in reducing bacterial skin colonization at insertion sites. Methods A prospective, single-center, open-label randomized controlled trial was performed at the ICU of a university hospital in The Netherlands to assess the efficacy of medical-grade honey to reduce skin colonization of insertion sites. Medical-grade honey was applied in addition to standard CVC-site dressing and disinfection with 0.5% chlorhexidine in 70% alcohol. Skin colonization was assessed on a daily basis before CVC-site disinfection. The primary end point was colonization of insertion sites with >100 colony-forming units at the last sampling before removal of the CVC or transfer of the patient from the ICU. Secondary end points were quantitative levels of colonization of the insertion sites and colonization of insertion sites stratified for CVC location. Results Colonization of insertion sites was not affected by the use of medical-grade honey, as 44 (34%) of 129 and 36 (34%) of 106 patients in the honey and standard care groups, respectively, had a positive skin culture (P = 0.98). Median levels of skin colonization at the last sampling were 1 (0 to 2.84) and 1 (0 to 2.70) log colony-forming units (CFUs)/swab for the honey and control groups, respectively (P = 0.94). Gender, days of CVC placement, CVC location, and CVC type were predictive for a positive skin culture. Correction for these variables did not change the effect of honey on skin-culture positivity. Conclusions Medical-grade honey does not affect colonization of the skin at CVC insertion sites in ICU patients when applied in addition to standard disinfection with 0.5% chlorhexidine in 70% alcohol. Trial registration Netherlands Trial Registry, NTR1652. PMID:23111148

2012-01-01

93

Pulmonary and coronary foreign particle embolism after central venous injection of liquid nutrition.  

PubMed

A man was found dead in his nursing bed. The responsible assistant nurse explained that she had administered liquid nutrition (Isosource Energy Fibre 500ml) via perfusion pump into the Hickman catheter, insisting that the Hickman catheter was a percutaneous endoscopic gastric tube. Autopsy findings were unspecific and could not reveal the cause of death. Histopathological examinations showed severe pulmonary foreign particle emboli, partially even emboli of the small coronary arteries. We present the pathological findings of the case in regard to the underlying pathophysiology. PMID:25563518

Hartung, Benno; Gahr, Britta; Ritz-Timme, Stefanie

2015-02-01

94

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

PubMed Central

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 (? 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

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

95

Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte)  

PubMed Central

Background Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as “intervention”), we compared luer lock caps with a “closed access system” consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). Methods For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation. Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. Results With the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result. In 50 reviewed samples (TWC’s), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%. Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%. Conclusions In the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene. PMID:24460652

2014-01-01

96

Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access  

SciTech Connect

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.

Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio, E-mail: sergio.sierre@usa.net [Hospital Aleman, Department of Interventional Radiology (Argentina)

2011-12-15

97

Pulmonary artery catheter.  

PubMed

Since its inception, the pulmonary artery catheter has enjoyed widespread use in both medical and surgical critically ill patients. It has also endured criticism and skepticism about its benefit in these patient populations. By providing information such as cardiac output, mixed venous oxygen saturation, and intracardiac pressures, the pulmonary artery catheter may improve care of the most complex critically ill patients in the intensive care unit and the operating room. With its ability to transduce pressures through multiple ports, one of the primary clinical uses for pulmonary artery catheters is real-time intracardiac pressure monitoring. Correct interpretation of the waveforms is essential to confirming correct placement of the catheter to ensure accurate data are recorded. Major complications related to catheter placement are infrequent, but misinterpretation of monitored data is not uncommon and has led many to question the utility of the pulmonary artery catheter. The evidence to date suggests that the use of the catheter does not change mortality in many critically ill patients and may expose these patients to a higher rate of complications. However, additional clinical trials are needed, particularly in the most complex critically ill patients, who have generally been excluded from many of the research trials performed to date. PMID:25480764

Whitener, Stephanie; Konoske, Ryan; Mark, Jonathan B

2014-12-01

98

Mycobacterium mucogenicum from the Hickman line of an immunocompromised patient.  

PubMed

Gram stain of a positive blood culture is the clinician's first indication of a possible causative infective organism and a guide to suitable antimicrobial therapy prior to cultural and phenotypic identification with susceptibility test results. Occasionally interpretation of a Gram stain can be difficult; if there is a low bacterial load, no organisms may be seen. Such a case is reported, where a positive blood culture taken from the Hickman line of an immunocompromised patient flagged as positive at 5 days' incubation, but no organisms were seen on Gram film. On subculture, a slow growing Gram-positive bacillus was isolated which was initially misidentified and reported as a "diphtheroid" species. The actual identity of this organism and further isolates was later elucidated as Mycobacterium mucogenicum, a rapidly growing non-tuberculous mycobacterium. PMID:17675537

Marshall, C; Samuel, J; Galloway, A; Pedler, S

2008-01-01

99

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

PubMed Central

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 last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). Conclusion The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact. PMID:24063563

2013-01-01

100

Catheter-related bloodstream infections.  

PubMed

Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review. PMID:25024944

Gahlot, Rupam; Nigam, Chaitanya; Kumar, Vikas; Yadav, Ghanshyam; Anupurba, Shampa

2014-04-01

101

Hydrophilic Catheters  

PubMed Central

Executive Summary Objective To review the evidence on the effectiveness of hydrophilic catheters for patients requiring intermittent catheterization. Clinical Need There are various reasons why a person would require catheterization, including surgery, urinary retention due to enlargement of the prostate, spinal cord injuries, or other physical disabilities. Urethral catheters are the most prevalent cause of nosocomial urinary tract infections, that is, those that start or occur in a hospital. A urinary tract infection (UTI) occurs when bacteria adheres to the opening of the urethra. Most infections arise from Escherichia coli, from the colon. The bacteria spread into the bladder, resulting in the development of an infection. The prevalence of UTIs varies with age and sex. There is a tenfold increase in incidence for females compared with males in childhood and throughout adult life until around 55 years, when the incidence of UTIs in men and women is equal, mostly as a consequence of prostatic problems in men. Investigators have reported that urethritis (inflammation of the urethra) is found in 2% to 19% of patients practising intermittent catheterization. The Technology Hydrophilic catheters have a polymer coating that binds o the surface of the catheter. When the polymer coating is submersed in water, it absorbs and binds the water to the catheter. The catheter surface becomes smooth and very slippery. This slippery surface remains intact upon insertion into the urethra and maintains lubrication through the length of the urethra. The hydrophilic coating is designed to reduce the friction, as the catheter is inserted with the intention of reducing the risk of urethral damage. It has been suggested that because the hydrophilic catheters do not require manual lubrication they are more sterile and thus less likely to cause infection. Most hydrophilic catheters are prepackaged in sterile water, or there is a pouch of sterile water that is broken and released into the catheter package when the catheter is ready to use. Review Strategy The Medical Advisory Secretariat searched for reports of systematic reviews of randomized controlled trials (RCTs), meta-analyses of RCTs, and RCTs. The following databases were searched: Cochrane Library International Agency for Health Technology Assessment (fourth quarter 2005), Cochrane Database of Systematic Reviews (fourth quarter 2005), Cochrane Central Register of Controlled Trials (fourth quarter 2005), MEDLINE (1966 to the third week of November 2005), MEDLINE In-Process and Other Non-indexed Citations (1966 to November 2005), and EMBASE (1980 to week 49 in 2005). Search terms were urinary catheterization, hydrophilic, intermittent, and bladder catheter. The Medical Advisory Secretariat also conducted Internet searches of Medscape (www.medscape.com) for recent reports on trials that were unpublished but presented at international conferences. In addition, the Web site Current Controlled Trials (www.controlled-trials.com) was searched for ongoing trials on urinary catheterization. Summary of Findings Five RCTs were identified that compared hydrophilic catheters to standard catheters. There was substantial variation across the studies in terms of the reason for catheterization, inclusion criteria, and type of catheter used. Two studies used reusable catheters in the control arm, while the other 3 RCTs used single-use catheters in the control arm. All 5 RCTs focused mainly on males requiring intermittent catheterization. Age varied considerably across studies. One study consisted of young males (mean age 12 years), while another included older males (mean age 71 years). The RCTs reported conflicting results regarding the effectiveness of the hydrophilic catheters compared with standard catheters in terms of rates of UTIs. All 5 RCTs had serious limitations. Two of the studies were small, and likely underpowered to detect significant differences between groups. One RCT reported 12-month follow-up data for all 123 patients even though more than one-half of the patients had dropped out of t

2006-01-01

102

Right atrial thrombus due to internal jugular vein catheter.  

PubMed

Right atrial thrombus is rare complication of hemodialysis central venous catheter. Literature survey revealed 49 documentations of right atrial thrombus due to a central venous catheter. We report a 58-year-old type 2 diabetic, hypertensive, end-stage renal disease patient, who 2 months after initiation of hemodialysis through a right internal jugular vein catheter, developed clinical features suggestive of pulmonary thromboembolism. An echocardiography revealed presence of a serpentine thrombus in right atrium. The internal jugular vein catheter was removed and unfractionated heparin was initiated. At the end of 6 weeks he was symptom free. We compared conservative treatment with surgery for RAT. Conservative management with central venous catheter removal and anticoagulation therapy is not inferior to the surgery. PMID:19614782

Ram, Rapur; Swarnalatha, Gudithi; Rakesh, Yarlagadda; Jyostna, Maddury; Prasad, Neela; Dakshinamurty, Kaligotla Venkata

2009-07-01

103

Central vascular catheters and infections.  

PubMed

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

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

2014-03-01

104

Physical and biological effects of a surface coating procedure on polyurethane catheters  

Microsoft Academic Search

Central venous catheters are widely used in clinical practice; however, complications such as venous thrombosis or infection are frequent. The physical and biological effects of a coating procedure designed to improve the blood-contacting properties of polyurethane central venous catheters (CVCs) were studied. The surface atomic composition of poly(vinyl pyrrolidone) (PVP)-coated or uncoated Pellethane® single lumen CVCs was characterized by electron

P. Francois; P. Vaudaux; N. Nurdin; H. J. Mathieu; P. Descouts; D. P. Lew

1996-01-01

105

Venous oxygen saturation.  

PubMed

Early detection and rapid treatment of tissue hypoxia are important goals. Venous oxygen saturation is an indirect index of global oxygen supply-to-demand ratio. Central venous oxygen saturation (ScvO2) measurement has become a surrogate for mixed venous oxygen saturation (SvO2). ScvO2 is measured by a catheter placed in the superior vena cava. After results from a single-center study suggested that maintaining ScvO2 values >70% might improve survival rates in septic patients, international practice guidelines included this target in a bundle strategy to treat early sepsis. However, a recent multicenter study with >1500 patients found that the use of central hemodynamic and ScvO2 monitoring did not improve long-term survival when compared to the clinical assessment of the adequacy of circulation. It seems that if sepsis is recognized early, a rapid initiation of antibiotics and adequate fluid resuscitation are more important than measuring venous oxygen saturation. PMID:25480771

Hartog, Christiane; Bloos, Frank

2014-12-01

106

Measurement of ultrasonic-induced chlorhexidine liberation: correlation of the activity of chlorhexidine-silver-sulfadiazine-impregnated catheters to agar roll technique and broth culture  

Microsoft Academic Search

The diagnosis of intravascular catheter-related infections continues to be a challenge to both the clinician and the microbiologist.To assess the antiseptic effects of silver-sulfadiazine-chlorhexidine-impregnated central venous catheters (SSC) on catheter culture systems, segments of fresh antiseptic- and non antiseptic-impregnated catheters as well as extracted catheters following five days of immersion in PBS were sonicated. The chlorhexidine liberated from the catheter

J. M. Schierholz; A. Bach; C. Fleck; J. Beuth; D. König; G. Pulverer

2000-01-01

107

Something's missing: peripheral intravenous catheter fracture.  

PubMed

We describe a case of peripheral intravenous catheter fracture occurring during a routine training exercise. The supervising instructor immediately placed a venous tourniquet proximal to the insertion site and urgently transported the patient to the hospital. The missing catheter segment was identified within the median cubital vein under ultrasonography and was removed by venous cutdown under local anesthesia. An investigation determined that reinsertion of the needle into the advanced catheter likely caused the fracture and that application of a tourniquet may have prevented embolism of the fractured segment. Our literature review suggested that peripheral intravenous catheter fracture is likely vastly underreported, with only one prior case identified in the English literature. Action was taken following the event to educate all Israeli Defense Force medical providers regarding both proper preventive measures and recognition and treatment of catheter fracture should it occur. This case highlights the importance of health care providers being aware of the possibility of catheter fracture, as well as steps to take to prevent and mitigate its occurrence. PMID:24204079

Glassberg, Elon; Lending, Gadi; Abbou, Benyamine; Lipsky, Ari M

2013-01-01

108

A rare case of septic pulmonary embolism caused by infection-associated catheter removal in a patient with Hodgkin's lymphoma.  

PubMed

As a reflection of the considerable increase in the number of cancer patients treated with chemotherapy, indications for the use of implanted venous catheters are rapidly growing. However, in some cases, implanted venous catheters induce unwelcome complications. We herein report a rare case of septic pulmonary embolism (SPE) caused by local infection-associated catheter removal during the administration of ABVd combination chemotherapy consisting of adriamycin, bleomycin, vinblastine and dacarbazine in a patient with Hodgkin's lymphoma of the mixed cellularity type. During the course of treatment with chemotherapy administered via implanted venous catheters, think it is crucial to monitor for the potential occurrence of SPE. PMID:24881752

Morichika, Kazuho; Nakachi, Sawako; Tomoyose, Takeaki; Shimabukuro, Natsuki; Tamaki, Keita; Tedokon, Iori; Nishi, Yukiko; Hyakuna, Nobuyuki; Fukushima, Takuya; Masuzaki, Hiroaki

2014-01-01

109

21 CFR 876.5130 - Urological catheter and accessories.  

Code of Federal Regulations, 2010 CFR

...urethral catheters, coude catheters, balloon retention type catheters, straight catheters, upper urinary tract catheters, double lumen female urethrographic catheters, disposable ureteral catheters, male urethrographic catheters, and urological...

2010-04-01

110

Single catheter approach for occlusion of a patent arterial duct with a Rashkind double umbrella.  

PubMed Central

OBJECTIVES--To determine the benefits of using a single venous catheter and a single angiogram during catheter occlusion of a patient arterial duct with the Rashkind double umbrella compared with those of venous and arterial catheters and multiple angiograms. DESIGN--Retrospective review of case notes. PATIENTS--103 consecutive patients. The long sheath could not be advanced adequately in two patients. 101 patients had 104 implantations. Median (range) age was 35 (7-549) months and median (range) weight 13 (7-62) kg. Fifty four implantations were performed using the venous and arterial method and 50 using the venous only method. RESULTS--Median procedure times (70 v 90 min), number of angiograms (one v four), and angiographic dye volume used (2 v 7 ml/kg) were significantly reduced using the venous only method compared with those of the venous and arterial method. There was no significant difference in fluoroscopy time (venous only 9 v venous and arterial 10 min). CONCLUSIONS--Considerable improvements can be made in the technique of catheter closure of patent arterial ducts using the Rashkind double umbrella without compromising outcome using venous cannulation alone and a single angiogram, rather than venous and arterial cannulation and multiple angiograms. reduced risk to arteries from cannulation, The benefits are reduced radiation exposure, reduced risk to arteries from cannulation, shorter procedures, and lower equipment costs. PMID:7547027

Abrams, S. E.; Walsh, K. P.; McDonald, E. A.; Boothroyd, A. E.

1995-01-01

111

Temporary hemodialysis catheters: recent advances  

PubMed Central

The insertion of non-tunneled temporary hemodialysis catheters (NTHCs) is a core procedure of nephrology practice. While urgent dialysis may be life-saving, mechanical and infectious complications related to the insertion of NTHCs can be fatal. In recent years, various techniques that reduce mechanical and infectious complications related to NTHCs have been described. Evidence now suggests that ultrasound guidance should be used for internal jugular and femoral vein NTHC insertions. The implementation of evidence-based infection-control ‘bundles' for central venous catheter insertions has significantly reduced the incidence of bloodstream infections in the intensive care unit setting with important implications for how nephrologists should insert NTHCs. In addition, the Cathedia Study has provided the first high-level evidence about the optimal site of NTHC insertion, as it relates to the risk of infection and catheter dysfunction. Incorporating these evidence-based techniques into a simulation-based program for training nephrologists in NTHC insertion has been shown to be an effective way to improve the procedural skills of nephrology trainees. Nonetheless, there are some data suggesting nephrologists have been slow to adopt evidence-based practices surrounding NTHC insertion. This mini review focuses on techniques that reduce the complications of NTHCs and are relevant to the practice and training of nephrologists. PMID:24805107

Clark, Edward G; Barsuk, Jeffrey H

2014-01-01

112

Epidural catheter with integrated light guides for spectroscopic tissue characterization  

PubMed Central

Epidural catheters are used to deliver anesthetics and opioids for managing pain in many clinical scenarios. Currently, epidural catheter insertion is performed without information about the tissues that are directly ahead of the catheter. As a result, the catheter can be incorrectly positioned within a blood vessel, which can cause toxicity. Recent studies have shown that optical reflectance spectroscopy could be beneficial for guiding needles that are used to insert catheters. In this study, we investigate the whether this technique could benefit the placement of catheters within the epidural space. We present a novel optical epidural catheter with integrated polymer light guides that allows for optical spectra to be acquired from tissues at the distal tip. To obtain an initial indication of the information that could be obtained, reflectance values and photon penetration depth were estimated using Monte Carlo simulations, and optical reflectance spectra were acquired during a laminectomy of a swine ex vivo. Large differences between the spectra acquired from epidural adipose tissue and from venous blood were observed. The optical catheter has the potential to provide real-time detection of intravascular catheter placement that could reduce the risk of complications. PMID:24298420

Soto-Astorga, R. P.; West, S.; Putnis, S.; Hebden, J. C.; Desjardins, A. E.

2013-01-01

113

Vascular catheter-related sepsis: diagnosis and prevention.  

PubMed

Although catheter-related sepsis (CRS) is an important cause of nosocomial infection and the major complication of intravenous catheter use, there is, as yet, no consensus concerning either a useful definition of CRS or the optimal method of catheter management and prevention of infection. Semiquantitative culture of catheter tips is a useful method of diagnosis of CRS but other techniques such as quantitative catheter blood cultures and Gram staining of the catheter have roles in selected patients. The most significant impact on the prevention of CRS is made by the introduction of an intravenous therapy team. The site and method of catheter insertion, type of dressing and antisepsis, catheter flushing and use of prophylactic antibiotics are also important issues. Techniques such as guide-wire exchange and catheters such as triple lumen and total implantable venous access devices have their own infection problems. Many new and interesting approaches to the prevention of CRS are being formulated. To facilitate further progress, a standardized definition for diagnosis, and revised recommendations for prevention of CRS would be helpful. PMID:1348765

Johnson, A; Oppenheim, B A

1992-02-01

114

Venous Valves  

NSDL National Science Digital Library

This simple FlashTM animation depicts the function of a venous valve. It is shown in the context of a transverse section. During systole corpuscles are shown flowing through the open valve. As the pressure reverses during diastole, the valve closes and back flow is blocked.

PhD Jack D Thatcher (West Virginia School of Osteopathic Medicine Structural Biology)

2009-11-20

115

Central venous access: techniques and indications in oncology  

Microsoft Academic Search

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial\\u000a caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been\\u000a placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters\\u000a are cancer patients undergoing long-term chemotherapy. The most important issues, in

Pierre-Yves Marcy; Antoine Lacassagne Anticancer

2008-01-01

116

Endovascular Removal of Long-Term Hemodialysis Catheters  

SciTech Connect

Central venous catheters that have been in place for a long time can become fixed to the vein wall, making them impossible to pull out. Leaving them in situ is undesirable because of the risk that they could act as a nidus for thrombosis. Moreover, inserting new catheters alongside the old ones might compromise flow in the superior vena cava, further predisposing to thrombosis. Surgical removal is likewise undesirable, as this would necessitate thoracotomy with the attendant risks. We describe a novel technique, which we were able to use to remove retained long-term hemodialysis catheters in a patient who needed new catheters and who would have been a high-risk candidate for surgery. The right internal jugular vein was punctured adjacent to the site of insertion and a guide wire was used to form a snare, which was passed around the catheters and used to saw through the fibrous attachments to the vein wall. The midsection of one catheter could not be freed but the snare was used to cut off the proximal and distal ends, which could then be removed, the latter via the femoral vein. New catheters were then inserted via the left internal jugular vein. This technique enabled successful catheter extraction and replacement in a patient who would have been a poor candidate for cardiothoracic surgery.

Foley, Peter T.; Carter, Ranjana M.; Uberoi, Raman [John Radcliffe Hospital, Radiology Department (United Kingdom)], E-mail: Raman.Uberoi@orh.nhs.uk

2007-09-15

117

Blood recirculation in temporary central catheters for acute hemodialysis.  

PubMed

The low-flow method has been shown as a reliable evaluation of access recirculation. Few data is available on temporary central catheter blood recirculation; results of 2% and 4% have been reported in subclavian, 10% in 24 cm long femoral, and 18% in 15 cm long femoral catheters, mostly in indwelling catheters for chronic hemodialysis. The purpose of this prospective study was to evaluate blood recirculation in a larger number of recently inserted temporary intravenous catheters for acute hemodialysis, comparing subclavian and femoral sites. Fifty blood recirculation measurements were performed in 38 different temporary central venous dialysis catheters inserted in thirty-one critically ill patients from medical and surgical intensive care units presenting acute renal failure supported by intermittent hemodialysis. All the catheters used were well-functioning 11.5 French dual lumen Quinton of 13.5 or 19.5 cm length. Catheters presenting mechanical dysfunction, which did not allow a blood flow rate of 300 ml/min or for which lines had to be reversed were excluded from the analysis. Access blood recirculation was measured shortly after catheter insertion according to the low flow method applied after the first 30 minutes of hemodialysis at a blood flow rate of 300 ml/min. Mean blood recirculation for the 50 measurements was 10.3 +/- 9.2%. It was significantly higher in the 26 femoral catheters than in the 24 subclavian catheters, reaching respective means of 16.1 +/- 9.1% and 4.1 +/- 3.6% (p = 0.0001). Blood recirculation rate was not different between 13.5 cm and 19.5 cm long subclavian catheters (3.0 +/- 2.6%, n = 13, versus 5.4 +/- 4.3%, n = 11, respectively), but was significantly higher in 13.5 cm long femoral catheters (22.8 +/- 9.1%, n = 9, versus 12.6 +/- 6.9%, n = 17) (p = 0.004). Blood recirculation was measured on two separate occasions in 12 catheters randomly selected (5 femoral and 7 subclavian catheters); the obtained results were reproducible with a mean difference of only 2.1 +/- 1.8% between the two measurements and a correlation of 0.96. The mean time elapsed between catheter insertion and recirculation assessment was 2.2 +/- 3.1 days and was similar for femoral and subclavian catheters. No correlation was found between the percentage of recirculation and the arterial and venous resistances recorded during dialysis session or with the time from catheter insertion. Mean urea reduction ratio (URR) for the 50 dialysis sessions was 57.8 +/- 13.0%. It was significantly higher for sessions performed with subclavian than with femoral catheters (62.5 +/- 10.9%, n = 24, versus 54.5 +/- 14.2%, n = 26) (p = 0.03). In conclusion, the expected blood recirculation in well-functioning and recently inserted temporary dialysis catheters is under 5% for subclavian, over 12% in 19.5 cm femoral, and over 22% in shorter 13.5 cm femoral catheters at a blood flow rate of 300 ml/min. The consequently reduced dialysis efficiency with femoral catheters is another factor to be considered in the choice of a site for temporary dialysis catheter insertion in acute renal failure patients, particularly when dialysis dose delivery is a priority, such as intoxication cases treated by extracorporeal therapy. PMID:8738663

Leblanc, M; Fedak, S; Mokris, G; Paganini, E P

1996-05-01

118

Principles of chronic venous access: recommendations based on the Roswell Park experience  

Microsoft Academic Search

At Roswell Park Cancer Institute, we have seen a dramatic increase in the need for long-term venous access. Chronic venous catheters are an indispensible part of the treatment provided to oncology patients. Cancer patients are often at higher risk for complications secondary to their underlying disease and treatment. These risks may be minimized by paying close attention to several important

Michael S. Sabel; Judy L. Smith

1997-01-01

119

Conversion of tunneled hemodialysis catheter into HeRO device can provide immediate access for hemodialysis.  

PubMed

Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter. PMID:20675310

Vasquez, Julio C; DeLaRosa, Jacob; Rahim, Fahim; Rahim, Naeem

2010-11-01

120

In Vitro Activity and Durability of a Combination of an Antibiofilm and an Antibiotic against Vascular Catheter Colonization  

PubMed Central

Catheter-associated infections can cause severe complications and even death. Effective antimicrobial modification of catheters that can prevent device colonization has the potential of preventing clinical infection. We studied in vitro the antimicrobial activities of central venous catheters impregnated with N-acetylcysteine (NAC), an antibiofilm agent, and a broad-spectrum antibiotic against a range of important clinical pathogens. NAC-levofloxacin-impregnated (NACLEV) catheters were also evaluated for their antiadherence activity. NACLEV catheters produced the most active and durable antimicrobial effect against both Gram-positive and Gram-negative isolates and significantly reduced colonization (P < 0.0001) by all tested pathogens compared to control catheters. These in vitro results suggest that this antimicrobial combination can potentially be used to combat catheter colonization and catheter-associated infection. PMID:23114776

Hull, Richard A.; Stager, Charles E.; Cadle, Richard M.; Darouiche, Rabih O.

2013-01-01

121

[Candida catheter related-blood stream infection].  

PubMed

Candida catheter-related bloodstream infection (CRBSI) is a biofilm-related disease, which is usually refractory because antifungals show limited effect. With medical development and increase in number of compromised hosts, CRBSI became more frequent. Candida, which is one of the opportunistic pathogens, ranks the fourth causative organism of bacteremia. The onset of bacteremia is greatly associated with the presence of catheter. Repeated blood cultures and the central venous catheter (CVC) tip culture are done for the definitive diagnosis of Candida CRBSI. Additionally serological examinations such as (1 --> 3)-beta-D-glucan and mannan antigen are also useful for early diagnosis. It is important for the appropriate treatment to remove CVC, which is an artificial contaminated material, and administer antifungals promptly. As to the choice of antifungals, we should also take into account the ability of antibiofilm effect of antifungals as well as immunological state of host including neutropenia, prior administration of azoles, isolated or estimated Candida species, sensitivity against antifungals, administration route, pharmacokinetics (bioavailability, metabolic and excretion pathway, distribution) and drug interaction. As to complication of Candida bacteremia, first we should check endophthalmitis, which occurs frequently and leads to the loss of eyesight, as well as infective endocarditis, arthritis, metastatic infections such as embolic pneumonia and suppurative thrombotic phlebitis of catheter insertion site. Lastly we emphasize that the appropriate treatment based on the character of Candida bacteremia and biofilm leads to favorable prognosis. PMID:24809204

Kadowaki, Masako; Shimono, Nobuyuki

2014-02-01

122

Venous Access Ports: Indications, Implantation Technique, Follow-Up, and Complications  

SciTech Connect

The subcutaneous venous access device (SVAD or 'port') is a critical component in the care of patients with chronic disease. The modern SVAD provides reliable access for blood withdrawal and medication administration with minimal disruption to a patient's lifestyle. Because of improved materials and catheter technology, today's ports are lighter and stronger and capable of high-pressure injections of contrast for cross-sectional imaging. The majority of SVAD placement occurs in interventional radiology departments due to their ability to provide this service at lower costs, lower, complication rates, and greater volumes. Port-insertion techniques vary depending on the operator, but all consist of catheter placement in the central venous circulation followed by subcutaneous pocket creation and port attachment to the catheter with fixation and closure of the pocket. Venous access challenges occasionally occur in patients with central vein occlusions, necessitating catheterization of collateral veins or port placement in alternate locations. Complications of SVADs include those associated with the procedure as well as short- (<30 days) and long-term problems. Procedural and early complications are quite rare due to the near-universal use of real-time ultrasound guidance for vein puncture, but they can include hematoma, catheter malposition, arrhythmias, and pneumothorax. Late problems include both thrombotic complications (native venous or port-catheter thrombosis) and infections (tunnel or pocket infections or catheter-associated bloodstream infections). Most guidelines suggest that 0.3 infections/1000 catheter days is an appropriate upper threshold for the insertion of SVADs.

Walser, Eric M., E-mail: walser.eric@mayo.edu [Mayo Clinic, Department of Radiology (United States)

2012-08-15

123

[Venous ecology].  

PubMed

The purpose of venous ecology is to study the effect of the environment on the peripheral vessels. It is very extensive but still little explored subject in need of multidisciplinary study. The author reviews some of the major problems of ecophlebology: --pollution and harmful effects of urban life (atmospheric pollution, stress and influence of noise on the vessels); --the influence of habitat (furniture, ergonomics, urbanism, sociological studies and under-floor heating); --the cites new research on terrestrial electro-magnettism, meteoropathology, biological clocks and the influence of the mass media. In conclusion he hopes that ecophlebology will be the object of research which will permit a better understanding, and hence better control, of the pathological mechanisms resulting from the environment. PMID:928510

Reinharez, D

1977-01-01

124

Placement of Hemodialysis Catheters Through Stenotic or Occluded Central Thoracic Veins  

SciTech Connect

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.

Haller, Claude, E-mail: claude.haller@rsv-gnw.ch; Deglise, Sebastien; Saucy, Francois [CHUV-University of Lausanne, Unit of Thoracic and Vascular Surgery (Switzerland); Mathieu, Claudine [CHUV-University of Lausanne, Unit of Nephrology (Switzerland); Haesler, Erik [CHUV-University of Lausanne, Unit of Vascular Medicine (Switzerland); Doenz, Francesco [CHUV-University of Lausanne, Unit of Interventional Radiology (Switzerland); Corpataux, Jean Marc [CHUV-University of Lausanne, Unit of Thoracic and Vascular Surgery (Switzerland); Qanadli, Salah Dine, E-mail: salah.qanadli@chuv.c [CHUV-University of Lausanne, Unit of Interventional Radiology (Switzerland)

2009-07-15

125

Catheter-related UTI  

MedlinePLUS

... catheter-related UTI. This type of UTI is harder to treat with common antibiotics. Common reasons to ... not have a UTI. This fact makes it harder for your health care provider to choose whether ...

126

Ethanol Causes Protein Precipitation—New Safety Issues for Catheter Locking Techniques  

PubMed Central

Objective The ethanol lock technique has shown great potential to eradicate organisms in biofilms and to treat or prevent central venous catheter related infections. Following instillation of ethanol lock solution, however, the inherent density gradient between blood and ethanol causes gravity induced seepage of ethanol out of the catheter and blood influx into the catheter. Plasma proteins so are exposed to highly concentrated ethanol, which is a classic agent for protein precipitation. We aimed to investigate the precipitating effect of ethanol locks on plasma proteins as a possible cause for reported catheter occlusions. Methods Plasma samples were exposed in-vitro to ethanol (concentrations ranging from 7 to 70 v/v%) and heparin lock solutions. In catheter studies designed to mimic different in-vivo situations, the catheter tip was placed in a plasma reservoir and the material contained within the catheter was analyzed after ethanol lock instillation. The samples underwent standardized investigation for protein precipitation. Results Protein precipitation was observed in plasma samples containing ethanol solutions above a concentration of 28%, as well as in material retrieved from vertically positioned femoral catheters and jugular (subclavian) catheters simulating recumbent or head down tilt body positions. Precipitates could not be re-dissolved by dilution with plasma, urokinase or alteplase. Plasma samples containing heparin lock solutions showed no signs of precipitation. Conclusions Our in-vitro results demonstrate that ethanol locks may be associated with plasma protein precipitation in central venous catheters. This phenomenon could be related to occlusion of vascular access devices locked with ethanol, as has been reported. Concerns should be raised regarding possible complications upon injection or spontaneous gravity induced leakage of such irreversibly precipitated protein particles into the systemic circulation. We suggest limiting the maximum advisable concentration of ethanol to 28 v/v% in catheter lock solutions. PMID:24391979

Schilcher, Gernot; Schlagenhauf, Axel; Schneditz, Daniel; Scharnagl, Hubert; Ribitsch, Werner; Krause, Robert; Rosenkranz, Alexander R.; Stojakovic, Tatjana; Horina, Joerg H.

2013-01-01

127

Superfund record of decision amendment (EPA Region 4): Wrigley Charcoal Superfund Site, Hickman County, Wrigley, TN, February 2, 1995  

SciTech Connect

This decision document presents the selected Interim Remedial Action (IRA) for the Wrigley Charcoal Site, in Wrigley, Hickman County, Tennessee. The U.S. EPA has modified a wide variety of items that require immediate response action for the first step of cleanup activities to be taken at the Wrigley Charcoal Site. The major goal of these cleanup activities is to address the most serious threats at the Wrigley Charcoal Site by removing contaminated media from the Primary Site flood plain, remediating wastes at the Storage Basin, and through limited access restrictions at the Primary Site and the Storage Basin. The cleanup activities as presented in this IRA Record of Decision (ROD) Amendment will achieve significant risk reduction and will prepare the Site for future remedial activities.

NONE

1995-03-01

128

Use of a Trellis Device for Endovascular Treatment of Venous Thrombosis Involving a Duplicated Inferior Vena Cava  

SciTech Connect

Congenital anomalies of the inferior vena cava (IVC) are increasingly recognized with CT and venography techniques. Although many patients with IVC anomalies are asymptomatic, recent studies have suggested an association with venous thromboembolism. We report the case of a 62-year-old woman with extensive venous clot involving the infrarenal segment of a duplicated left IVC who underwent pharmacomechanical thrombectomy and tissue plasminogen activator catheter-directed thrombolysis with complete deep venous thrombosis resolution. To our knowledge this is the first reported case in the English literature of the use of a Trellis thrombectomy catheter in the setting of duplicated IVC.

Saettele, Megan R., E-mail: SaetteleM@umkc.edu [University of Missouri, Kansas City, Department of Radiology, Saint Luke's Hospital (United States); Morelli, John N., E-mail: dr.john.morelli@gmail.com [Texas A and M University Health Science Center, Department of Radiology, Scott and White Clinic and Hospital (United States); Chesis, Paul; Wible, Brandt C. [University of Missouri, Kansas City, Department of Interventional Radiology, Saint Luke's Hospital (United States)] [University of Missouri, Kansas City, Department of Interventional Radiology, Saint Luke's Hospital (United States)

2013-12-15

129

Transhepatic Guidance of Translumbar Hemodialysis Catheter Placement in the Setting of Chronic Infrarenal IVC Occlusion  

SciTech Connect

When patients with end-stage renal disease have exhausted both conventional and unconventional venous access options, creative solutions must be sought for hemodialysis catheter placement in order to ensure survival. This case describes a patient in urgent need of a dialysis catheter despite total occlusion of the jugular, subclavian, and femoral veins. Occlusion of the inferior vena cava (IVC) and right renal vein resulted in failed attempts at translumbar catheter placement. A gooseneck snare was temporarily advanced through the liver to the IVC for use as a fluoroscopic target to facilitate successful single-puncture, translumbar catheterization.

Lorenz, Jonathan M., E-mail: jlorenz@radiology.bsd.uchicago.edu; Regalado, Sidney; Navuluri, Rakesh, E-mail: rnavuluri@gmail.com; Zangan, Steven; Thuong Van Ha; Funaki, Brian [University of Chicago Hospitals, Department of Radiology, Section of Interventional Radiology (United States)

2010-06-15

130

Clinical review: New technologies for prevention of intravascular catheter-related infections  

PubMed Central

Intravascular catheters have become essential devices for the management of critically and chronically ill patients. However, their use is often associated with serious infectious complications, mostly catheter-related bloodstream infection (CRBSI), resulting in significant morbidity, increased duration of hospitalization, and additional medical costs. The majority of CRBSIs are associated with central venous catheters (CVCs), and the relative risk for CRBSI is significantly greater with CVCs than with peripheral venous catheters. However, most CVC-related infections are preventable, and different measures have been implemented to reduce the risk for CRBSI, including maximal barrier precautions during catheter insertion, catheter site maintenance, and hub handling. The focus of the present review is on new technologies for preventing infections that are directed at CVCs. New preventive strategies that have been shown to be effective in reducing risk for CRBSI, including the use of catheters and dressings impregnated with antiseptics or antibiotics, the use of new hub models, and the use of antibiotic lock solutions, are briefly described. PMID:15153233

Cicalini, Stefania; Palmieri, Fabrizio; Petrosillo, Nicola

2004-01-01

131

Previous PICC Placement May Be Associated With Catheter-Related Infections in Hemodialysis Patients  

SciTech Connect

Background: Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs. Methods: A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history. Results: One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71-3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed. Conclusion: Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

Butler, Philip J., E-mail: philip.butler@yale.edu; Sood, Shreya; Mojibian, Hamid; Tal, Michael G. [Yale University School of Medicine, Department of Diagnostic Radiology (United States)

2011-02-15

132

Prevention of transmission of multidrug-resistant organisms during catheter exchange using antimicrobial catheters.  

PubMed

Exchanging a central venous catheter (CVC) over a guide wire for a fresh uncoated CVC in the presence of bacteremia can result in cross-infection of the newly exchanged CVC. A recent retrospective clinical study showed that exchanging a catheter over a guide wire in the presence of bacteremia using an antimicrobial minocycline-rifampin (M/R) catheter may improve outcomes. To expand on this, we developed an in vitro cross-contamination model of exchange to evaluate the efficacy of different antimicrobial CVCs in preventing cross-contamination of multidrug-resistant organisms during exchange. Uncoated CVCs were allowed to form biofilm by methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. After 24 h, the biofilm-colonized CVCs were placed in a glass tube containing bovine calf serum plus Mueller-Hinton broth, and each catheter was exchanged over a guide wire for a fresh uncoated or an M/R-, chlorhexidine-silver sulfadiazine (CHX/SS)-, or chlorhexidine-M/R (CHX-M/R)-coated CVC. Cross-contamination of exchanged catheters was enumerated by sonication and quantitative plating methods. The exchange of M/R CVCs completely prevented cross-contamination by MRSA biofilms compared to control exchanged CVCs (P<0.0001). Exchange with CHX/SS CVCs reduced but did not completely prevent cross-contamination by MRSA (P=0.005). Exchange with CHX-M/R CVCs completely prevented cross-contamination by MRSA, P. aeruginosa, and C. albicans biofilms (P<0.0001). Furthermore, CHX-M/R CVCs were superior to M/R CVCs against P. aeruginosa and C. albicans (P=0.003) and were superior to CHX/SS CVCs against MRSA and P. aeruginosa (P=0.01). In conclusion, exchange with the novel CHX-M/R CVC was the only exchange effective in completely and concurrently preventing cross-contamination from bacteria and Candida. PMID:24957841

Jamal, Mohamed A; Rosenblatt, Joel; Jiang, Ying; Hachem, Ray; Chaftari, Ann-Marie; Raad, Issam I

2014-09-01

133

Prevention of hemodialysis catheter-related bloodstream infection using an antimicrobial lock.  

PubMed

Among currently available vascular access options for hemodialysis, central venous catheters show the poorest reliability, with frequent complications of thrombosis and stenosis impairing patency. The most serious problem, however, is catheter-related bloodstream infection (CRBI), which is typically a cause for removal of the catheter and protracted systemic antibiotic therapy. In our experience, a totally implanted device (Dialock, Biolink Corp.) seems to confer a better global protection against catheter-related infections than standard tunneled catheters, accounting for 0.97 vs. 4.75 infection episodes/1,000 catheter-days, respectively (p < 0.001). Bloodstream infection rates, however, are not statistically different in the two groups (0.85 vs. 0.81 per 1,000 catheter-days; p = n.s.), indicating that the improvement is mainly related to local cutaneous infections. On the other hand, in the Sodemann experience, a new taurolidine-based lock solution (Neutrolin, Biolink Corp.) greatly reduced CRBI rates with both subcutaneous ports and tunneled catheters to 0.29 and 0.20 episodes/1,000 catheter-days, respectively. These promising results await further confirmation from ongoing clinical trials. PMID:11803164

Quarello, Francesco; Forneris, Giacomo

2002-01-01

134

Semi-automated location identification of catheters in digital chest radiographs  

NASA Astrophysics Data System (ADS)

Localization of catheter tips is the most common task in intensive care unit imaging. In this work, catheters appearing in digital chest radiographs acquired by portable chest x-rays were tracked using a semi-automatic method. Due to the fact that catheters are synthetic objects, its profile does not vary drastically over its length. Therefore, we use forward looking registration with normalized cross-correlation in order to take advantage of a priori information of the catheter profile. The registration is accomplished with a two-dimensional template representative of the catheter to be tracked generated using two seed points given by the user. To validate catheter tracking with this method, we look at two metrics: accuracy and precision. The algorithms results are compared to a ground truth established by catheter midlines marked by expert radiologists. Using 12 objects of interest comprised of naso-gastric, endo-tracheal tubes, and chest tubes, and PICC and central venous catheters, we find that our algorithm can fully track 75% of the objects of interest, with a average tracking accuracy and precision of 85.0%, 93.6% respectively using the above metrics. Such a technique would be useful for physicians wishing to verify the positioning of catheter tips using chest radiographs.

Keller, Brad M.; Reeves, Anthony P.; Cham, Matthew D.; Henschke, Claudia I.; Yankelevitz, David F.

2007-03-01

135

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

SciTech Connect

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.

Ni, Nina, E-mail: nina.ni@yale.edu; Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael, E-mail: Michael.Tal@yale.edu [Yale University School of Medicine, Department of Diagnostic Radiology, Vascular and Interventional Radiology (United States)

2011-02-15

136

Ultrasound-Guided Central Venous Cannulation in Bariatric Patients  

Microsoft Academic Search

Background  Central venous catheterization may be difficult in morbidly obese patients because anatomic landmarks are often obscured.\\u000a \\u000a \\u000a \\u000a Methods  We evaluated the efficacy and safety of ultrasound-guided central venous cannulation in 55 patients undergoing bariatric surgery.\\u000a The usefulness of ultrasonic examination combined with intraatrial electrocardiogram as a diagnostic tool for catheter misplacement\\u000a was studied.\\u000a \\u000a \\u000a \\u000a Results  Preliminary ultrasound examination of the neck vessels demonstrated anatomical

Claudia Brusasco; Francesco Corradi; Pier Luigi Zattoni; Claudio Launo; Yigal Leykin; Salvatore Palermo

2009-01-01

137

Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein? Report of a case.  

PubMed

Catheter rupture after totally implantable access port (TIAP) implantation via the right internal jugular vein is thought to be very rare. We report a case of catheter rupture found 682 days after TIAP surgery in a 52-year-old woman with recurrent right breast cancer. It is possible that chronic stress at the flexure of the catheter induced by neck movements caused the catheter to rupture. Therefore, when inserting a TIAP via the right internal jugular vein, the site of venous puncture should be decided on carefully. Although a fracture of this type is rarely reported in the literature, the incidence of catheter injury of a TIAP inserted via the internal jugular vein at our institute is 1.8 %. This highlights the need to educate and caution medical staff and patients about preventing catheter fracture being caused by external factors. PMID:23732842

Nagasawa, Yoshinobu; Shimizu, Tomoharu; Sonoda, Hiromichi; Chou, Hirotomi; Mekata, Eiji; Tani, Tohru

2014-07-01

138

How to deal with dialysis catheters in the ICU setting  

PubMed Central

Acute kidney insufficiency (AKI) occurs frequently in intensive care units (ICU). In the management of vascular access for renal replacement therapy (RRT), several factors need to be taken into consideration to achieve an optimal RRT dose and to limit complications. In the medium and long term, some individuals may become chronic dialysis patients and so preserving the vascular network is of major importance. Few studies have focused on the use of dialysis catheters (DC) in ICUs, and clinical practice is driven by the knowledge and management of long-term dialysis catheter in chronic dialysis patients and of central venous catheter in ICU patients. This review describes the appropriate use and management of DCs required to obtain an accurate RRT dose and to reduce mechanical and infectious complications in the ICU setting. To deliver the best RRT dose, the length and diameter of the catheter need to be sufficient. In patients on intermittent hemodialysis, the right internal jugular insertion is associated with a higher delivered dialysis dose if the prescribed extracorporeal blood flow is higher than 200 ml/min. To prevent DC colonization, the physician has to be vigilant for the jugular position when BMI < 24 and the femoral position when BMI > 28. Subclavian sites should be excluded. Ultrasound guidance should be used especially in jugular sites. Antibiotic-impregnated dialysis catheters and antibiotic locks are not recommended in routine practice. The efficacy of ethanol and citrate locks has yet to be demonstrated. Hygiene procedures must be respected during DC insertion and manipulation. PMID:23174157

2012-01-01

139

Antibiofilm activity of Cobetia marina filtrate upon Staphylococcus epidermidis catheter-related isolates  

PubMed Central

We report the antibiofilm activity by the sponge-associated bacterium Cobetia marina upon Staphylococcus epidermidis clinical isolates obtained from central venous catheters. Antibiofilm activity/antimicrobial susceptibility correlation might predict the action of the metabolite(s) upon Staphylococcus epidermidis in the clinic, making it a possible adjuvant in therapies against biofilm-associated infections. PMID:24031760

Trentin, D.S.; Gorziza, D. F.; Abraham, W.R.; Antunes, A.L.S.; Lerner, C.; Mothes, B.; Termignoni, C.; Macedo, A.J.

2011-01-01

140

Improved antibiotic-impregnated catheters with extended-spectrum activity against resistant bacteria and fungi.  

PubMed

Minocycline-rifampin-impregnated central venous catheters (M/R CVCs) have been shown to be efficacious in reducing catheter-related bloodstream infections (CRBSI) and inhibiting the biofilm adherence of resistant Gram-positive and Gram-negative pathogens, with the exception of Pseudomonas aeruginosa and Candida spp. To expand the spectrum of antimicrobial activity, a novel second-generation M/R catheter was developed by adding chlorhexidine (CHX-M/R). CVCs and peripherally inserted central catheters (PICCs) were impregnated with CHX-M/R and compared with first-generation M/R catheters, CHX-silver sulfadiazine-treated CVCs (CHX/SS-CVCs), chlorhexidine-treated PICCs, and uncoated catheters. A biofilm catheter colonization model was used to assess the efficacy of catheters against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), P. aeruginosa, Candida albicans, and Candida glabrata. CHX-M/R-impregnated CVCs were the only antimicrobial catheters that completely inhibited the biofilm colonization of all resistant bacterial and fungal organisms tested at all time intervals, and they were significantly superior to uncoated catheters (all P values were ?0.003). Furthermore, CHX-M/R-coated CVCs had a significantly more effective and prolonged (up to 3 weeks) antimicrobial activity against MRSA and P. aeruginosa than M/R, CHX/SS, and uncoated CVCs (P < 0.0001). Similarly, CHX-M/R-coated PICCs were also superior to M/R-coated and CHX-coated PICCs in preventing biofilms of MRSA, VRE, P. aeruginosa, and Candida species (P value = 0.003 for all). Our study shows that novel CHX-M/R-coated catheters have unique properties in completely inhibiting biofilm colonization of MRSA, VRE, P. aeruginosa, and fungi in a manner superior to that of M/R- and chlorhexidine-treated catheters. PMID:22123686

Raad, Issam; Mohamed, Jamal A; Reitzel, Ruth A; Jiang, Ying; Raad, Sammy; Al Shuaibi, Munirah; Chaftari, Anne-Marie; Hachem, Ray Y

2012-02-01

141

Resistance and Venous Oxygen Dynamics during Sinusoidal Exercise of Dog Skeletal Muscle  

Microsoft Academic Search

We observed the response of vascular resistance and venous oxygen (O2) satu- ration to sinusoidally modulated continuous exercise of the isolated dog calf. Stimulus frequency was varied sinusoidally between 0.5 Hz and 1 Hz with modulation fre- quencies ranging from 0.005 Hz to 0.05 Hz. Venous O2 responses were corrected for dispersion due to vascular and catheter transit. As modulation

David E. Mohrman; Harvey V. Sparks

142

The peritoneal dialysis catheter.  

PubMed

The results obtained from the positioning and management of the catheter for peritoneal dialysis depend on the techniques used, but also and above all, on the experience of the practitioners. A comparison between practitioners may help to change their convictions, as well as to further improve results, in the interests of patient welfare. This is the aim of these Best Practice Guidelines.. PMID:24307439

Amici, Gianpaolo; Bernacconi, Tonino; Bonforte, Giuseppe; Ceraudo, Emilio; Dell'Aquila, Roberto; Galli, Emilio; Maffei, Stefano; Sardellini, Cecilia; Zeiler, Matthias; Santarelli, Stefano; Iadarola, Gian Maria; La Milia, Vincenzo; Virga, Giovambattista; Brunori, Giuliano; Garosi, Guido; Cancarini, Giovanni

2013-01-01

143

Atrial fibrillation: catheter ablation.  

PubMed

Catheter ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach in which the PVs and other foci were targeted for ablation. The pendulum then appeared to swing back toward the substrate approach after it was shown that left atrial circumferential ablation afforded improved outcomes in patients with paroxysmal and persistent AF. It has become clear that there are several possible approaches in the catheter ablation of AF, each with its strengths and limitations. It is also becoming evident that not all patients will respond to a single ablation technique and that the ablation protocol is best tailored to suit the individual patient. This article strives to present an evidence-based review of the many techniques, and then offer a practical guide to the catheter ablation of AF. PMID:17053976

Chugh, Aman; Morady, Fred

2006-06-01

144

Cerebral venous angiomas  

SciTech Connect

Several unusual cases of cerebral venous angiomas as well as some characteristic cases are reported. The characteristic angiographic feature is that of a collection of dilated medullary veins draining into a single large draining vein, which appears first in the early venous phase and persists into the late venous phase of the arteriogram. Computed tomography (CT) was abnormal in 12/13 cases. The draining vein was the most common abnormality identified on CT. Coronal and sagittal reconstruction may be helpful in demonstrating the draining vein. A case of large twin venous angiomas, a case of hemorrhage from a venous angioma, and a case of a venous angioma with an incidentally associated glioblastoma are presented.

Olson, E.; Gilmor, R.L.; Richmond, B.

1984-04-01

145

Advances in the Diagnosis and Management of Central Venous Access Device Infections in Children  

Microsoft Academic Search

\\u000a Infection is a well-known complication of central venous access device (CVAD) use, with an incidence of 3–6 bloodstream infections\\u000a per 1,000 catheter days in children. Prevention of CVAD infections has improved with new strategies including the use of chlorhexidine\\u000a antisepsis, bundles, maximal sterile barriers for insertion, prophylactic locks, antibiotic impregnated catheters and tunnelling\\u000a of long-term devices. Despite these strategies, catheter-related

Asha Bowen; Jonathan Carapetis

146

Epidemiology of venous thromboembolism.  

PubMed Central

This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease. PMID:329779

Coon, W W

1977-01-01

147

Remaining Small Bowel Length: Association with Catheter Sepsis in Patients Receiving Home Total Parenteral Nutrition: Evidence of Bacterial Translocation  

Microsoft Academic Search

.   Patients with short bowel syndrome (SBS) receiving total parenteral nutrition (TPN) have a high incidence of catheter-related\\u000a sepsis, one of its major complications. The aim of this study was to correlate the length of remaining small bowel (RSB) with\\u000a septic episodes related to the central venous catheter in a group of patients with severe SBS with home TPN. The

Ricardo M. Terra; Caio Plopper; Dan L. Waitzberg; Celso Cukier; Sérgio Santoro; Juliana R. Martins; Rubens J. Song; Joaquim Gama-Rodrigues

2000-01-01

148

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center  

PubMed Central

Objective To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. Materials and Methods We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. Results A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Conclusion Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate. PMID:22563269

Ahn, Se Jin; Chung, Jin Wook; An, Sang Bu; Yin, Yong Hu; Jae, Hwan Jun; Park, Jae Hyung

2012-01-01

149

Feasibility and Safety of Endovascular Stripping of Totally Implantable Venous Access Devices  

SciTech Connect

Purpose: To evaluate the safety and feasibility of percutaneous stripping of totally implantable venous access devices (TIVAD) in case of catheter-related sleeve and to report a technique to free the catheter tip from vessel wall adherence. Materials and Methods: A total of 37 stripping procedures in 35 patients (14 men, 40%, and 21 women, 60%, mean age 53 {+-} 14 years) were reviewed. Totally implantable venous access devices were implanted because of malignancy in most cases (85.7%). Catheter-related sleeve was confirmed as cause of persistent catheter dysfunction despite instillation of thrombolytics. A technique to mobilize the catheter tip from the vessel wall was used when stripping with the snare catheter was impossible. Technical success, complication rate, and outcome were noted. Results: A total of 55.9% (n = 19) of the 34 technically successful procedures (91.9%) could be done with the snare catheter. In 15 cases (44.1%), additional maneuvers to free the TIVAD's tip from the vessel wall were needed. Success rate was not significantly lower before (72.4%) than after (96.7%) implementation of the new technique (P = 0.09). No complications were observed. Follow-up was available in 67.6% of cases. Recurrent catheter dysfunction was found in 17 TIVADs (78.3%) at a mean of 137.7 days and a median of 105 days. Conclusions: Stripping of TIVADs is technically feasible and safe, with an overall success rate of 91.9%. Additional endovascular techniques to mobilize the distal catheter tip from the wall of the superior vena cava or right atrium to allow encircling the TIVAD tip with the snare catheter may be needed in 44.1% of cases.

Heye, Sam, E-mail: sam.heye@uzleuven.be; Maleux, Geert [University Hospitals Leuven, Department of Radiology (Belgium); Goossens, G. A. [University Hospitals Leuven, Department of Surgical Oncology (Belgium); Vaninbroukx, Johan [University Hospitals Leuven, Department of Radiology (Belgium); Jerome, M.; Stas, M. [University Hospitals Leuven, Department of Surgical Oncology (Belgium)

2012-06-15

150

Recanalization of Aged Venous Thrombotic Occlusions with the Aid of a Rheolytic System: An Experimental Study  

SciTech Connect

Purpose: The suitability of a rheolytic system for recanalization of aged venous thrombotic occlusions was tested in an animal experiment. Methods: The system consists of a flush-suction catheter and a high-pressure liquid pump. Thrombosis was experimentally induced in 13 venous segments of 10 adult goats. Results: After a mean period of 12 days, a complete thrombectomy using the flush-suction system was achieved in 12 cases. No complications such as perforation or dissection were observed. Conclusion: This system seems to be an appropriate device for percutaneous transluminal venous thrombectomy, even in older occlusions.

Vicol, Calin; Dalichau, Harald [Clinic for Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Robert-Koch-Str. 40, D-37075 Goettingen (Germany)

1996-04-15

151

Catheter associated urinary tract infections  

PubMed Central

Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation. PMID:25075308

2014-01-01

152

REPAIR OF CHRONIC PERITONEAL DIALYSIS CATHETER  

Microsoft Academic Search

.Background: Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement. .Objective and Design: Retrospective analysis of seven peritoneal catheters

Kumari Usha; Leonor Ponferrada; Barbara F. Prowant; Zbylut J. Twardowski

153

Injection From Side Holes on a Generic Catheter Tip  

NASA Astrophysics Data System (ADS)

Central venous catheters (CVC), typically positioned within the superior vena cava (SVC), play an important role in the process of hemodialysis. Simultaneous extraction and injection of blood typically occur through one or more side holes at the catheter tip. High-image-density particle image velocimetry is employed, in conjunction with a scaled-up water facility, to characterize the structure of single and multiple jets. The injection jets that penetrate the steady crossflow generate complex, but deterministic, flow patterns. Significant interaction between multiple jets generates flow features that are more pronounced than those of a single jet, including increased jet penetration and elevated levels of turbulent shear stresses. In addition, the effects of a pulsatile throughflow on the structure of an isolated, single jet are determined as a function of phase of the systole-diastole cycle, corresponding to actual blood flow in a normal adult.

Foust, Jason; Rockwell, Donald

2006-11-01

154

Uncommon aetiological agents of catheter-related bloodstream infections.  

PubMed

SUMMARY The clinical and microbiological characteristics of catheter-related bloodstream infection (CR-BSI) due to uncommon microorganisms was assessed in a retrospective case-control study over a 9-year period in a tertiary teaching hospital. Uncommon microorganisms were defined as those representing <0·5% of all CR-BSI. Diagnosis of CR-BSI required that the same microorganism was grown from at least one peripheral venous blood culture and a catheter tip culture. Thirty-one episodes of CR-BSI were identified due to 13 different genera and these accounted for 2·3% of all CR-BSI in the hospital. Although these infections were not associated with increased mortality, they occurred in patients with more severe underlying conditions who were receiving prolonged antibiotic therapy. PMID:24887020

Reigadas, E; Rodríguez-Créixems, M; Sánchez-Carrillo, C; Martín-Rabadán, P; Bouza, E

2014-06-01

155

Focus on peripherally inserted central catheters in critically ill patients.  

PubMed

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 associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. PMID:25374804

Cotogni, Paolo; Pittiruti, Mauro

2014-11-01

156

Catheter-Induced Thrombosis of the Superior Vena Cava  

PubMed Central

There has been an increase in the use of central venous catheters (CVCs) in clinical practice. One of the most dangerous complications associated with their use is symptomatic or asymptomatic thrombosis (T), sometimes associated with superior vena cava (SVC) syndrome, resulting from impaired venous drainage. The right heart clots can induce an increased risk of mortality due the potential pulmonary embolism (PE). We report a case of asymptomatic 83-year-old woman in whom the thrombosis was detected after an echocardiogram. Echocardiography demonstrated a cardiac mass, and the T was confirmed by (magnetic resonance imaging) MRI. The clinical scenario, a high index of suspicion and routine use of echocardiogram in patients with CVC, can lead to a correct diagnosis, preventing dangerous complications. PMID:23198269

Venturini, Elio; Becuzzi, Lucia; Magni, Lucia

2012-01-01

157

[Chronic venous insufficiency (CVI)].  

PubMed

Chronic venous insufficiency (CVI) is an important and frequent disease for dermatologists, phlebologists and general practitioners. There are various hypotheses for the ethiopathology in CVI, e. g. hormone receptors and impairments concerning the venous contraction or relaxation of the vessel wall and the venous valves might play an important role. At the moment, colour doppler-duplex sonography seems to be the diagnostic method of choice. Modern therapeutic options include compression systems alone or in combination with topical or systemic treatment including minimal invasive methods like endovenous laser or radiofrequency obliteration or foam sclerotherapy. PMID:19826982

Renner, R; Simon, J

2009-10-01

158

[Functional venous explorations].  

PubMed

The methods for exploring venous function globally are presented first. These methods include venous pressure and plethysmography for which the methods using a garrot are separated from those using air volumetry which give reliable physiological and reproducible results. The Nachev method, the thermometry, the thermography and isotope clearances are also reviewed since they have been important in the development of exploration of venous function. The methods giving morphological or segmentary data are then presented in historical order: phlebography (completed by tomodensitography and nuclear magnetic resonance), then ultrasonography with Doppler, echography and duplex and colour techniques. Finally promising methods for the future including oxygen partial pressures, laser-Doppler, capillaroscopy and venous endoscopy are discussed. For each method, there is a description of the technique, a presentation of the measured parameters and their reliability, the signification of the measurement and its clinical use. Finally, each method is discussed in the context of concrete clinical situations with a schema for management of diagnosis. PMID:8177873

Mollard, J M

1994-02-10

159

Management of venous thromboembolism.  

PubMed

This article describes the risk factors, diagnostic tools, and therapeutic approaches for venous thromboembolism (VTE), which includes primarily deep vein thrombosis and pulmonary embolism, as well as VTE occurring at other sites. Outpatient management strategies are emphasized. PMID:23402462

Burnett, Bruce

2013-03-01

160

21 CFR 870.1300 - Catheter cannula.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1300 Catheter cannula. (a) Identification. A catheter...

2013-04-01

161

21 CFR 870.1340 - Catheter introducer.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1340 Catheter introducer. (a) Identification. A catheter...

2013-04-01

162

21 CFR 870.1340 - Catheter introducer.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1340 Catheter introducer. (a) Identification. A catheter...

2014-04-01

163

21 CFR 870.1300 - Catheter cannula.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1300 Catheter cannula. (a) Identification. A catheter...

2014-04-01

164

Catheter-Malposition-Induced Cardiac Tamponade via Contrast Media Leakage During Computed Tomography Study  

SciTech Connect

We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status.

Liang, C.-D. [Chang Gung University (China)], E-mail: cdliang@adm.cgmh.org.tw; Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M. [Chang Gung Children's Hospital, Department of Pediatric Cardiology and Radiology (China)

2005-12-15

165

Catheter-malposition-induced cardiac tamponade via contrast media leakage during computed tomography study.  

PubMed

We present a rare case of a central venous catheter-malposition-induced life-threatening cardiac tamponade as a result of computed tomography (CT) with contrast enhancement in an infant with a ventricular septal defect and pulmonary atresia after a modified Blalock-Taussig shunt. The diagnosis was confirmed by chest radiographs and CT study with catheter perforation through the right atrial wall and extravasation of the contrast medium into the pericardium, leading to cardiac tamponade and subsequent circulatory collapse. Two hours after successful cardiopulmonary resuscitation, the patient gradually resumed normal hemodynamic status. PMID:16059760

Liang, Chi-Di; Ko, Sheung-Fat; Huang, Chien-Fu; Chien, Shao Ju; Tiao, Mao Meng

2005-01-01

166

Diagnosing Deep Venous Thrombosis  

PubMed Central

Patients often present with unexplained lower limb pain and swelling. It is important to exclude deep venous thrombosis in the diagnosis because of the threat of sudden death. Simple clinical diagnosis is unacceptable, and noninvasive tests should be used initially. Serial testing detects proximal extension of isolated calf thrombi. Multiple diagnostic modalities are employed to diagnose a new deep venous thrombosis in patients with postphlebitic syndrome. PMID:21221369

Doyle, D. Lynn

1992-01-01

167

Preliminary clinical investigations of a new noninvasive venous pulse oximeter  

NASA Astrophysics Data System (ADS)

For decades, the monitoring of mixed venous oxygen saturation, SvO2 has been performed invasively using fibre-optic catheters. This procedure is not without risk as complications may arise from catheterisation. The group has devised a new non-invasive venous oximetry method which involves inducing regular modulations of the venous blood volume and associated measurement of those modulations using optical means. A clinical investigation was conducted in Glenfield Hospital, UK to evaluate the sensitivity of the new technique to haemodynamic changes such as Cardiac Output (CO) in intraoperative and postoperative cardiac patients. Preliminary trials on patients recovering from cardiac surgery yielded an average correlation of r = 0.72 between CO at different Intra Aortic Balloon Pump (IABP) augmentation levels and SvO2 measured by the new venous oximeter. In intraoperative patients undergoing off-pump cardiac surgery, SvO2 recorded by the new technique responded to unplanned events such as a cardiac arrest. CONCLUSION: The new venous oximetry technique is a promising technique which responds to haemodynamic changes such as CO and with further development might offer an alternative means of monitoring SvO2 non-invasively.

Chan, Daniel; Smith, Peter R.; Caine, Michael P.; Spyt, Tomasz; Boehm, Maria; Machin, David

2003-10-01

168

A numerical study of the effect of catheter angle on the blood flow characteristics in a graft during hemodialysis  

NASA Astrophysics Data System (ADS)

For patients with renal failure, renal replacement therapies are needed. Hemodialysis is a widely used renal replacement method to remove waste products. It is important to improve the patency rate of the vascular access for efficient dialysis. Since some complications such as an intimal hyperplasia are associated with the flow pattern, the hemodynamics in the vascular access must be considered to achieve a high patency rate. In addition, the blood flow from an artificial kidney affects the flow in the vascular access. Generally, the clinical techniques of hemodialysis such as the catheter angle or dialysis dose have been set up empirically. In this study, a numerical analysis is performed on the effect of the catheter angle on the flow in the graft. Blood is assumed to be a non-Newtonian fluid. According to the high average wall shear stress value, the leucocytes and platelets can be activated not only at the arterial anastomosis, but also at the bottom of the venous graft, when the catheter angle is not zero. For a catheter angle less than five degrees, there is a low shear and high oscillatory shear index region that appears at the venous graft and the venous anastomosis. Thus, a catheter angle less than five degrees should be avoided to prevent graft failure.

Ryou, Hong Sun; Kim, Soyoon; Ro, Kyoungchul

2013-02-01

169

Catheter removal versus retention in the management of catheter-associated enterococcal bloodstream infections  

PubMed Central

BACKGROUND: Enterococci are an important cause of central venous catheter (CVC)-associated bloodstream infections (CA-BSI). It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI. METHODS: A 12-month retrospective cohort study of adults with enterococcal CA-BSI was conducted at a tertiary care hospital; clinical, microbiological and outcome data were collected. RESULTS: A total of 111 patients had an enterococcal CA-BSI. The median age was 58.2 years (range 21 to 94 years). There were 45 (40.5%) infections caused by Entercoccus faecalis (among which 10 [22%] were vancomycin resistant), 61 (55%) by Enterococcus faecium (57 [93%] vancomycin resistant) and five (4.5%) by other Enterococcus species. Patients were treated with linezolid (n=51 [46%]), vancomycin (n=37 [33%]), daptomycin (n=11 [10%]), ampicillin (n=2 [2%]) or quinupristin/dalfopristin (n=2 [2%]); seven (n=6%) patients did not receive adequate enterococcal treatment. Additionally, 24 (22%) patients received adjunctive gentamicin treatment. The CVC was retained in 29 (26.1%) patients. Patients with removed CVCs showed lower rates of in-hospital mortality (15 [18.3%] versus 11 [37.9]; P=0.03), but similar rates of recurrent bacteremia (nine [11.0%] versus two (7.0%); P=0.7) and a similar post-BSI length of hospital stay (median days [range]) (11.1 [1.7 to 63.1 days] versus 9.3 [1.9 to 31.8 days]; P=0.3). Catheter retention was an independent predictor of mortality (OR 3.34 [95% CI 1.21 to 9.26]). CONCLUSIONS: To the authors’ knowledge, the present article describes the largest enterococcal CA-BSI series to date. Mortality was increased among patients who had their catheter retained. Additional prospective studies are necessary to determine the optimal management of enterococcal CA-BSI. PMID:24421837

Marschall, Jonas; Piccirillo, Marilyn L; Fraser, Victoria J; Doherty, Joshua A; Warren, David K

2013-01-01

170

CHLORHEXIDINE-IMPREGNATED DRESSING FOR PREVENTION OF CATHETER-RELATED BLOODSTREAM INFECTION: A META-ANALYSIS  

PubMed Central

Background Catheter related bloodstream infections (CRBSI) are associated with significant morbidity and mortality and effective methods for their prevention are needed. Objective To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and CRBSI using meta-analysis. Data Sources Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. Study Selection Randomized controlled trials (RCT) evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and CRBSI. Data Extraction Data were extracted on patient and catheter characteristics and outcomes. Data Synthesis Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2. Subgroup analyses were used to explore heterogeneity. Results Nine RCTs met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced incidence of CRBSI (random effects RR 0.57, 95% CI 0.42–0.79, P=0.002). The incidence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects RR 0.51, 95% CI 0.39–0.67, P< 0.001). There was significant benefit for prevention of catheter colonization and CRBSI, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. Conclusions Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, CRBSI and warrants routine use in patients at high risk of CRBSI and CVC or arterial catheter colonization in ICUs. PMID:24674924

Safdar, Nasia; O’Horo, John C.; Ghufran, Aiman; Bearden, Allison; Didier, Maria Eugenia; Chateau, Dan; Maki, Dennis G.

2014-01-01

171

Balloon catheter coronary angioplasty  

SciTech Connect

The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty.

Angelini, P.

1987-01-01

172

Safety and Efficacy of Mobility Interventions in Patients with Femoral Catheters in the ICU: A Prospective Observational Study  

PubMed Central

Introduction There are limited data describing mobility interventions provided to patients with femoral catheters. The purpose of this study was to examine the incidence of femoral catheter related adverse effects during physical therapy (PT) sessions in a cardiovascular intensive care unit (ICU). Methods This was a prospective, observational study and included patients with at least one femoral catheter. Data were collected after each PT session. Results There were 77 subjects with a total of 92 femoral catheters (50 arterial, 15 central venous, and 27 dialysis) treated. A total of 210 separate PT sessions occurred with 630 mobility activities including sitting on side of bed, standing at the bedside, transfers to stretcher chair or regular chair, and walking. There were no catheter related mechanical or thrombotic complications during any of the PT sessions. Conclusions Physical therapy sessions, including standing and walking were feasible and safe in cardiovascular ICU patients with femoral catheters who met the criteria for mobility interventions. The results from this study support the hypothesis that early mobilization in patients with femoral catheters is important to minimize functional decline and provide evidence that the presence of femoral catheters alone should not be a reason to limit progressive mobility interventions. PMID:23801900

Perme, Christiane; Nalty, Theresa; Winkelman, Chris; Kenji Nawa, Ricardo; Masud, Faisal

2013-01-01

173

Catheter ablation in supraventricular tachycardia.  

PubMed

The evolution of catheter ablation for the treatment of supraventricular tachycardias represents a major advance in the management of cardiac arrhythmias. Excellent results in the majority of patients undergoing the procedure, together with a low rate of early complications and a brief hospitalization, make catheter ablation a highly cost-effective permanent cure. At present, however, its place in relation to alternate therapies in the management of supraventricular tachycardias has not been clearly established owing to unresolved risk-benefit issues. Continuing technical advances will likely enable catheter ablation to be successfully applied to a broader range of cardiac arrhythmias. PMID:7598475

Deshpande, S; Jazayeri, M; Dhala, A; Blanck, Z; Sra, J; Bremner, S; Akhtar, M

1995-01-01

174

The Use of Peripherally Inserted Central Catheter (PICC) in Adult with Acute Leukemia  

Microsoft Academic Search

The purpose of this study is to evaluate peripher- ally inserted central catheter (PICC) as a sole venous access device for management of patients with newly diagnosed leukemia. Forty-four PICCs (4-French, single lumen) were placed in 41 newly diagnosed acute leukemia patients mostly complicated with active systemic infection and bleeding tendency. Sonography-guided venipuncture using a 14-gauge needle sheath was performed

SUNG-YU CHU; CHEN-HSIEN WU; JIAN-LUN WU; CHEN-HONG TOH; JENG-HWEI TSENG; CHIAN-FU HUNG; KEE-MIN YEOW

2004-01-01

175

Declotting a Thrombosed Brescia-Cimino Fistula by Manual Catheter-Directed Aspiration of the Thrombus  

SciTech Connect

Acute thrombosis of native fistulae for hemodialysis occurs more rarely than for prosthetic grafts. The vascular access should be reopened as soon as possible in order to resume regular dialysis and to avoid resorting to a temporary central line. Manual aspiration is one of the numerous methods described in this setting. Clinical examination is essential to rule out local infection, which is the only serious contraindication to percutaneous maneuvers. Two introducer-sheaths are placed in a criss-cross fashion in order to gain access to the venous outflow and to the anastomosis. Access to the venous outflow is performed first in order to check the proximal extent of the thrombosis. Heparin and antibiotics are injected systemically. A similar maneuver is then performed in the direction of the anastomosis. The aspiration phase is then initiated. A 7-9 Fr aspiration catheter is pushed through the 'venous' introducer. Manual aspiration is created through a 50 ml syringe while the catheter is progressively removed with back and forth movements. The catheter and the contents of the syringe are flushed through a gauze on the working table to evaluate the amount of thrombus which has been removed and the maneuver is repeated as often as necessary to remove all the thrombus. Once all the clots located downstream from the venous introducer have been removed, any unmasked underlying stenosis is NOT dilated at this stage since it provides protection against major embolism coming from the inflow. The aspiration catheter is then pushed through the 'arterial' introducer down to the anastomosis in order to aspirate the thrombus located between the tip of the introducer and the anastomosis. Dilatation of unmasked stenoses is finally performed using high-pressure balloons. The holes made by the two introducers are closed using a U-shaped suture with interposition of a short piece of plastic and the patient is sent back to the nephrologists for dialysis.

Turmel-Rodrigues, Luc A [Clinique Saint-Gatien, Radiologie Vasculaire, Diagnostique et Interventionnelle (France)], E-mail: luc.turmel@wanadoo.fr, E-mail: cim.stgatien@wanadoo.fr

2005-01-15

176

21 CFR 878.4200 - Introduction/drainage catheter and accessories.  

Code of Federal Regulations, 2010 CFR

...certain physiologic conditions. Examples include irrigation and drainage catheters, pediatric catheters, peritoneal catheters (including dialysis), and other general surgical catheters. An introduction/drainage catheter accessory is...

2010-04-01

177

21 CFR 878.4200 - Introduction/drainage catheter and accessories.  

Code of Federal Regulations, 2011 CFR

...certain physiologic conditions. Examples include irrigation and drainage catheters, pediatric catheters, peritoneal catheters (including dialysis), and other general surgical catheters. An introduction/drainage catheter accessory is...

2011-04-01

178

Improved ureteral stone fragmentation catheter  

NASA Technical Reports Server (NTRS)

Catheter includes fiber optic viewer, more reliable ultrasonic probe, and better contact sensor. It is guided by four steering wires, and irrigation fluid is supplied through lumen to remove stone fragments.

Gammell, P. M.

1981-01-01

179

Peripherally inserted central catheter - flushing  

MedlinePLUS

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

180

Evaluation of prosthetic venous valves, fabricated by electrospinning, for percutaneous treatment of chronic venous insufficiency.  

PubMed

Chronic venous insufficiency (CVI) remains a major health problem worldwide. Direct venous valve surgical repair and venous segment transplantation are clinical options; however, they are highly invasive procedures. The objectives of this study were to fabricate prosthetic venous valves (PVVs) by electrospinning, for percutaneous treatment of CVI, and evaluate their hydrodynamic characteristics in vitro at the same locations and under the same flow conditions. The PVVs consisted of polyurethane fiber scaffolds attached to a cobalt-chromium stent. PVVs with two different valve-leaflet configurations were compared: biomimetic PVV (bPVV) and open PVV (oPVV). A balloon catheter was used to implant the devices in a poly(vinyl chloride) tube and the column outlet was set at a height of 100 cm above the test valve to simulate the elevation of the heart above a distal vein valve while standing; 50 wt% glycerin solution was used as the test fluid. The devices were evaluated for antegrade flow, effect of ankle flexion, and stagnation zones around the valve leaflets. During sudden hydrostatic backpressure, little leakage and constant peripheral pressure were observed for the devices; under forward pulsatile pressure of 0-4 mmHg, to simulate the effect of breathing, the oPVV had a higher flow rate than the bPVV. With regard to the effect of ankle flexion, the oPVV was functionless. Moreover, the stagnation zone around the oPVV valve leaflets was larger than that around the bPVV valve leaflets. These results suggest that the bPVV would be clinically suitable for percutaneous treatment of CVI. PMID:21789716

Moriyama, Masaki; Kubota, Shinichiro; Tashiro, Hideo; Tonami, Hiroyuki

2011-12-01

181

Ionic implantation of silicone chronic venous access devices does not alter thrombotic complications: A double-blinded, randomized clinical trial  

Microsoft Academic Search

Background. Ion implantation of silicone vascular catheters has been shown in preclinical and pilot studies to alter the thrombogenicity of silicone surfaces through the reduced adherence of thrombin. This prospective, randomized double-blinded study was designed to detect differences in function related to thrombotic events between ion-implanted and standard silicone chronic venous access devices (CVAD) placed in patients with cancer who

James L. Frank; Jane L. Garb; Beth Halla; William P. Reed

2001-01-01

182

[Venous surgery for impotence].  

PubMed

The treatment of cavernovenous leak consists of the ligation resection of the deep dorsal vein and the cavernous veins when the arterial inflow is normal. When the penile arterial inflow is reduced, deep dorsal vein arterialization can improve the venous leakage. PMID:2064362

Wespes, E

1991-01-01

183

Neonatal venous cerebral hemorrhage. Report of two cases.  

PubMed

Intracranial pathological changes can occur as a result of impaired craniocervical venous return. Thrombosis of central venous access catheters was demonstrated in two neonates born at 38 and 27 weeks' gestation. Neither infant developed hemorrhage of prematurity as confirmed on cranial ultrasonography. Clinical evidence of vena cava thrombosis and associated spontaneous intraventricular hemorrhage developed on Day 24 and 36, respectively, and these findings were confirmed on imaging studies. In one infant the hemorrhage was accompanied by communicating hydrocephalus. The cause of the intracranial disease was attributable to the retrograde cerebral venous congestion. This, together with the primitive venous bed developing in the periventricular region, was associated with the spontaneous hemorrhage in the region of the foramen of Monro. To the authors' knowledge, this is the first report in the English-language literature of spontaneous neonatal intracerebral hemorrhage, due to thrombosis of the superior or inferior vena cava. The natural history of this condition is resolution without sequelae after appropriate therapeutic intervention for the vena cava thrombosis. PMID:15344898

Misra, Sanjay N; Misra, Ashish K

2003-10-15

184

What went wrong? The flawed concept of cerebrospinal venous insufficiency  

PubMed Central

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency (‘CCSVI'). The diagnosis of ‘CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of ‘CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the ‘CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the ‘CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat ‘CCSVI' in the care of MS patients, outside of the setting of scientific research. PMID:23443168

Valdueza, José M; Doepp, Florian; Schreiber, Stephan J; van Oosten, Bob W; Schmierer, Klaus; Paul, Friedemann; Wattjes, Mike P

2013-01-01

185

What went wrong? The flawed concept of cerebrospinal venous insufficiency.  

PubMed

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research. PMID:23443168

Valdueza, José M; Doepp, Florian; Schreiber, Stephan J; van Oosten, Bob W; Schmierer, Klaus; Paul, Friedemann; Wattjes, Mike P

2013-05-01

186

Development of Needle Insertion Manipulator for Central Venous Catheterization  

NASA Astrophysics Data System (ADS)

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.

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

187

Modification of the HeRO Graft Allowing Earlier Cannulation and Reduction in Catheter Dependent Days in Patients with End Stage Renal Disease: A Single Center Retrospective Review  

PubMed Central

After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access. PMID:24516365

Cummings, L. S.; Wible, Brandt C.; Borsa, John; Randall, Henry

2014-01-01

188

Cardiac type of total anomalous pulmonary venous connection: diagnosis and demonstration by multidetector CT angiography  

PubMed Central

Pulmonary venous developmental anomalies have been evaluated conventionally with echocardiography and catheter angiography, multidetector CT angiography (MDCTA) and MR angiography are playing increasing roles in their characterisation. Here, we report a rare case of a 15-year-old boy, who presented with cyanosis and dyspnoea which he had had since childhood. Cardiac type of total anomalous pulmonary venous connection (TAPVC) was diagnosed and demonstrated using MDCTA in this case. Only a few case reports describing the MDCTA findings in cardiac TAPVC are available in the published literature. PMID:23291825

Singh, Neha; Singh, Ragini; Aga, Pallavi; Singh, Shailesh Kumar

2013-01-01

189

A Modified Metallic Coil Embolization Technique for Pulmonary Arteriovenous Malformations Using Coil Anchors and Occlusion Balloon Catheters  

SciTech Connect

Purpose. To evaluate the feasibility and efficacy of a modified metallic coil embolization technique for pulmonary arteriovenous malformations (PAVMs) using coil anchors and occlusion balloon catheters. Methods. Five consecutive female patients with 6 PAVMs were included in the present study. One of the 6 PAVMs was of the complex type with four feeding arteries. An occlusion balloon catheter was inserted into the feeding artery as close to the venous sac as possible. The coil anchor, which was a simple W-shaped bent stainless steel wire with two markers at each end, was deployed prior to embolization to prevent the systemic migration of embolic materials. Then, metallic coils were deployed around the coil anchors under inflow stoppage using the inflated occlusion balloon catheter. In the complex-type PAVM, the main feeder was occluded by this technique and the other three small feeders were embolized with metallic coils only. Results. In all 5 cases, occlusion balloon catheters could be inserted into the feeding arteries just proximal to the venous sacs, coil anchors were easily deployed, and complete occlusion was achieved without any migration of metallic coils or paradoxical embolism during the procedure. Conclusions. The modified metallic coil embolization technique with coil anchors and occlusion balloon catheters was feasible and considered to be useful in preventing procedure-related complications.

Mori, Kensaku [Institute of Clinical Medicine, University of Tsukuba, Department of Diagnostic and Interventional Radiology (Japan)], E-mail: moriken@md.tsukuba.ac.jp; Shiigai, Masanari [Tsukuba Medical Center Hospital, Department of Radiology (Japan); Saida, Tsukasa; Anno, Izumi [Institute of Clinical Medicine, University of Tsukuba, Department of Diagnostic and Interventional Radiology (Japan); Wada, Mitsuyoshi [Seinan Medical Center Hospital, Department of Radiology (Japan); Minami, Manabu [Institute of Clinical Medicine, University of Tsukuba, Department of Diagnostic and Interventional Radiology (Japan)

2008-05-15

190

Catheter-based photoacoustic endoscope  

NASA Astrophysics Data System (ADS)

We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

2014-06-01

191

21 CFR 870.1250 - Percutaneous catheter.  

...1250 Percutaneous catheter. (a) Identification. A percutaneous catheter is a device that is introduced into a vein or artery through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class II...

2014-04-01

192

21 CFR 870.1250 - Percutaneous catheter.  

Code of Federal Regulations, 2013 CFR

...1250 Percutaneous catheter. (a) Identification. A percutaneous catheter is a device that is introduced into a vein or artery through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class II...

2013-04-01

193

21 CFR 870.1250 - Percutaneous catheter.  

Code of Federal Regulations, 2010 CFR

...1250 Percutaneous catheter. (a) Identification. A percutaneous catheter is a device that is introduced into a vein or artery through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class II...

2010-04-01

194

Multielectrode Pulmonary Vein Ablation Catheter (PVAC(®)): current data on results and risks.  

PubMed

Electrical isolation of pulmonary veins is the cornerstone of catheter ablation for patients with symptomatic atrial fibrillation. However, uncertainty surrounds the choice of energy source in pulmonary vein isolation (PVI). Various alternative techniques such as the Pulmonary Vein Ablation Catheter (PVAC(®), Medtronic Inc., Minneapolis, MN, USA) have been developed to facilitate PVI. This over-the-wire multielectrode catheter is delivering duty-cycled bipolar and unipolar radiofrequency (RF) energy at relatively low power.PVI with this "one-shot" PVACatheter can shorten the procedure duration and lower fluoroscopy time compared to irrigated RF. It enables mapping and ablation with the same array, but fails to show signals during RF energy delivery. The effectiveness of PVAC is comparable to other technologies in randomized studies. The overall complication rate of PVAC PVI is comparable to irrigated RF and possibly slightly higher for cryoballoon PVI. Special attention has to be paid to an effective anticoagulation throughout the ablation procedure, avoidance of embolic events and pulmonary venous stenosis.The novel catheter design of the PVAC Gold(®) array may improve safety by reducing embolic events through avoidance of electrode 1-to-10 interaction and by better tissue contact due to the 20° forward tilt. Although clinical data with this new array are lacking so far, the PVAC system has been shown to be a promising tool for PVI. However, prospective studies especially with the novel array are required to determine its true role for catheter ablation of atrial fibrillation in the future. PMID:25070931

Mönnig, Gerold; Eckardt, Lars

2014-12-01

195

Low Serum Citrulline Concentration Correlates With Catheter-Related Bloodstream Infections in Children With Intestinal Failure  

PubMed Central

Background Serum citrulline concentration is used as a biomarker of enterocyte mass and enteral tolerance, and low serum concentrations are correlated with bacteremia in immunosuppressed adults undergoing hematopoietic stem cell transplant. The authors sought to determine if citrulline was associated with the development of catheter-related bloodstream infections (CRBSIs) in children with intestinal failure. Methods Data were reviewed from 66 children treated in a multidisciplinary intestinal rehabilitation program, who had serum concentration citrulline measured between January 2007 and August 2009. All patients had a diagnosis of intestinal failure requiring parenteral nutrition (PN) support. Exclusion criteria included central venous catheter in situ <30 days, creatinine clearance <20 mL/ minute, or a history of organ transplant/immunosuppression. Results A total of 15 patients were excluded because of the above criteria. In this cohort of 51 patients, 26 (51%) developed CRBSIs. Both groups were similar in terms of gestational age, diagnosis, nutrition status, and biochemical liver function tests. The mean (± standard deviation [SD]) minimum serum citrulline concentration was significantly lower in patients who developed CRBSIs (6.7 ± 4.6 ?mol/L) than in those who did not (11.3 ± 6.4 ?mol/L, P = .004). Multivariate logistic regression analysis identified lower minimum serum citrulline concentration and longer central venous catheter duration as independently associated with CRBSI (P = .003 and P = .038, respectively). Conclusions Low serum citrulline concentration and longer central venous catheter time are independently associated with CRBSI in children with intestinal failure. Serum citrulline concentration may be a useful biomarker to identify patients with intestinal failure who are at high risk of developing a CRBSI. PMID:21378247

Hull, Melissa A.; Jones, Brian A.; Zurakowski, David; Raphael, Bram; Lo, Clifford; Jaksic, Tom; Duggan, Christopher

2012-01-01

196

Radiofrequency Guide Wire Recanalization of Venous Occlusions in Patients with Malignant Superior Vena Cava Syndrome  

SciTech Connect

Fibrotic central venous occlusions in patients with thoracic malignancy and prior radiotherapy can be impassable with standard catheters and wires, including the trailing or stiff end of a hydrophilic wire. We report two patients with superior vena cava syndrome in whom we successfully utilized a radiofrequency guide wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) to perforate through the occlusion and recanalize the occluded segment to alleviate symptoms.

Davis, Robert M.; David, Elizabeth; Pugash, Robyn A.; Annamalai, Ganesan, E-mail: ganesan.annamalai@sunnybrook.ca [Sunnybrook Health Sciences Centre, Department of Interventional Radiology (Canada)

2012-06-15

197

Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis  

PubMed Central

Acute portal vein and mesenteric vein thrombosis (PVMVT) can cause acute mesenteric ischemia and be fatal with mortality rate of 37%-76%. Therefore, early diagnosis and prompt venous revascularization are warranted in patients with acute symptomatic PVMVT. Due to advances in catheter-directed treatment, endovascular treatment has been used for revascularization of affected vessels in PVMVT. We report two cases of symptomatic PVMVT treated successfully by transhepatic percutaneous mechanical thrombectomy-assisted thrombolysis. PMID:24949327

Jun, Kang Woong; Kim, Mi Hyeong; Park, Keun Myoung; Chun, Ho Jong; Hong, Kee Chun; Jeon, Yong Sun; Cho, Soon Gu

2014-01-01

198

Sepsis associated with central vein catheters in critically ill patients  

Microsoft Academic Search

In 440 critically ill patients, the association between different central vein catheter insertion sites, the duration of catheter insertion and catheter-associated sepsis was examined. Of 780 catheter tips studied, 19% were colonized by microorganisms. The incidence of colonization varied with the different insertion sites. The lowest percentage of colonized catheters occurred with catheters inserted via the subclavian vein (15%) and

P. Collignon; N. Soni; I. Pearson; T. Sorrell; P. Woods

1988-01-01

199

Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room  

SciTech Connect

We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 {+-} 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thus required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.

Kroepil, Patric; Lanzman, Rotem S., E-mail: rotemshlomo@yahoo.de; Miese, Falk R.; Blondin, Dirk [University Hospital Duesseldorf, Department of Radiology (Germany); Winter, Joachim [University Hospital Duesseldorf, Department of Cardiovascular Surgery (Germany); Scherer, Axel; Fuerst, Guenter [University Hospital Duesseldorf, Department of Radiology (Germany)

2011-04-15

200

Peripherally inserted central catheters (PICCs) in the management of oncohematological patients submitted to autologous stem cell transplantation.  

PubMed

The aim of our study was to evaluate the feasibility and the safety of the use of peripherally inserted central catheters (PICCs) during autologous peripheral blood stem cell transplantation. Sixty PICCs were inserted in 57 patients (23 females and 34 males; mean age 48, range 19-68 years) and remained in place for an overall period of 1,276 days. All PICCs were positioned by a team of specifically trained physicians and nurses and utilized by specifically trained nurses of our hematology unit. No major insertion-related complications were observed; the only complication during insertion was one local hematoma (1.6 %) due to accidental arterial puncture. Late complications were accidental catheter removal (5 %, 2.3 per 1,000 PICC days), symptomatic catheter-related venous thrombosis (5 %, 2.3 per 1,000 PICC days), and catheter-related bloodstream infection (CRBSI; 3.3 %, 1.5 CRBSI per 1,000 PICC days). The reasons for catheter removal were completion of therapy (42 patients, 70 %), fever of unknown origin (9 patients, 15 %), catheter-related thrombosis (2 patients, 3.3 %), CRBSI (2 patients, 3.3 %), accidental removal (3 patients, 5 %), lumen occlusion (1 patient, 1.6 %), positive culture from peripheral blood (1 patient, 1.6 %), and death (1 patient, 1.6 %). Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in patients particularly prone to infective and hemorrhagic complications such as patients receiving autologous stem cell transplantation. PMID:22864473

Bellesi, Silvia; Chiusolo, Patrizia; De Pascale, Gennaro; Pittiruti, Mauro; Scoppettuolo, Giancarlo; Metafuni, Elisabetta; Giammarco, Sabrina; Sorà, Federica; Laurenti, Luca; Leone, Giuseppe; Sica, Simona

2013-02-01

201

Cytometric Catheter for Neurosurgical Applications  

SciTech Connect

Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

Evans III, Boyd Mccutchen [ORNL; Allison, Stephen W [ORNL; Fillmore, Helen [ORNL; Broaddus, William C [ORNL; Dyer, Rachel L [ORNL; Gillies, George [ORNL

2010-01-01

202

Comparison of four skin preparation strategies to prevent catheter-related infection in intensive care unit (CLEAN trial): a study protocol for a randomized controlled trial  

PubMed Central

Background Catheter-related infection is the third cause of infections in intensive care units (ICU), increasing the length of stay in ICU and hospital, mortality, and costs. Skin antisepsis is one of the most prevalent preventive measures. In this respect, it would appear preferable to recommend the use of alcoholic povidone iodine or chlorhexidine rather than aqueous povidone iodine. However, the data comparing chlorhexidine to povidone-iodine, both of them in alcoholic solutions, remain limited. Moreover, the benefits of enhanced cleaning prior to disinfection of skin that is not visibly soiled have yet to be confirmed in a randomized study. Methods A prospective multicenter, 2×2 factorial, randomized-controlled, assessor-blind trial will be conducted in 11 intensive care units in six French hospitals. All adult patients aged over 18 years requiring the insertion of at least one peripheral arterial catheter and/or a non-tunneled central venous catheter and/or a hemodialysis catheter and/or an arterial pulmonary catheter will be randomly assigned to have all their catheters cared with one of four skin preparation strategies (2% chlorhexidine/70% isopropyl alcohol or 5% povidone iodine/69% ethanol with or without prior skin scrubbing). At catheter removal, catheter tips will be quantitatively cultured. Sets of aerobic and anaerobic blood cultures will be routinely obtained when a patient has fever, hypothermia, or other indications. In case of suspected catheter-related infection the patient’s form will be reviewed by an independent adjudication committee. We plan to enroll 2,400 patients (4,800 catheters). The main objective is to demonstrate that use of 2% alcoholic chlorhexidine compared to 5% alcoholic povidone iodine in skin preparation lowers the rate of catheter-related infection. The second endpoint is to demonstrate that enhanced skin cleaning prior to disinfection of skin that is not visibly soiled does not reduce catheter colonization. Other outcomes include comparison of skin colonization at catheter insertion site, comparison of catheter colonization and catheter-related bacteremia taking place during implementation of the four strategies of skin preparation, and cutaneous tolerance, length of hospitalization, mortality, and costs. Discussion This study will help to update recommendations on the choice of an antiseptic agent to use in skin preparation prior to insertion of a vascular catheter and, by extension, of an epidural catheter and it will likewise help to update recommendations on the usefulness of skin scrubbing prior to disinfection when the skin is not visibly soiled. Trial registration Clinicaltrials.gov number NCT01629550 PMID:23782845

2013-01-01

203

Stability of Trisodium Citrate and Gentamicin Solution for Catheter Locks after Storage in Plastic Syringes at Room Temperature  

PubMed Central

Background: Catheter-related infections are a major problem for hemodialysis patients with central venous catheters for vascular access. Catheter lock solutions containing an anticoagulant are used to maintain the patency of the catheter between hemodialysis sessions. There is evidence that the use of lock solutions containing an antibiotic is associated with lower rates of infection but also that these solutions can kill microbes in colonized catheters and thus avoid the risks and costs associated with replacing the catheter. Objective: This stability study was conducted to determine whether an extemporaneously prepared gentamicin–citrate catheter lock solution would retain its potency over time, thus allowing for advance preparation of the solution. Methods: Catheter lock solutions containing gentamicin alone, citrate alone, and the combination of gentamicin and citrate were prepared aseptically and packaged in polyethylene syringes. The syringes were stored at room temperature. At timed intervals over 112 days, samples were withdrawn for analysis by means of validated high-performance liquid chromatography. Results: None of the 3 lock solutions showed any evidence of degradation during the 112-day observation period. In the formulation containing both gentamicin 2.5 mg/mL and sodium citrate 40 mg/mL (4%), there was no change in the concentration of either gentamicin (p = 0.34) or citrate (p = 0.55). Linear regression analysis of the concentration–time data for the combined formulation showed that 99.97% of the labelled amount of gentamicin and 101.30% of the labelled amount of citrate remained at day 112. The lower limit of the 95% confidence intervals indicated that more than 98.17% of the gentamicin and more than 99.57% of the citrate remained on day 112. Conclusion: The results of this study will allow pharmacies to extemporaneously compound the combined gentamicin–citrate catheter lock solution in advance of use. The method described here will yield a stable product for use in clinical applications. PMID:22478993

Cote, Dennis; Lok, Charmaine E; Battistella, Marisa; Vercaigne, Lavern

2010-01-01

204

Venous thromboembolism in adolescents.  

PubMed

The incidence of venous thromboembolism (VTE) during childhood is low with two peaks - neonatal and adolescent age. This retrospective study is focused on clinical characteristics ofVTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed--16 girls (88.9%), 2 boys (11.1%). In 9 patients (50%) thrombosis of the lower limb deep veins was diagnosed, six patients (33.3%) suffered from symptomatic pulmonary embolism (PE) and 3 patients (16.7%) from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%). The most frequent acquired risk factor was oral contraception (OC) in 12 out of 16 girls (75%). All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6%) patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50%) in patients with distal lower limb thrombosis, but very high (100%) in patients with PE. PMID:23101270

Samková, Aneta; Lejhancová, Katerina; Hak, Jirí; Lukes, Antonín

2012-01-01

205

In utero nephrostomy catheter placement.  

PubMed

In utero diagnosis of severe oligohydramnios and fetal ureteral pelvic outlet obstruction resulted in the placement of nephrostomy catheters in two fetuses. The amniotic fluid index improved, mid-chest thoracic circumference increased and renal calyceal dilation decreased in both patients. Both neonates had evidence of pulmonary hypoplasia but survived. This new technique offers an alternative for antenatal management of obstructive uropathy when the bladder is not accessible or is distal to the site of the obstruction. PMID:7818785

Pinckert, T L; Kiernan, S C

1994-01-01

206

Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients  

PubMed Central

Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive. PMID:22947496

2012-01-01

207

Smart central venous port for early detection of bacterial biofilm related infections.  

PubMed

Central venous catheters (CVC) are commonly used in clinical practice to improve a patient's quality of life. Unfortunately, there is an intrinsic risk of acquiring an infection related to microbial biofilm formation inside the catheter lumen. It has been estimated that 80 % of all human bacterial infections are biofilm-associated. Additionally, 50 % of all nosocomial infections are associated with indwelling devices. Bloodstream infections account for 30-40 % of all cases of severe sepsis and septic shock, and are major causes of morbidity and mortality. Diagnosis of bloodstream infections must be performed promptly so that adequate antimicrobial therapy can be started and patient outcome improved. An ideal diagnostic technology would identify the infecting organism(s) in a timely manner, so that appropriate pathogen-driven therapy could begin promptly. Unfortunately, despite the essential information it provides, blood culture, the gold standard, largely fails in this purpose because time is lost waiting for bacterial or fungal growth. This work presents a new design of a venous access port that allows the monitoring of the inner reservoir surface by means of an impedimetric biosensor. An ad-hoc electronic system was designed to manage the sensor and to allow communication with the external receiver. Historic data recorded and stored in the device was used as the reference value for the detection of bacterial biofilm. The RF communication system sends an alarm signal to the external receiver when a microbial colonization of the port occurs. The successful in vitro analysis of the biosensor, the electronics and the antenna of the new indwelling device prototype are shown. The experimental conditions were selected in each case as the closest to the clinical working conditions for the smart central venous catheter (SCVC) testing. The results of this work allow a new generation of this kind of device that could potentially provide more efficient treatments for catheter-related infections. PMID:24515846

Paredes, J; Alonso-Arce, M; Schmidt, C; Valderas, D; Sedano, B; Legarda, J; Arizti, F; Gómez, E; Aguinaga, A; Del Pozo, J L; Arana, S

2014-06-01

208

Pseudozyma spp catheter-associated blood stream infection, an emerging pathogen and brief literature review.  

PubMed

Pseudozyma spp are amorphic yeasts. They are commonly plant pathogens, but rarely cause invasive fungal disease in humans. Only three cases of central venous catheter (CVC)-associated blood stream infections due to this organism have been reported in the literature. Main underlying risk factors for Pseudozyma spp infection are bowel surgery, CVC and total parenteral nutrition. We present a rare case of Pseudozyma spp catheter-associated blood stream infection that was successfully treated with antifungal therapy and removal of CVC. It is important to recognise and differentiate this species from other yeasts as it may require the use of amphotericin B or voriconazole instead of fluconazole, to which the organism is variably resistant. PMID:25498807

Siddiqui, Wajid; Ahmed, Yasir; Albrecht, Helmut; Weissman, Sharon

2014-01-01

209

Catheter-related Mycobacterium fortuitum bloodstream infection: rapid identification using MALDI-TOF mass spectrometry.  

PubMed

We present the case of a 6-year-old boy diagnosed with stage III mediastinal Non Hodgkin Lymphoblastic T cell Lymphoma who suffered from catheter-related bloodstream infection (CRBI) due to Mycobacterium fortuitum whilst receiving chemotherapy. Isolation of this rare pathogen was done directly from blood culture and identification was made rapidly within 48?h using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectro-metry as well as specific polymerase chain reaction (PCR)-reverse hybridization method. This allowed prompt directed antibiotic therapy apart from central venous catheter removal and resulted in an excellent clinical response. This case highlights the potential benefit of using MALDI-TOF mass spectrometry, a fast, cost-effective and precise methodology, in the diagnosis and subsequent management of invasive bacterial infection. PMID:24554588

Artacho-Reinoso, M J; Olbrich, P; Solano-Paéz, P; Ybot-Gonzalez, P; Lepe, J A; Neth, O; Aznar, J

2014-04-01

210

An Organoselenium Compound Inhibits Staphylococcus aureus Biofilms on Hemodialysis Catheters In Vivo  

PubMed Central

Colonization of central venous catheters (CVCs) by pathogenic bacteria leads to catheter-related bloodstream infections (CRBSIs). These colonizing bacteria form highly antibiotic-resistant biofilms. Staphylococcus aureus is one of the most frequently isolated pathogens in CRBSIs. Impregnating CVC surfaces with antimicrobial agents has various degrees of effectiveness in reducing the incidence of CRBSIs. We recently showed that organoselenium covalently attached to disks as an antibiofilm agent inhibited the development of S. aureus biofilms. In this study, we investigated the ability of an organoselenium coating on hemodialysis catheters (HDCs) to inhibit S. aureus biofilms in vitro and in vivo. S. aureus failed to develop biofilms on HDCs coated with selenocyanatodiacetic acid (SCAA) in either static or flowthrough continuous-culture systems. The SCAA coating also inhibited the development of S. aureus biofilms on HDCs in vivo for 3 days. The SCAA coating was stable and nontoxic to cell culture or animals. This new method for coating the internal and external surfaces of HDCs with SCAA has the potential to prevent catheter-related infections due to S. aureus. PMID:22123688

Tran, Phat L.; Lowry, Nathan; Campbell, Thomas; Reid, Ted W.; Webster, Daniel R.; Tobin, Eric; Aslani, Arash; Mosley, Thomas; Dertien, Janet; Colmer-Hamood, Jane A.

2012-01-01

211

Manual Aspiration Thrombectomy with Stent Placement: Rapid and Effective Treatment for Phlegmasia Cerulea Dolens with Impending Venous Gangrene  

SciTech Connect

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene.

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology (Turkey)

2008-01-15

212

Translumbar placement of paired hemodialysis catheters (Tesio Catheters) and follow-up in 10 patients  

SciTech Connect

For lack of other suitable access, 10 consecutive patients received paired hemodialysis catheters for long-term hemodialysis using a translumbar approach to the inferior vena cava (IVC). All attempts were successful. Five paired catheters were placed using the single-puncture technique, and five using the dual-puncture technique. Catheters were in place for a total of 2252 catheter days. The average duration of catheter placement was 250 days (range 30-580 days). All catheters were functioning up to the time the study was completed or the patient died. The most common complication was partial dislodgment of the catheter in 3 of 23 catheters (13%), all occurring in obese patients. One episode of retroperitoneal hemorrhage was noted in a patient having the single-access technique. There were no episodes of infection or IVC thrombosis.

Biswal, Rajiv; Nosher, John L.; Siegel, Randall L.; Bodner, Leonard J. [UMDNJ-Robert Wood Johnson Medical School, Department of Radiology, MEB 404 (United States)

2000-01-15

213

21 CFR 870.5150 - Embolectomy catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5150 Embolectomy catheter. (a) Identification. An...

2014-04-01

214

21 CFR 870.1280 - Steerable catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1280 Steerable catheter. (a) Identification. A...

2014-04-01

215

21 CFR 870.1280 - Steerable catheter.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1280 Steerable catheter. (a) Identification. A...

2013-04-01

216

21 CFR 870.5150 - Embolectomy catheter.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5150 Embolectomy catheter. (a) Identification. An...

2013-04-01

217

21 CFR 870.5175 - Septostomy catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Therapeutic Devices § 870.5175 Septostomy catheter. (a) Identification. A...

2014-04-01

218

Hemodialysis vascular catheter-related bacteremia.  

PubMed

Bacteremia in hemodialysis patients with cuffed tunneled catheters is a significant cause of morbidity and mortality. Native arteriovenous fistulas or vascular prostheses are preferred forms of vascular access, but their creation may not always be possible. Catheter-related bacteremia is due primarily to Gram-positive organisms, but Gram-negative infections are of increasing importance. Bacteremia in patients with catheters results from luminal or extraluminal contamination and may be perpetuated by infected fibrin sheaths associated with the catheter. Bacteremic patients require antibiotic therapy and catheter removal. Guide wire catheter exchange is appropriate in stable patients, but catheter removal and later reinsertion of a new catheter is indicated for tunnel infection or frank sepsis. Late diagnosis or ineffective therapy predisposes to vascular and extravascular infectious complications. Catheter-related bacteremia may be minimized with appropriate sterile technique at insertion, meticulous exit site care, and antibiotic lock solutions. Early recognition and treatment minimize morbidity and mortality, but the optimal solution remains the placement of permanent access. PMID:18091368

Sullivan, Robert; Samuel, Vinny; Le, Carol; Khan, Mohammad; Alexandraki, Irene; Cuhaci, Bulent; Nahman, N Stanley

2007-12-01

219

Pycnogenol® in chronic venous insufficiency and related venous disorders.  

PubMed

The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. PMID:23775628

Gulati, Om P

2014-03-01

220

Catheter indwell time and phlebitis development during peripheral intravenous catheter administration  

PubMed Central

Objective: Intravenous catheters have been indispensable tools of modern medicine. Although intravenous applications can be used for a multitude of purposes, these applications may cause complications, some of which have serious effects. Of these complications, the most commonly observed is phlebitis. This study was conducted to determine the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. Methods: This study determined the effect of catheter indwell time on phlebitis development during peripheral intravenous catheter administration. The study included a total of 103 individuals who were administered 439 catheters and satisfied the study enrollment criteria at one infectious diseases clinic in Istanbul/Turkey. Data were compiled from Patient Information Forms, Peripheral Intravenous Catheter and Therapy Information Forms, reported grades based on the Visual Infusion Phlebitis Assessment Scale, and Peripheral Intravenous Catheter Nurse Observation Forms. The data were analyzed using SPSS. Results : The mean patient age was 53.75±15.54 (standard deviation) years, and 59.2% of the study participants were men. Phlebitis was detected in 41.2% of peripheral intravenous catheters, and the rate decreased with increased catheter indwell time. Analyses showed that catheter indwell time, antibiotic usage, sex, and catheterization sites were significantly associated with development of phlebitis. Conclusion: The results of this study show that catheters can be used for longer periods of time when administered under optimal conditions and with appropriate surveillance. PMID:25097505

Pasalioglu, Kadriye Burcu; Kaya, Hatice

2014-01-01

221

Venous complications of pancreatitis: a review.  

PubMed

Pancreatitis is notorious to cause vascular complications. While arterial complications include pseudoaneurysm formation with a propensity to bleed, venous complications can be quite myriad. Venous involvement in pancreatitis often presents with thrombosis. From time to time case reports and series of unusual venous complications associated with pancreatitis have, however, been described. In this article, we review multitudinous venous complications in the setting of pancreatitis and propose a system to classify pancreatitis associated venous complications. PMID:25640778

Aswani, Yashant; Hira, Priya

2015-01-01

222

Activity and dosage of alteplase dilution for clearing occlusions of venous-access devices.  

PubMed

The activity and sterility of reconstituted alteplase solution and the effectiveness of an alteplase dose-escalation protocol for the clearance of midline-catheter and central-venous-access device occlusions were studied. Reconstituted alteplase solution was stored at -70, -25, or 2 degrees C at concentrations of 0.5, 1, or 2 mg/mL. Durations of storage in the freezer were 0, 7, and 14 days, and durations of storage in the refrigerator were 0, 48, and 72 hours and 7 and 14 days. Samples were also assayed and cultured without prior freezing after refrigeration at 2 degrees C for 0, 48, and 72 hours and 7, 14, and 28 days. Fifty-eight pediatric and adult patients were enrolled in a separate study in which catheter clearance was initiated with alteplase 0.5 mg, and the dose was escalated to 1 and 2 mg sequentially until the catheter was cleared. The primary endpoint was restoration of catheter patency, and the secondary endpoint was the occurrence of bleeding episodes within 24 hours of alteplase administration. Catheter removal due to failure to restore patency was also documented. The activity and sterility of alteplase were maintained under all conditions studied. Fifty catheters (86.2%) were cleared with alteplase 0.5 mg, 5 (8.6%) after dose escalation to 1 mg, and 1 (1.7%) after escalation to 2 mg. The alteplase solution did not clear the occlusion in 2 catheters (3.4%): 1 had a mechanical obstruction and 1 cleared two hours after the 1-mg dose was deemed a failure. None of the six catheter removals was due to recalcitrant clots. Bleeding observed was not considered to be the result of alteplase administration. For use in clearing occlusions of venous-access devices, alteplase 0.5, 1, and 2 mg/mL retained sufficient fibrinolytic activity when stored for up to 14 days at 2 degrees C (28 days for the 0.5-mg/mL dilution) and when stored for 14 days at -70 or -25 degrees C followed by up to 14 days at 2 degrees C. The dose-escalation protocol was effective. PMID:10876745

Davis, S N; Vermeulen, L; Banton, J; Schwartz, B S; Williams, E C

2000-06-01

223

Venous ulcers - self-care  

MedlinePLUS

... When these valves become weak, blood can flow backward and pool in your legs. This is called ... are at risk for venous ulcers, take these steps to help prevent problems. Raise your feet above ...

224

Randomized clinical trial comparing ultrasound-guided procedure with the Seldinger's technique for placement of implantable venous ports.  

PubMed

The aim of this randomized controlled study was to compare ultrasound-guided procedure with the Seldinger's technique for placement of implantable venous ports. A total of 214 patients were randomized to receive TIAP placement by either ultrasound-guided procedure or the Seldinger's technique. Complications and pain perception were compared between these two groups. No severe perioperative or periinterventional complication occurred. Significantly (P < 0.05) lower pain perception was observed in the ultrasound-guided group. Seldinger's technique group showed higher rate in incidence of early and late complications including catheter dislocation, catheter occlusion, venous thrombosis, fever of unknown origin, skin necrosis, and sepsis. In conclusion, both techniques, the TIAP implantation via ultrasound-guided jugular vein puncture and via Seldinger's technique subclavian vein puncture, are feasible and safe. Regarding intrainterventional pain perception and implantation-related complications, the jugular vein puncture under ultrasound guidance seems to be advantageous. PMID:24748179

Miao, Jianzhong; Ji, Lijun; Lu, Jianjun; Chen, Jianqing

2014-09-01

225

Central Venous Access for Chemotherapy  

Microsoft Academic Search

\\u000a Systemic chemotherapy is the cornerstone of modern day cancer treatment. Chemotherapeutic agents are often caustic solutions\\u000a that require large high flow venous channels for safe delivery; hence the need for central venous access. Chemotherapeutic\\u000a protocols vary greatly with respect to frequency, intensity, and duration. The concept of dose intensity is being scrutinized\\u000a with current trends favoring more frequent administration of

M. Andreas Mauro

226

Pathophysiology of chronic venous disease.  

PubMed

Chronic venous disease (CVD) is a debilitating condition with a prevalence between 60-70%. The disease pathophysiology is complex and involves genetic susceptibility and environmental factors, with individuals developing visible telengiectasias, reticular veins, and varicose veins. Patient with significant lower extremity symptoms have pain, dermal irritation, swelling, skin changes, and are at risk of developing debilitating venous ulceration. The signature of CVD is an increase in venous pressure referred to as venous hypertension. The various symptoms presenting in CVD and the clinical signs that are observed indicate that there is inflammation, secondary to venous hypertension, and it leads to a number of inflammatory pathways that become activated. The endothelium and glycocalyx via specialized receptors are critical at sensing changes in shear stress, and expression of adhesion molecules allows the activation of leukocytes leading to endothelial attachment, diapedisis, and transmigration into the venous wall/valves resulting in venous wall injury and inflammatory cells in the interstitial tissues. There is a complex of cytokines, chemokines, growth factors, proteases and proteinases, produced by activated leukocytes, that are expressed and unbalanced resulting in an environment of persistent inflammation with the clinical changes that are commonly seen, consisting of varicose veins to more advanced presentations of skin changes and venous ulceration. The structural integrity of protein and the extracellular matrix is altered, enhancing the progressive events of CVD. Work focusing on metabolic changes, miRNA regulation, inflammatory modulation and the glycocalyx will further our knowledge in the pathophysiology of CVD, and provide answers critical to treatment and prevention. PMID:24755829

Raffetto, J D; Mannello, F

2014-06-01

227

21 CFR 876.5030 - Continent ileostomy catheter.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...

2010-04-01

228

21 CFR 876.5030 - Continent ileostomy catheter.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...

2011-04-01

229

21 CFR 876.5030 - Continent ileostomy catheter.  

Code of Federal Regulations, 2012 CFR

...2012-04-01 2012-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...

2012-04-01

230

21 CFR 876.5030 - Continent ileostomy catheter.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...

2013-04-01

231

21 CFR 876.5030 - Continent ileostomy catheter.  

...2014-04-01 2014-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...

2014-04-01

232

21 CFR 870.1350 - Catheter balloon repair kit.  

...2014-04-01 2014-04-01 false Catheter balloon repair kit. 870.1350 Section 870...Diagnostic Devices § 870.1350 Catheter balloon repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair...

2014-04-01

233

21 CFR 868.5120 - Anesthesia conduction catheter.  

Code of Federal Regulations, 2012 CFR

... 2012-04-01 false Anesthesia conduction catheter. 868.5120 Section 868...Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular...

2012-04-01

234

21 CFR 868.5120 - Anesthesia conduction catheter.  

Code of Federal Regulations, 2010 CFR

... 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section 868...Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular...

2010-04-01

235

21 CFR 868.5120 - Anesthesia conduction catheter.  

... 2014-04-01 false Anesthesia conduction catheter. 868.5120 Section 868...Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular...

2014-04-01

236

21 CFR 868.5120 - Anesthesia conduction catheter.  

Code of Federal Regulations, 2011 CFR

... 2011-04-01 false Anesthesia conduction catheter. 868.5120 Section 868...Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular...

2011-04-01

237

21 CFR 868.5120 - Anesthesia conduction catheter.  

Code of Federal Regulations, 2013 CFR

... 2013-04-01 false Anesthesia conduction catheter. 868.5120 Section 868...Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular...

2013-04-01

238

21 CFR 870.1370 - Catheter tip occluder.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 false Catheter tip occluder. 870.1370 Section...ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...Devices § 870.1370 Catheter tip occluder. (a) Identification. A catheter tip occluder is a device...

2013-04-01

239

Totally Implantable Venous Access Devices – 20 Years' Experience of Implantation in Cystic Fibrosis Patients  

PubMed Central

INTRODUCTION Totally implantable venous access devices (TIVADs) are widely used to provide long-term, central venous access for antibiotic delivery in cystic fibrosis patients. However, few studies have demonstrated long-term follow-up with large cohorts. PATIENTS AND METHODS This is a retrospective review of TIVADs implanted in cystic fibrosis patients by vascular surgeons at a tertiary referral centre, using an open venous cut-down technique, from March 1986 to July 2006. The cephalic vein was preferentially chosen for line placement, in the deltopectoral groove, under fluoroscopic control. TIVAD performance (life-span or survival) and complications were evaluated. Data were extracted by review of a local database (data collated prospectively since 1986), with supplementation from electronic patient records and medical notes. RESULTS In total 165 TIVADs in 109 patients (34 males, 75 females) were reviewed. Median survival was 1441 days (range, 6–4440 days). Cumulative patency was 146,072 catheter-days. No immediate intrathoracic complications (pneumothorax, haemothorax, nerve injury) occurred. There were 3 early and 82 late complications, namely: occlusion (33 TIVADs; median age 510 days), infection (23 TIVADs; median 376 days), leakage (16; median 283 days), pain or discomfort (6), venous thrombosis (5), extravasation/skin necrosis (1), vegetation in right atrium (1). Overall incidence of complications was 0.58 per 1000 catheter-days. CONCLUSIONS This study concurs with others that TIVADs are safe and effective, with a favourable life-span in cystic fibrosis patients if well looked after in a specialist centre. Complications of infection, leakage and occlusion do occur. Using an open, venous cut-down technique with fluoroscopic control avoids any immediate intrathoracic complications. PMID:18990281

Royle, T James; Davies, Ruth E; Gannon, Mark X

2008-01-01

240

Detection of emetic activity in the cat by monitoring venous pressure and audio signals  

NASA Technical Reports Server (NTRS)

To investigate the use of audio signals as a simple, noninvasive measure of emetic activity, the relationship between the somatic events and sounds associated with retching and vomiting was studied. Thoracic venous pressure obtained from an implanted external jugular catheter was shown to provide a precise measure of the somatic events associated with retching and vomiting. Changes in thoracic venous pressure monitored through an indwelling external jugular catheter with audio signals, obtained from a microphone located above the animal in a test chamber, were compared. In addition, two independent observers visually monitored emetic episodes. Retching and vomiting were induced by injection of xylazine (0.66mg/kg s.c.), or by motion. A unique audio signal at a frequency of approximately 250 Hz is produced at the time of the negative thoracic venous pressure change associated with retching. Sounds with higher frequencies (around 2500 Hz) occur in conjunction with the positive pressure changes associated with vomiting. These specific signals could be discriminated reliably by individuals reviewing the audio recordings of the sessions. Retching and those emetic episodes associated with positive venous pressure changes were detected accurately by audio monitoring, with 90 percent of retches and 100 percent of emetic episodes correctly identified. Retching was detected more accurately (p is less than .05) by audio monitoring than by direct visual observation. However, with visual observation a few incidents in which stomach contents were expelled in the absence of positive pressure changes or detectable sounds were identified. These data suggest that in emetic situations, the expulsion of stomach contents may be accomplished by more than one neuromuscular system and that audio signals can be used to detect emetic episodes associated with thoracic venous pressure changes.

Nagahara, A.; Fox, Robert A.; Daunton, Nancy G.; Elfar, S.

1991-01-01

241

[Thromboprophylaxis of venous thromboembolism].  

PubMed

Recently in Japan, venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE)] has increased with the Westernization of eating habits and the aging of society. In the West, prophylactic guidelines have been discussed for many years, and, unfortunately, Japan falls far behind the West in this area. We developed Japanese Guidelines for VTE prophylaxis based on the 6th ACCP guidelines in 2004. The incidence of perioperative PTE in Japan has been investigated by the Japanese Society of Anesthesiologists since 2002. The rate of perioperative PTE was estimated to be 4.76 per 10,000 operations in 2003. As we expected, it significantly decreased after the guidelines for thromboprophylaxis were issued and the management fee for PTE prophylaxis was covered by health insurance in April 2004. However, mechanical prophylaxis is not sufficient to prevent mortality rates, and advanced prophylaxis by anticoagulants, such as low-molecular-weight heparin/Xa inhibitors along with unfractionated heparin/vitamin K antagonists will be essential. As a result of use of anticoagulants, mortality rates have been significantly decreased recently. PMID:25163326

Kobayashi, Takao

2014-07-01

242

Safety of a Totally Implantable Central Venous Port System with Percutaneous Subclavian Vein Access  

PubMed Central

Background The role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method. Materials and Methods Between March 2009 and December 2010, 245 ports were implanted in 242 patients by surgeon. These procedures were performed with one small skin incision and subcutaneous puncture of subclavian vein. Patient's profiles, indications of port system, early and delayed complications, and implanted period were evaluated. Results There were 82 men and 160 women with mean age of 55.74. Port system was implanted on right chest in 203, and left chest in 42 patients. There was no intraoperative complication. Early complications occurred in 11 patients (4.49%) including malposition of catheter tip in 6, malfunction of catheter in 3, and port site infection in 2. Late complication occurred in 12 patients (4.90%). Conclusion Surgical insertion of TICVP system with percutaneous subclavian venous access is safe procedures with lower complications. Careful insertion of system and skilled management would decrease complication incidence. PMID:23772408

Kim, Jae-Bum; Chae, Min-Cheol

2013-01-01

243

21 CFR 884.6110 - Assisted reproduction catheters.  

Code of Federal Regulations, 2010 CFR

...Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), or other assisted reproduction procedures to...

2010-04-01

244

Robust pigtail catheter tip detection in fluoroscopy  

NASA Astrophysics Data System (ADS)

The pigtail catheter is a type of catheter inserted into the human body during interventional surgeries such as the transcatheter aortic valve implantation (TAVI). The catheter is characterized by a tightly curled end in order to remain attached to a valve pocket during the intervention, and it is used to inject contrast agent for the visualization of the vessel in fluoroscopy. Image-based detection of this catheter is used during TAVI, in order to overlay a model of the aorta and enhance visibility during the surgery. Due to the different possible projection angles in fluoroscopy, the pigtail tip can appear in a variety of different shapes spanning from pure circular to ellipsoid or even line. Furthermore, the appearance of the catheter tip is radically altered when the contrast agent is injected during the intervention or when it is occluded by other devices. All these factors make the robust real-time detection and tracking of the pigtail catheter a challenging task. To address these challenges, this paper proposes a new tree-structured, hierarchical detection scheme, based on a shape categorization of the pigtail catheter tip, and a combination of novel Haar features. The proposed framework demonstrates improved detection performance, through a validation on a data set consisting of 272 sequences with more than 20,000 images. The detection framework presented in this paper is not limited to pigtail catheter detection, but it can also be applied successfully to any other shape-varying object with similar characteristics.

Tzoumas, Stratis; Wang, Peng; Zheng, Yefeng; John, Matthias; Comaniciu, Dorin

2012-02-01

245

Polypoid cystitis unrelated to indwelling catheters  

Microsoft Academic Search

Since polypoid cystitis (PC) is generally caused by indwelling catheter use, in order to evaluate the patients with PC unrelated to a intravesical catheter, a retrospective analysis of the records of the Pathology Department of Turgut Özal Medical Center was performed and this revealed 8 patients. Mean age of the 2 female and 6 male patients was 48 years (28

Süleyman Kiliç; Rezzan Erguvan; Deniz ?pek; Hasan Gökçe; Ali Güne?; N. Engin Aydin; Can Baydinç

2002-01-01

246

Automated Pointing of Cardiac Imaging Catheters  

PubMed Central

Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control. PMID:24683501

Loschak, Paul M.; Brattain, Laura J.; Howe, Robert D.

2013-01-01

247

A Retrospective Comparative Study of Tunneled Haemodialysis Catheters Inserted Through Occluded or Collateral Veins Versus Conventional Methods  

SciTech Connect

Tunneled hemodialysis catheters become essential in dialysis access when there is no possibility of using a functioning arteriovenous fistula. Collateral or occluded veins visible on ultrasound are used for puncture and passage of catheters into the central venous system. Chronically occluded veins are crossed with guidewires to allow dilatation and subsequent passage of hemodialysis catheters. We performed a retrospective analysis of patient demographics, comorbidities, procedural complications, functional survival, performance, and history of previous vascular access. The study group was compared with two control groups in which dialysis catheters were inserted either by radiologists in the interventional suite or by clinicians on the wards. Nineteen patients from the study group were compared with same number of patients in both control groups. The mean age of the study group was higher compared with the control groups. There was no significant difference in mean functional survival, infection rates, dialysis pump speeds in the first 2 weeks, and procedural complications between the study group and the controls. The study group had a significantly higher number of previous vascular access interventions, longer dialysis careers, and more comorbidities. Tunneled dialysis catheter placement by way of collateral or occluded veins appears safe and effective. These techniques give the operator further options when faced with patients possessing challenging vascular access. Indeed, there may be a case for preferential use of these veins to keep patent central veins in reserve.

Powell, Steven; Chan, Tze Yuan, E-mail: tze2000@hotmail.co [Royal Liverpool University Hospital, Department of Radiology (United Kingdom); Bhat, Rammohan; Lam, Kimberly [Royal Liverpool University Hospital, Department of Nephrology (United Kingdom); Narlawar, Ranjeet S.; Cullen, Nicola; Littler, Peter [Royal Liverpool University Hospital, Department of Radiology (United Kingdom)

2010-08-15

248

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms  

PubMed Central

Antimicrobial catheter lock therapy is practiced to prevent lumenal-sourced infections of central venous catheters. Citrate has been used clinically as an anticoagulant in heparin-free catheter locks. Ethanol has also been widely studied as an antimicrobial lock solution component. This study reports on the synergy of glyceryl trinitrate (GTN) with citrate and ethanol in rapidly eradicating methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans biofilms in an in vitro model for catheter biofilm colonization. GTN has a long history of intravenous use as a hypotensive agent. It is potentially attractive as a component of a catheter lock solution because its physiologic half-life is quite short and its metabolic pathways are known. A lock containing 7% citrate and 20% ethanol required 0.01% GTN to fully eradicate biofilms of all test organisms within 2 h in the model. This GTN concentration is below the levels where clinically significant hypotensive effects are expected. PMID:23669393

Reitzel, Ruth; Dvorak, Tanya; Jiang, Ying; Hachem, Ray Y.; Raad, Issam I.

2013-01-01

249

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

PubMed

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

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

2014-03-01

250

Prolonged Antimicrobial Activity of a Catheter Containing Chlorhexidine-Silver Sulfadiazine Extends Protection against Catheter Infections In Vivo  

Microsoft Academic Search

The present study evaluated in vitro and in vivo a new chlorhexidine (C)-silver sulfadiazine (S) vascular catheter (the CS2 catheter) characterized by a higher C content and by the extended release of the surface- bound antimicrobials. The CS2 catheter was compared with a first-generation, commercially available CS catheter (the CS1 catheter). The CS2 catheter produced slightly smaller zones of inhibition

STEFANO BASSETTI; JEAN HU; RALPH B. D'AGOSTINO; R. J. Sherertz

2001-01-01

251

Development of Bend Sensor for Catheter Tip  

NASA Astrophysics Data System (ADS)

Recently, a minimally invasive surgery which makes the best use of the catheter has been becoming more popular. In endovascular coil embolization for a cerebral aneurysm, the observation of the catheter's painting phenomenon is very important to execute the appropriate manipulation of the delivery wire and the catheter. In this study, the internal bend sensor which consists of at least two bending enhanced plastic optical fibers was developed in order to measure the curvature of the catheter tip. Consequently, the painting could be more sensitively detected in the neighborhood of the aneurysm. In this paper, the basic characteristics of the developed sensor system are described and its usefulness is confirmed from the comparison of the insertion force of delivery wire and the curvature of catheter tip in the experiment of coil embolization.

Nagano, Yoshitaka; Sano, Akihito; Fujimoto, Hideo

252

Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children  

PubMed Central

Summary Background and objectives Hemodialysis (HD) catheter-related complications are regarded as the main cause of HD failure in infants and children with ESRD. In this study, we determined HD catheter infection rates and survival times in children. Design, setting, participants, & measurements We analyzed demographic, clinical, laboratory, and microbiologic data on all infants and children with ESRD who received HD therapy through a tunneled central venous catheter (CVC) in our Pediatric Dialysis Unit between January 2001 and December 2009. Our strict care of HD-CVCs makes no use of any kind of prophylactic antibiotic therapy. Results Twenty-nine children with ESRD (median age, 10 years) received HD through a CVC, for a total of 22,892 days during the study period. Eleven (38%) children were infants (<1 year of age) who received HD for a cumulative 3779 days (16% of total). Fifty-nine CVCs were inserted, of which 13 (22%) were in infants. There were 12 episodes of CVC infection—a rate of 0.52/1000 CVC days. Four (33%) episodes occurred in infants—a rate of 1.06/1000 CVC days. Only three (5%) of the CVCs were removed because of infection. Median catheter survival time for all children was 310 days and for infants was 211 days. Conclusions Very low CVC infection rates (one infection per 5 CVC years) and prolonged CVC survival times (around 1 year) are achievable in infants and children with ESRD receiving HD therapy by adhering to a strict catheter management protocol and without using prophylactic antibiotic therapy. PMID:21127138

Eisenstein, Israel; Tarabeih, Mahdi; Magen, Daniella; Pollack, Shirley; Kassis, Imad; Ofer, Amos; Engel, Ahuva

2011-01-01

253

Impact of Different Vein Catheter Sizes for Mechanical Power Injection in CT: In Vitro Evaluation with Use of a Circulation Phantom  

SciTech Connect

The purpose of this study was to evaluate the influence of different peripheral vein catheter sizes on the injection pressure, flow rate, injection duration, and intravascular contrast enhancement. A flow phantom with a low-pressure venous compartment and a high-pressure arterial compartment simulating physiological circulation parameters was used. High-iodine-concentration contrast medium (370 mg iodine/ml; Ultravist 370) was administered in the venous compartment through peripheral vein catheters of different sizes (14, 16, 18, 20, 22, and 24 G) using a double-head power injector with a pressure limit of 325 psi. The flow rate was set to 5 ml/s, with a total iodine load of 36 g for all protocols. Serial CT scans at the level of the pulmonary artery and the ascending and the descending aorta replica were obtained. The true injection flow rate, injection pressure, injection duration, true contrast material volume, and pressure in the phantom during and after injection were continuously monitored. Time enhancement curves were computed and both pulmonary and aortic peak time and peak enhancement were determined. Using peripheral vein catheters with sizes of 14-20 G, flow rates of approximately 5 ml/s were obtained. During injection through a 22-G catheter the pressure limit was reached and the flow rate was decreased, with a consecutive decreased pulmonary and aortic contrast enhancement compared to the 14- to 20-G catheters. Injection through a 24-G peripheral vein catheter was not possible because of disconnection of the canula due to the high flow rate and pressure. In summary, intravenous catheters with sizes of 14-20 G are suitable for CT angiography using an injection protocol with a high flow rate and a high-iodine-concentration contrast medium.

Behrendt, Florian F., E-mail: behrendt@rad.rwth-aachen.de; Bruners, Philipp; Keil, Sebastian; Plumhans, Cedric; Mahnken, Andreas H. [University Hospital (RWTH) Aachen, Department of Diagnostic Radiology (Germany); Stanzel, Sven [University Hospital (RWTH) Aachen, Institute of Medical Statistics (Germany); Das, Marco; Guenther, Rolf W.; Muehlenbruch, Georg [University Hospital (RWTH) Aachen, Department of Diagnostic Radiology (Germany)

2009-01-15

254

Taurolidine-citrate lock solution (TauroLock) significantly reduces CVAD-associated grampositive infections in pediatric cancer patients  

Microsoft Academic Search

BACKGROUND: Taurolidin\\/Citrate (TauroLock™), a lock solution with broad spectrum antimicrobial activity, may prevent bloodstream infection (BSI) due to coagulase-negative staphylococci (CoNS or 'MRSE' in case of methicillin-resistant isolates) in pediatric cancer patients with a long term central venous access device (CVAD, Port- or\\/Broviac-\\/Hickman-catheter type). METHODS: In a single center prospective 48-months cohort study we compared all patients receiving anticancer chemotherapy

Arne Simon; Roland A Ammann; Gertrud Wiszniewsky; Udo Bode; Gudrun Fleischhack; Mette M Besuden

2008-01-01

255

Sharp Central Venous Recanalization by Means of a TIPS Needle  

SciTech Connect

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.

Honnef, Dagmar, E-mail: honnef@rad.rwth-aachen.de; Wingen, Markus; Guenther, Rolf W.; Haage, Patrick [University Hospital, Department of Diagnostic Radiology (Germany)

2005-06-15

256

Double-lumen arterial balloon catheter technique for Onyx embolization of dural arteriovenous fistulas: initial experience  

PubMed Central

Background Dural arteriovenous fistulas are vascular malformations with variable clinical symptoms that range in severity from completely asymptomatic to seizures, dementia, loss of vision and intracranial hemorrhage. Historically, surgical obliteration was the treatment of choice but, more recently, endovascular embolization has become the first-line treatment. The liquid embolic agent Onyx (ethyl vinyl copolymer) has become the agent of choice, but problems with reflux around the delivery microcatheter and inadvertent venous penetration have arisen. Methods and results We present six cases in which the double-lumen balloon microcatheter was used to transarterially embolize dural arteriovenous fistulas via injection of Onyx through the wire lumen. Depending on the individual pathology a venous balloon was also used in some cases. The advantages and disadvantages of the use of these devices are discussed. Conclusions We consider that the use of the double-lumen balloon technique for fistula embolization has the potential for reducing overall procedural times, procedural failures and catheter retention in certain situations. In such cases we would advocate this as a first-line technique. When lower profile, more navigable balloon catheters become available, this may become the standard of care. PMID:23749795

Chiu, Albert Ho Yuen; Aw, Grace; Wenderoth, Jason David

2014-01-01

257

ATLS: Catheter and tube placement  

NASA Technical Reports Server (NTRS)

The specific objectives of this experiment are: to evaluate the rack mounted equipment and medical supplies necessary for medical procedures; to evaluate the attachments, mounting points, and inner drawer assemblies for the medical supplies; and to evaluate the procedures for performing medical scenarios. The resources available in the HMF miniracks to accomplish medical scenarios and/or procedures include: medical equipment mounted in the racks; a patch panel with places to attach tubing and catheters; self contained drawers full of critical care medical supplies; and an ALS 'backpack' for deploying supplies. The attachment lines, tubing and associated medical supplies will be deployed and used with the equipment and a patient mannequin. Data collection is provided by direct observations by the inflight experimenters, and analysis of still and video photography.

Gosbee, John; Krupa, Debra T.; Pepper, L.; Orsak, Debra

1991-01-01

258

Dutch Venous Ulcer guideline update.  

PubMed

The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. PMID:24843102

Maessen-Visch, M Birgitte; de Roos, Kees-Peter

2014-05-19

259

[Spiral x-ray computed tomography in the diagnosis of central venous catheterization complications].  

PubMed

In this work we report our initial experience on the utilisation of the spiral tomodensitometry in the study of the vascular complications due to the catheterization of the internal jugular vein. We present the results of a systematic search of vascular lesions after removal of an indwelling catheter in a group of 18 patients and describe a few cases of acute complications where the use of TDMS has been very useful in the diagnostic workout. The results confirm the risks associated with the catheterization of the internal jugular vein, showing a frequency of lesions of various degree in about 50% of the cases. Moreover, we discuss some aspects of the thrombotic complications in the patients carrying a central venous catheter and the advantages of the diagnostic application of the spiral tomodensitometry. PMID:11811017

Forneris, G; Quarello, F; Pozzato, M; Vaudano, G P

2001-01-01

260

Portopulmonary venous anastomosis detected at balloon-occluded retrograde transvenous obliteration for gastric varices.  

PubMed

The present report describes three patients with portopulmonary venous anastomosis (PPVA) in whom balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices was attempted. No patients had a gastrorenal shunt. In one patient, after an approach from the inferior phrenic vein (IPV), the PPVA was embolized with the use of microcoils. In another patient, after an approach from the IPV, the balloon catheter was advanced to a distal position from the PPVA. B-RTO was performed in these two cases without systemic infarction. In the remaining patient, after an approach from the azygos vein, the balloon catheter was not advanced distally from the PPVA, and therefore sclerotic agents were not infused. PMID:23273702

Miura, Hiroshi; Yamagami, Takuji; Tanaka, Osamu; Yoshimatsu, Rika

2013-01-01

261

[Catheter measurements of the urethral pressure].  

PubMed

The outflow of viscous incompressible fluid from catheter holes into a small gap between the catheter and surrounding elastic tube is considered. Initially, the catheter is inserted into the tube lumen in such a manner that a considerable tube wall prestress exists. An additional longitudinally non-uniform external load is applied to the outer tube surface. The procedure of measuring the urethral "pressure profile" is discussed. It is shown that there is no easy way for extracting the external load (muscle forces in reality) from the measured pressure. PMID:15612559

Bykova, A A; Regirer, S A

2004-01-01

262

Cardiogenic shock in right ventricular infarction managed with a combined thermodilution and pacing pulmonary artery flotation catheter.  

PubMed Central

When cardiogenic shock complicates right ventricular infarction it is widely appreciated that rational therapy can only be achieved by use of plasma volume expansion and inotropic agents guided by invasive monitoring (Cohn et al., 1974). In these cases, there is a high incidence of symptomatic heart block and serious atrial and ventricular dysrhythmias (Cohn, 1979). Thus, venous access may be required for monitoring, pacing, infusion of fluid, and vasoactive or antiarrhythmic drugs. A case of right ventricular infarction complicated by cardiogenic shock, heart block, multiple arrhythmias and severe hypoxaemic respiratory failure is described. Technical problems in venous access were encountered and overcome by the use of a single multi-purpose catheter for haemodynamic monitoring, infusion of drugs and fluids and passage of a pacing wire. We believe that this is the first description of the use of such a catheter in the United Kingdom, although the use of a multi-purpose pulmonary artery flotation catheter with fixed pacing electrodes has been described before (Zaidan & Freniere, 1983). PMID:3620050

Edwards, J D; Wilkins, R; Gibson, H

1987-01-01

263

Geochemistry of and radioactivity in ground water of the Highland Rim and Central Basin aquifer systems, Hickman and Maury counties, Tennessee  

USGS Publications Warehouse

A reconnaissance of the geochemistry of and radioactivity in ground water from the Highland Rim and Central Basin aquifer systems in Hickman and Maury Counties, Tennessee, was conducted in 1989. Water in both aquifer systems typically is of the calcium or calcium magnesium bicarbonate type, but concentrations of calcium, magnesium, sodium, potassium, chloride, and sulfate are greater in water of the Central Basin system; differences in the concentrations are statistically significant. Dissolution of calcite, magnesium-calcite, dolomite, and gypsum are the primary geochemical processes controlling ground-water chemistry in both aquifer systems. Saturation-state calculations using the computer code WATEQF indicated that ground water from the Central Basin system is more saturated with respect to calcite, dolomite, and gypsum than water from the Highland Rim system. Geochemical environments within each aquifer system are somewhat different with respect to dissolution of magnesium-bearing minerals. Water samples from the Highland Rim system had a fairly constant calcium to magnesium molar ratio, implying congruent dissolution of magnesium-bearing minerals, whereas water samples from the Central Basin system had highly variable ratios, implying either incongruent dissolution or heterogeneity in soluble constituents of the aquifer matrix. Concentrations of radionuclides in water were low and not greatly different between aquifer systems. Median gross alpha activities were 0.54 picocuries per liter in water from each system; median gross beta activities were 1.1 and 2.3 picocuries per liter in water from the Highland Rim and Central Basin systems, respectively. Radon-222 concentrations were 559 and 422 picocuries per liter, respectively. Concentrations of gross alpha and radium in all samples were substantially less than Tennessee?s maximum permissible levels for community water-supply systems. The data indicated no relations between concentrations of dissolved radionuclides (uranium, radium-226, radium-228, radon-222, gross alpha, and gross beta) and any key indicators of water chemistry, except in water from the Highland Rim system, in which radon-222 was moderately related to pH and weakly related to dissolved magnesium. The only relation among radiochemical constituents indicated by the data was between radium-226 and gross alpha activity; this relation was indicated for water from both aquifer systems.

Hileman, G.E.; Lee, R.W.

1993-01-01

264

Systematic review: malfunction of totally implantable venous access devices in cancer patients  

Microsoft Academic Search

Purpose  Malfunction of totally implantable venous access devices is a common complication. The purpose was to identify definitions\\u000a used to describe malfunction and to investigate the incidence of malfunction in different types of port and catheter designs.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Relevant studies were identified in PubMed that were published between January 1993 and February 2011. Empirical studies reporting\\u000a functional outcomes in adults and where,

Godelieve Alice Goossens; Marguerite Stas; Martine Jérôme; Philip Moons

2011-01-01

265

Venous and arterial thrombotic risks with thalidomide: evidence and practical guidance  

PubMed Central

Oral immunomodulatory drugs (IMiDs), namely thalidomide, lenalidomide and pomalidomide, interfere with several pathways important for disease progression. Today they play a crucial role in the treatment of multiple myeloma patients, and have considerably improved myeloma outcomes. These agents, and thalidomide in particular, are associated with higher rates of thromboembolic events, both venous and arterial. Individual risk factors for thromboembolic events include advanced age, previous history of thromboembolism, an indwelling central venous catheter, comorbid conditions (e.g. infections, diabetes, cardiac disease, obesity), current or recent immobilization, recent surgery and inherited thrombophilic abnormalities. Cancer therapy and cancer itself also increase the risk of thromboembolic events. The aim of this review is to help clinicians to define the risk of thrombotic events in patients treated with thalidomide and thus to provide practical recommendations to manage thromboprophylaxis in these patients. PMID:25083240

Palladino, Carmela

2012-01-01

266

Mechanical Thrombectomy of Occluded Hemodialysis Native Fistulas and Grafts Using a Hydrodynamic Thrombectomy Catheter: Preliminary Experience  

SciTech Connect

The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (PTFE) grafts. In all cases, an Oasis hydrodynamic catheter was used. Five patients had native fistulas and 17 had PTFE grafts. Six patients required repeat procedures. All patients with native fistulas and 15 of the 17 with PTFE grafts also underwent angioplasty of the venous limb following the thrombectomy. Major outcome measures included technical success, clinical success, primary and secondary patency, and complication rates. Twenty-eight procedures were performed in total. The technical success rate was 100% and 90% and clinical success was 86% and 76% for native fistulas and grafts, respectively. The primary patency at 6 months was 50% and 59% for fistulas and grafts, respectively, and the secondary patency at 6 months was 75% and 70% for fistulas and grafts, respectively. Two patients died of unrelated causes during the follow-up period. The Oasis catheter is an effective mechanical device for the percutaneous treatment of thrombosed hemodialysis access. Our initial success rate showed that the technique is safe in the treatment of both native fistulas and grafts.

Sahni, Vikram, E-mail: vassahni@hotmail.com; Kaniyur, Sunil; Malhotra, Anmol [Barts and London NHS Trust, Royal London Hospital, Department of Radiology (United Kingdom); Fan, Stanley [Barts and London NHS Trust, Royal London Hospital, Department of Nephrology (United Kingdom); Blakeney, Charles; Fotheringham, Tim [Barts and London NHS Trust, Royal London Hospital, Department of Radiology (United Kingdom); Sobeh, Mohammed [Barts and London NHS Trust, Royal London Hospital, Department of Vascular Surgery (United Kingdom); Matson, Matthew [Barts and London NHS Trust, Royal London Hospital, Department of Radiology (United Kingdom)

2005-12-15

267

Severe catheter kinking and entrapment during transradial coronary angiography: Percutaneous retrieval using a sheathless guide catheter.  

PubMed

The transradial (TR) approach for coronary angiography and intervention is increasingly used worldwide because of several advantages such as reduced bleeding and vascular complications. During TR procedures, aggressive catheter manipulation in the setting of complex and tortuous arterial anatomy can lead to catheter kinking and entrapment. Several percutaneous retrieval techniques using either homolateral radial access or femoral access have been described previously. We demonstrate, for the first time, the use of a sheathless guide catheter as a rescue technique to successfully retrieve a severely kinked and entrapped diagnostic catheter during TR access. © 2014 Wiley Periodicals, Inc. PMID:24740882

Aminian, Adel; Fraser, Douglas G; Dolatabadi, Dariouch

2015-01-01

268

Adult Catheter Care and Infection Prevention Guide  

MedlinePLUS

... chlorhexidine solution in 70% alcohol, 70% alcohol or povidone-iodine. 5. Properly clean/disinfect the exit site ... g. sensitivity or allergy), use 70% alcohol or povidone-iodine. 6. Cover the catheter exit site with ...

269

21 CFR 882.4100 - Ventricular catheter.  

...Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II (performance...

2014-04-01

270

21 CFR 882.4100 - Ventricular catheter.  

Code of Federal Regulations, 2010 CFR

...Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II (performance...

2010-04-01

271

Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage  

SciTech Connect

Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric (donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy. Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular pharmacomechanical therapy.

Stockland, Andrew H. [Mayo Clinic, Department of Radiology (United States); Willingham, Darrin L. [Mayo Clinic, Department of Transplantation (United States); Paz-Fumagalli, Ricardo [Mayo Clinic, Department of Radiology (United States); Grewal, Hani P. [Mayo Clinic, Department of Transplantation (United States); McKinney, J. Mark [Mayo Clinic, Department of Radiology (United States); Hughes, Christopher B. [Mayo Clinic, Department of Transplantation (United States); Walser, Eric M., E-mail: Walser.eric@mayo.ed [Mayo Clinic, Department of Radiology (United States)

2009-03-15

272

A keratoacanthoma with venous invasion  

PubMed Central

Keratoacanthomas are variously regarded as a self-limiting variant of squamous cell carcinoma or as a distinct benign lesion and they very seldom show attributes normally associated with malignant behaviour, such as perineural invasion. Herein we report the case of a keratoacanthoma with venous invasion proven by immunoperoxidase and elastic tissue stains. PMID:23785617

Tschandl, Philipp; Rosendahl, Cliff; Williamson, Richard; Weedon, David

2012-01-01

273

Anomalies of pulmonary venous return  

Microsoft Academic Search

Total anomalous pulmonary venous return is a rare but life-threatening congenital heart lesion. We present our experience with 48 consecutive infants operated on from 1977 to 1983. Improved results are due to earlier diagnosis, improved surgical technique, and meticulous postoperative care. Since 1980 some patients with this lesion were submitted to surgery on the basis of two-dimensional echocardiography, thus avoiding

Jaroslav Stark

1985-01-01

274

Prevalence of extracranial venous abnormalities: results from a sample of 586 multiple sclerosis patients.  

PubMed

The aim of this study was to assess the prevalence of chronic cerebrospinal venous insufficiency in an unselected cohort of multiple sclerosis (MS) patients. A total of 586 patients with clinically defined MS underwent catheter venography of the internal jugular veins, brachiocephalic veins and azygos vein. The following findings were regarded as pathologic: no outflow, slowed outflow, reversal of flow direction, prestenotic dilation accompanied by impaired outflow, outflow through collaterals, intraluminal structures obstructing the vein, hypoplasia, agenesia or significant narrowing of the vein. Venous abnormalities were found in 563 patients (96.1%). Lesions in one vein were found in 43.5%, in two veins in 49.5%, and in three veins in 3.1% of patients. Venous pathologies in the right internal jugular vein were found in 64.0% of patients, in the left internal jugular vein in 81.7%, in the left brachiocephalic vein in 1.0%, and in the azygos vein in 4.9%. Venous pathologies were found to be highly associated with MS, yet the clinical relevance of this phenomenon remains to be established. PMID:22364940

Simka, M; Latacz, P; Ludyga, T; Kazibudzki, M; Swierad, M; Janas, P; Piegza, J

2011-01-01

275

Limiting damage to the urethra from catheters.  

PubMed

Urethral erosion can occur at either the bladder neck or the urethral meatus in male and female patients who have been catheterised. Sudden pulling on the catheter can cause damage or necrosis can develop after longer-term pressure. This can be exacerbated by the tension put on the catheter by a drainage bag full of urine. As a result, painful cleavage can develop along the shaft of the penis or similar damage can occur to the labia in women. PMID:25633703

2015-01-29

276

Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited  

PubMed Central

The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required. PMID:23833470

Tomar, Gaurav Singh; Chawla, Sonali; Ganguly, Suprio; Cherian, Grace; Tiwari, Akhilesh

2013-01-01

277

carried out in the left catheter and the venous blood samples were taken in the  

E-print Network

) The major characteristic of ageing is a pro- gressive loss of lean body mass (LBM), par- ticularly of muscle proteins. This protein Ioss leads to decreased muscle strength and to unsuitable metabolic responses to stresses or trauma. It could result from changes in amino acid disposal between the muscle and splanchnic

Boyer, Edmond

278

A new technology of microdispersed silver in polyurethane induces antimicrobial activity in central venous catheters  

Microsoft Academic Search

Summary  Metal ions or metal ions in complexes or compounds have been used for centuries to disinfect fluids, solids and tissues. The\\u000a biocidal effect of silver, with its broad spectrum of activity including bacterial, fungal and viral agents, is particularly\\u000a well known and the term “oligodynamic activity” was coined for this phenomenon. Silver ions have an affinity to sulfhydryl\\u000a groups in

J.-P. Guggenbichler; M. Böswald; S. Lugauer; T. Krall

1999-01-01

279

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

PubMed Central

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

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

280

Conversion of Non-Tunneled to Tunneled Hemodialysis Catheters  

SciTech Connect

Purpose. To determine the safety and efficacy of conversion of non-tunneled (temporary) catheters to tunneled catheters in hemodialysis patients. Methods. A retrospective review of 112 consecutive conversions in 111 patients was performed over a period of 4 years. Fourteen patients were lost to follow-up. The remaining 97 patients had clinical follow-up. Temporary catheters were converted to tunneled catheters utilizing the same internal jugular venotomy sites and a modified over-the-wire technique with use of a peel-away sheath . Follow-up clinical data were reviewed. Results. Technical success was achieved in all 112 procedures. None of the 97 patients with follow-up suffered early infection within 30 days. The total number of follow-up catheter days was 13,659 (range 2-790). Cases of confirmed and suspected bacteremia requiring catheter removal occurred at a frequency of 0.10 per 100 catheter days. Suspected catheter infection treated with antibiotics but not requiring catheter intervention occurred at a frequency of 0.04 per 100 catheter days. Frequency of all suspected or confirmed infections was 0.14 per 100 catheter days. Catheter interventions as a result of poor blood flow, inadvertent removal, catheter fracture, or kinking occurred at a rate of 0.18 per 100 catheter days. Life table analysis revealed primary patency rates of 86%, 64%, and 39% at 30 days, 90 days, and 180 days, respectively. Conclusion. Conversion of temporary catheters to tunneled catheters using the pre-existing venotomy sites is safe and has low rates of infection and malfunction. These rates are comparable to previously published rates for tunneled catheters placed de novo and tunneled catheter exchanges.

Ha, Thuong G. Van, E-mail: tgvanha@radiology.bsd.uchicago.edu; Fimmen, Derek [University of Chicago, Department of Radiology, Section of Interventional Radiology (United States); Han, Laura [University of Chicago, Pritzker School of Medicine (United States); Funaki, Brian S.; Santeler, Scott; Lorenz, Jonathan [University of Chicago, Department of Radiology, Section of Interventional Radiology (United States)

2007-04-15

281

Catheter-Directed Thrombolysis of Inferior Vena Cava Thrombosis in a 13-Day-Old Neonate and Review of Literature  

SciTech Connect

Complete inferior vena cava thrombosis (IVC) in neonates is uncommon, but may cause significant morbidity. A 13-day-old neonate suffered IVC thrombosis secondary to antithrombin III deficiency, possibly contributed to by a mutation in the methyl tetrahydrofolate reductase gene. Catheter-directed thrombolysis (CDT) with recombinant tissue plasminogen activator (rt-PA, Alteplase) was used successfully to treat extensive venous thrombosis in this neonate without complications. We also review the literature on CDT for treatment of IVC thrombosis in critically ill neonates and infants.

Khan, Jawad U. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Takemoto, Clifford M.; Casella, James F. [Johns Hopkins University School of Medicine, Department of Pediatrics (United States); Streiff, Michael B. [Johns Hopkins University School of Medicine, Department of Medicine (United States); Nwankwo, Ikechi J.; Kim, Hyun S., E-mail: sikhkim@jhmi.ed [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States)

2008-07-15

282

Imaging of cerebral venous thrombosis.  

PubMed

Cerebral venous thrombosis (CVT) is a potentially life-threatening emergency. The wide ranging of clinical symptoms makes the use of imaging in "slices" even more important for diagnosis. Both CT and MRI are used to diagnose the occlusion of a venous sinus, but MRI is superior to CT for detecting a clot in the cortical or deep veins. CT can show the hyperintense clot spontaneously and CT angiography the intraluminal defect. MRI also detects this thrombus, whose signal varies over time: in the acute phase, it is hypointense in T2*, whilst T1 and T2 can appear falsely reassuring; in the subacute phase, it is hyperintense on all sequences (T1, T2, FLAIR, T2*, diffusion). MRI easily shows the ischemic damage, even hemorrhagic, in the cerebral parenchyma in cases of CVT. Finally, imaging may reveal pathology at the origin of the CVT, such as a fracture of the skull, infection, tumor, dural fistula, or intracranial hypotension. PMID:25465119

Bonneville, F

2014-12-01

283

Inherited thrombophilia and venous thromboembolism.  

PubMed

Pulmonary thromboembolism (PTE) is the major cause of maternal death in the UK. Underlying PTE is the problem of deep venous thrombosis (DVT). Inherited thrombophilia will be found in about 50% of women with a personal history of venous thromboembolism (VTE), and screening for thrombophilia should be considered in women with a personal or family history of VTE. There is currently no place for universal screening for thrombophilia in pregnancy. There are particular considerations with regard to the management of thrombophilia in pregnancy. Low-molecular-weight heparins are now the heparin of choice in pregnancy because of a better side-effect profile (substantially reduced risk of heparin-induced osteoporosis and heparin-induced thrombocytopaenia) compared to unfractionated heparin, good safety record for mother and fetus and convenient once-daily dosing for prophylaxis. PMID:12787535

Greer, Ian A

2003-06-01

284

Protein adsorption to hydrocephalus shunt catheters: CSF protein adsorption  

PubMed Central

OBJECTIVE—To assess the quantity and nature of the proteins that adsorb to hydrocephalus shunt catheters after implantation, and to determine whether sufficient could accumulate to obstruct the catheter.?DESIGN—Elution of proteins from 102 explanted shunt catheters, with protein assay and electrophoresis of the eluate, and scanning electron microscopy (SEM) of the catheters.?RESULTS—The amount of protein elutable was extremely low, and significant protein, apart from a thin film, was not found on SEM. Qualitative analysis disclosed that most of the adsorbed protein was albumin.?CONCLUSIONS—Protein deposition on hydrocephalus catheters does not occur in sufficient quantities to cause catheter obstruction.?? PMID:9598681

Brydon, H.; Keir, G.; Thompson, E.; Bayston, R.; Hayward, R.; Harkness, W.

1998-01-01

285

Where does venous reflux start?  

Microsoft Academic Search

Purpose: This study was designed to identify the origin of lower limb primary venous reflux in asymptomatic young individuals and to compare patterns of reflux with age-matched subjects with prominent or clinically apparent varicose veins.Methods: Forty age- and sex-matched subjects with no symptoms (age, 15 to 35 years; 80 limbs; group A), 20 subjects (age, 19 to 32 years; 40

Nicos Labropoulos; Athanasios D. Giannoukas; Kostas Delis; M. Ashraf Mansour; Steven S. Kang; Andrew N. Nicolaides; John Lumley; William H. Baker

1997-01-01

286

Macroglossia due to venous malformation  

Microsoft Academic Search

Massive vascular malformation involving tongue can cause significant functional impairment. In this report we describe a rare\\u000a case of extensive venous malformation involving tongue leading to obstructive sleep apnoea, inability to speak, eat, severe\\u000a discomfort due to exposure induced dryness and ulceration. Multimodality treatment approach comprising of sclerotherapy, electrocautery\\u000a and radiation therapy was used in this case.

T. S Anand; Ritu Mittal; T. B. Shashidhar; R. K. Sharma

2006-01-01

287

Experience with penile venous surgery.  

PubMed

Venogenic impotence was detected in 37 out of 141 patients who attended our clinic with a complaint of erectile dysfunction. Eighteen patients presented with primary impotence and the rest had progressive secondary impotence. All 37 patients have shown partial or poor response to 60 mg of intracavernosal papaverine. The corporovenous leak (CVL) was diagnosed on the careful workup of dynamic pharmacocavernosometry and cavernosography. Concomitant arterial cause was noted in 10% cases on the basis of penile duplex Doppler ultrasound study. 24 patients in the age group of 23-60 years underwent the penile venous surgery. The CVL was noted in the deep dorsal vein (23 cases), cavernous vein (16) and in the crural vein (2). The operation consisted of deep dorsal vein (DDV) ligation and excision with all tributaries (8 cases) or DDV ligation and excision+cavernous vein ligation (13 cases), through an infrapubic curvilinear incision. One patient had crural vein ligation and corporoplasty through a perineal incision, one had direct corporeal revascularization for associated arteriogenic impotence with venous leak and another had distal spongiolysis and closure of a corporospongiosal shunt. The results were excellent in 11 cases, improved in 6 and 7 had failures. Surgical intervention is effective in CVL in selected cases but limiting factors in the form of increasing age, concomitant arteriogenic cause, significant crural leak, missing tributaries, recurrent venous leak and unknown factors may also be present to prevent total cure. PMID:8333094

Motiwala, H G; Patel, D D; Joshi, S P; Baxi, H M; Desai, K D; Shah, K N

1993-01-01

288

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

NASA Astrophysics Data System (ADS)

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.

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

289

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

PubMed

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs. PMID:24593804

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

2014-05-01

290

[Ultrasound guidance of central venous catheterisation].  

PubMed

Portacath implantation with introduction of a catheter into the superior vena caval system is a commonly performed procedure. Catheterization of the internal jugular vein can be difficult due to anatomical variation, individual patient morphology, or as a result of previous catheterization. Use of 2D ultrasonography facilitates localization of the internal jugular vein and decreases the risks of catheter placement. PMID:19906375

Le Ray Ferrières, I; Guinier, D

2009-12-01

291

Left Atrial Anatomy Relevant to Catheter Ablation  

PubMed Central

The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. PMID:25057427

Sánchez-Quintana, Damián; Cabrera, José Angel; Saremi, Farhood

2014-01-01

292

Catheter tip force transducer for cardiovascular research  

NASA Technical Reports Server (NTRS)

A force transducer for measuring dynamic force activity within the heart of a subject essentially consists of a U-shaped beam of low elastic compliance material. Two lines extend from the beams's legs and a long coil spring is attached to the beam. A strain gauge is coupled to one of the beam's legs to sense deflections thereof. The beam with the tines and most of the spring are surrounded by a flexible tube, defining a catheter, which is insertable into a subject's heart through an appropriate artery. The tines are extractable from the catheter for implantation into the myocardium by pushing on the end of the spring which extends beyond the external end of the catheter.

Feldstein, C.; Lewis, G. W.; Silver, R. H.; Culler, V. H. (inventors)

1976-01-01

293

Saphenous Venous Ablation with Hot Contrast in a Canine Model  

SciTech Connect

Purpose. To determine the feasibility, efficacy, and safety of thermal ablation of the saphenous vein with hot contrast medium. Methods. Twelve saphenous veins of 6 dogs were percutaneously ablated with hot contrast medium. In all animals, ablation was performed in the vein of one leg, followed by ablation in the contralateral side 1 month later. An occlusion balloon catheter was placed in the infragenicular segment of the saphenous vein via a jugular access to prevent unwanted thermal effects on the non-target segment of the saphenous vein. After inflation of the balloon, 10 ml of hot contrast medium was injected under fluoroscopic control through a sheath placed in the saphenous vein above the ankle. A second 10 ml injection of hot contrast medium was made after 5 min in each vessel. Venographic follow-up of the ablated veins was performed at 1 month (n = 12) and 2 months (n = 6). Results. Follow-up venograms showed that all ablated venous segments were occluded at 1 month. In 6 veins which were followed up to 2 months, 4 (66%) remained occluded, 1 (16%) was partially patent, and the remaining vein (16%) was completely patent. In these latter 2 cases, an inadequate amount of hot contrast was delivered to the lumen due to a closed balloon catheter downstream which did not allow contrast to displace blood within the vessel. Discussion. Hot contrast medium thermal ablation of the saphenous vein appears feasible, safe, and effective in the canine model, provided an adequate amount of embolization agent is used.

Prasad, Amit [University of Texas at Southwestern Medical Center, Department of Internal Medicine (United States)], E-mail: aprasa02@stanfordalumni.org; Qian Zhong; Kirsch, David; Eissa, Marna; Narra, Pavan; Lopera, Jorge [Louisiana State University Health Sciences Center, Department of Radiology (United States); Espinoza, Carmen G. [Louisiana State University Health Sciences Center, Department of Pathology (United States); Castaneda, Wifrido [Louisiana State University Health Sciences Center, Department of Radiology (United States)

2008-01-15

294

21 CFR 884.6110 - Assisted reproduction catheters.  

...2014-04-01 2014-04-01 false Assisted reproduction catheters. 884.6110 Section 884...OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a)...

2014-04-01

295

21 CFR 884.6110 - Assisted reproduction catheters.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Assisted reproduction catheters. 884.6110 Section 884...OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a)...

2011-04-01

296

21 CFR 884.6110 - Assisted reproduction catheters.  

Code of Federal Regulations, 2012 CFR

...2012-04-01 2012-04-01 false Assisted reproduction catheters. 884.6110 Section 884...OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a)...

2012-04-01

297

21 CFR 884.6110 - Assisted reproduction catheters.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Assisted reproduction catheters. 884.6110 Section 884...OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a)...

2013-04-01

298

21 CFR 870.1210 - Continuous flush catheter.  

Code of Federal Regulations, 2013 CFR

...continuous flush catheter is an attachment to a catheter-transducer system that permits continuous intravascular flushing at a slow infusion rate for the purpose of eliminating clotting, back-leakage, and waveform damping. (b) Classification. Class...

2013-04-01

299

Multi-turn, tension-stiffening catheter navigation system  

E-print Network

In poorly constrained extra-vascular environments such as hollow viscera, current catheter navigation techniques are restricted to simple paths and therefore limit a doctor's ability to position the catheter. This paper ...

Gupta, Rajiv

300

21 CFR 870.1210 - Continuous flush catheter.  

Code of Federal Regulations, 2010 CFR

...continuous flush catheter is an attachment to a catheter-transducer system that permits continuous intravascular flushing at a slow infusion rate for the purpose of eliminating clotting, back-leakage, and waveform damping. (b) Classification. Class...

2010-04-01

301

21 CFR 870.1210 - Continuous flush catheter.  

Code of Federal Regulations, 2011 CFR

...continuous flush catheter is an attachment to a catheter-transducer system that permits continuous intravascular flushing at a slow infusion rate for the purpose of eliminating clotting, back-leakage, and waveform damping. (b) Classification. Class...

2011-04-01

302

Catheter-related bacteremia by Cupriavidus metallidurans.  

PubMed

Cupriavidus bacteremia is a rare infection and identification of the pathogen is difficult. We present four cases of bacteremia by Cupriavidus metallidurans that were initially identified to the genus level by both Bruker and Vitek matrix-assisted laser desorption ionization-time of flight mass spectrometry and later identified to the species level by 16S rRNA gene sequencing. To our knowledge, these are the first cases of C. metallidurans catheter-related infections. Patients were successfully treated with antibiotic therapy and catheter removal. PMID:25446890

D'Inzeo, Tiziana; Santangelo, Rosaria; Fiori, Barbara; De Angelis, Giulia; Conte, Viola; Giaquinto, Alessia; Palucci, Ivana; Scoppettuolo, Giancarlo; Di Florio, Viviana; Giani, Tommaso; Sanguinetti, Maurizio; Rossolini, Gian Maria; Spanu, Teresa

2015-01-01

303

Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation  

PubMed Central

The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review. PMID:24109528

Ul-Haq, Anwar; Al-Otaibi, Faisal; Alshanafey, Saud; Sabbagh, Mohamed Diya; Al Shail, Essam

2013-01-01

304

Strategies for prevention of catheter-related bloodstream infections  

Microsoft Academic Search

Prevention of catheter-related bloodstream infections is critically dependent on an accurate knowledge of the two main routes\\u000a by which intravascular devices become contaminated: the extraluminal (skin-related) and the intraluminal (hub-related) routes.\\u000a Extraluminal catheter seeding results from infection of the catheter entry site by microorganisms and leads to bacteremia\\u000a most often during the week following catheter placement. The main ways of

Antonio Sitges-Serra

1999-01-01

305

Fracture of temporary femoral haemodialysis catheter: our experience.  

PubMed

We report two similar cases of fracture and proximal migration of temporary femoral haemodialysis catheters. The two cases were encountered 6 years apart. These types of occurrences, especially in centres where catheter reuse is practiced, are not uncommon but seldom reported in the literature. Alert dialysis staff on both the occasions took remedial steps in time, which prevented embolisation of the catheters into the inferior vena cava. Both the catheters were removed successfully by the surgical team. PMID:23729711

Cruz, Sanjay D; Gupta, Monica; Kaur, Ravinder; Gupta, Sanjay

2013-01-01

306

Ability of Proteus mirabilis to Swarm over Urethral Catheters  

Microsoft Academic Search

The aim of this study was to investigate the ability of Proteus mirabilis to swarm over various types of urinary catheters. The test strain was found to swarm over catheters for distances of up to\\u000a 10?cm within 24?h. Migration was significantly more rapid over hydrogel-coated latex catheters than over all-silicone or silicone-coated\\u000a latex catheters. Scanning electron micrographs revealed discrete rafts

D. Stickler; G. Hughes

1999-01-01

307

A novel method for salvage of malfunctioning peritoneal dialysis catheter  

PubMed Central

Context: Continuous ambulatory peritoneal dialysis (CAPD) has been widely used as an effective therapy in the management of patients with end-stage renal disease. Long-term use of CAPD needs methods with low incidence of catheter-related complications. Moreover, some complications may cause failure of fluid drainage and treatment interruption. Aims: We have innovated and studied a new minimal-invasive method of malfunctioning peritoneal catheter repair. Materials and Methods: Thirty-five patients agreed to undergo catheter rescue operation by this new method during 2004 and 2012. Under local anesthesia and light sedation, access to the abdominal cavity was made, the catheter and wrapped omentum grasped and the tip of catheter was released, debris were removed and the catheter was directed toward the pelvic floor with a finger guide. The patients were followed after catheter salvage up to the end of study (April 2012). PD catheter function restored to the normal level in 28 (80%) of patients, and PD was started 1-2 days after the procedure. Results: All patients had an uneventful recovery. PD catheter function was restored to the normal level in 28 (80%) patients, and PD was started 1-2 days after the procedure. Of these patients, 10 (35%) died of reasons unrelated to catheter or catheter complications; 7 (25%) were ultimately referred for kidney transplant; 8 (29%) continued PD up to the end of this study with no problem, and only 3 (11%) due to catheter complications. Catheter function did not restore to the normal level in seven patients (20%); however, six patients continued PD for 1-18 months with the catheter. Conclusions: Comparing the advantages and disadvantages of this method to the previous laparoscopically repaired catheter, we concluded that this new method is efficient, and is a suitable way for malfunctioning PD catheter salvage. PMID:24833828

Beig, Ali Akbar; Marashi, Sayed Mahdi; Asadabadi, Hojatollah Raji; Sharifi, Ali; Zarch, Zohre Nasiri

2014-01-01

308

Queckenstedt's Test Affects More than Jugular Venous Congestion in Rat  

PubMed Central

Jugular venous compression by the Queckenstedt's test (Q-test) increases the intracranial pressure, but the effects of isolated jugular venous congestion are not well known. Intraventricular pressure (IVP) was compared during direct obstruction of the common jugular veins (bilateral CJV clipping) and during external compression of bilateral CJV flows (Q-test) in a rat model. Intracerebroventricular catheters were inserted into the right lateral ventricle of nine male Sprague-Dawley rats (371.1±44.8 g, 82.2±12.0 days old). The initial mean IVP, arterial pressure (MAP), and pulse rate were 2.8±1.3 mmHg, 88.8±12.7 mmHg, and 348.3±69.1 beats/min, respectively. The mean IVP increment and MAP decrement were 6.5±2.5 and 13.5±5.7 mmHg, respectively, during the Q-test, compared to 2.3±1.5 and 7.3±3.8 mmHg, respectively, during bilateral CJV clipping (all p?=?0.008). The IVP increment and MAP decrement were greater during the Q-test than during bilateral CJV clipping (p?=?0.008 and p?=?0.038). Although the Q-test and bilateral CJV clipping showed similar effects, the response with the Q-test was greater. Thus, the Q-test appears to obstruct other collateral cerebral veins in addition to bilateral CJV flows. Since this model revealed significant differences between the manual Q-test and bilateral CJV clipping, the finding should be taken into account in future studies on the Q-test in SD rats. PMID:23516633

Chou, Chi-Hsiang; Doong, Ming-Luen; Fuh, Jong-Ling; Wu, Jaw-Ching; Wang, Shuu-Jiun

2013-01-01

309

Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery  

SciTech Connect

The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up.

Peynircioglu, Bora, E-mail: borapeynir@gmail.com; Arslan, E. Bengi; Cil, Barbaros E.; Geyik, Serdar; Hazirolan, Tuncay [Hacettepe University, School of Medicine, Department of Radiology (Turkey); Konan, Ali [Hacettepe University, School of Medicine, Department of General Surgery (Turkey); Balkanci, Ferhun [Hacettepe University, School of Medicine, Department of Radiology (Turkey)

2007-06-15

310

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2011 CFR

...2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section...Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device...

2011-04-01

311

21 CFR 870.1140 - Venous blood pressure manometer.  

...2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section...Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device...

2014-04-01

312

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2013 CFR

...2013-04-01 2013-04-01 false Venous blood pressure manometer. 870.1140 Section...Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device...

2013-04-01

313

21 CFR 870.1140 - Venous blood pressure manometer.  

Code of Federal Regulations, 2010 CFR

...2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section...Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device...

2010-04-01

314

[Fiber light guide-catheter for laser irradiation].  

PubMed

A laser catheter with fibre optic light guide for surgery is developed. As experimental studies have shown, the laser power at the catheter output was more than 70 Wt. The catheter may operate with both flexible and rigid endoscopes and may be used for coagulation of hemorrhages and destruction of neoplasms. PMID:4079712

Grigor'iants, V V; Korolev, V A

1985-01-01

315

Research Journal Highlights Embedding sensors on balloon catheters  

E-print Network

3 Research Journal Highlights Embedding sensors on balloon catheters Nature Materials, March 7 into the thin membranes of balloon catheters -- used in heart surgery to eliminate blockage in blood vessels -- is presented in a study in rats published online this week in Nature Materials. These balloon catheters could

Rogers, John A.

316

Retrieval of embolized tip of port catheter from branch of right pulmonary artery using a macro snare catheter  

PubMed Central

Rupture of the silicon port catheter is a relatively rare complication. Ruptured part usually embolizes; therefore, removal of foreign body may be difficult. These ports usually migrate to right-sided chambers, main pulmonary arteries, and pulmonary subbranches. Different devices such as snares, basket catheters, and ablation catheters are utilized for retrieval. Hereby, we report successful extraction of an embolized 10-cm tip of a vascular access port using a macro snare catheter. PMID:24936312

Durako?lugil, Murtaza Emre; ?atiro?lu, Ömer; Erdivanli, Ba?ar; Tufan, Gülnihal

2014-01-01

317

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

PubMed Central

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

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

2015-01-01

318

Ultraminiature manometer-tipped cardiac catheter  

NASA Technical Reports Server (NTRS)

Miniature diaphragm-type capacitance transducer capable of being mounted on the end of a cardiac catheter has been developed for measurement of intravascular pressures. The transducer can be inserted in small ducts /arteries and veins/ without disturbing the flow characteristics. It is very useful for making measurements in babies.

Coon, G. W.

1967-01-01

319

A Retrospective Clinical Study: Complications of Totally Implanted Central Venous Access Ports  

PubMed Central

Background When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs. PMID:24570862

Seok, June Pill; Cho, Hyun Min; Ryu, Han Young; Hwang, Wan Jin; Sung, Tae Yun

2014-01-01

320

Suspected migration of cervical epidural catheter into the brainstem after a difficult catheter insertion.  

PubMed

We report a case of diplopia during continuous epidural injection presumably caused by catheter migration. A 61-year-old woman underwent shoulder surgery under general anesthesia with cervical epidural anesthesia. The epidural catheter was placed in the C6-C7 epidural space with some difficulty before general anesthesia. The depth of the catheter placed under the skin was 10 cm. On POD 2, the patient noticed diplopia and developed dysarthria despite of good pain control so far. She complained of sudden headache after the rate of continuous epidural infusion was increased to relieve postoperative pain. Computed tomography and T2-weighted cerebral magnetic resonance imaging revealed an air image and surrounding edema in the pons. Diplopia and dysarthria disappeared after ceasing continuous epidural injection. A 15-cm-long mark under the skin and leak of colorless clear fluid from the puncture site were noted at removal of the catheter. On POD 13, diplopia recurred, which improved gradually. On the 9-month radiologic follow-up, we considered that the symptoms on POD 2 were caused by migration of the epidural catheter into the pons and that her later diplopia was induced by intracranial hypotension syndrome. One should be aware that such an unexpected migration of the catheter can occur following a difficult insertion. PMID:24141810

Asano, Maiko; Akatsuka, Masafumi; Uda, Rumiko; Son, Hiroki; Nagano, Yuuzou; Tatsumi, Toshiaki

2014-06-01

321

Stent Placement on Fresh Venous Thrombosis  

SciTech Connect

Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 {+-} 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases.

Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl [Department of Diagnostic Radiology, Technical University of Aachen, Pauwelstrasse, D-52057 Aachen (Germany)

1997-09-15

322

Venous Anatomy of the Right Colon  

Microsoft Academic Search

PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and

Shigeki Yamaguchi; Hiroya Kuroyanagi; Jeffrey W. Milsom; Richard Sim; Hiroshi Shimada

2002-01-01

323

Total anomalous systemic and pulmonary venous connection.  

PubMed

Total anomalous systemic and pulmonary venous connection is an extremely rare congenital cardiac anomaly. We present our unique experience of managing this complex partially diagnosed cardiac anomaly in a 16-month-old boy. The systemic venous anomaly was not detected during the initial preoperative evaluation. He was doing well on follow-up, with normal pulmonary artery pressure. PMID:24887855

Mishra, Amit; Sharma, Pranav; Shah, Ritesh; Oswal, Nilesh; Rana, Yashpal

2015-01-01

324

Venous Thromboembolism in Patients with Membranous Nephropathy  

PubMed Central

Summary Background and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors. Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models. Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level <2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest. Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly <2.8 g/dl, is the most significant independent predictor of venous thrombotic risk. PMID:22076873

Lionaki, Sophia; Derebail, Vimal K.; Hogan, Susan L.; Barbour, Sean; Lee, Taewoo; Hladunewich, Michelle; Greenwald, Allen; Hu, Yichun; Jennette, Caroline E.; Jennette, J. Charles; Falk, Ronald J.; Cattran, Daniel C.; Nachman, Patrick H.; Reich, Heather N.

2012-01-01

325

GAVeCeLT* consensus statement on the correct use of totally implantable venous access devices for diagnostic radiology procedures.  

PubMed

The use of totally implantable venous access devices in radiology may be associated with complications such as occlusion of the system (because of the high density of some contrast), infection (if the port is not handled in aseptic conditions, using proper barrier protections), and mechanical complications due to the high-pressure administration of contrast by automatic injectors (so-called power injector), including extravasation of contrast media into the soft tissues, subintimal venous or myocardial injection, or serious damage to the device itself (breakage of the external connections, dislocation of the non-coring needle, or breakage of the catheter). The last problem - i.e., the damage of the device from a power injection - is not an unjustified fear, but a reality. A warning by the US Food and Drug Administration of July 2004 reports around 250 complications of this kind, referring to both port and central venous catheters and peripherally inserted central catheter systems, which occurred over a period of several years; in all cases, the damage occurred during the injection of contrast material by means of power injectors for computed tomography or magnetic resonance imaging procedures. Though the risk associated with the use of ports in radiodiagnostics is thus clear, it has been suggested that administration of the contrast material via the port may have some advantage in terms of image quality, increased comfort for the patient, and maybe more accurate reproducibility of the patient's own follow-up exams. This contention needs to be supported by evidence. Also, since many cancer patients who need frequent computed tomography studies already have totally implantable systems, it would seem reasonable to try to define how and when such systems may safely be used. The purpose of this consensus statement is to define recommendations based on the best available evidence, for the safe use of implantable ports in radiodiagnostics. PMID:21534233

Bonciarelli, Giorgio; Batacchi, Stefano; Biffi, Roberto; Buononato, Massimo; Damascelli, Bruno; Ghibaudo, Flavio; Orsi, Franco; Pittiruti, Mauro; Scoppettuolo, Giancarlo; Verzè, Alessia; Borasi, Guido; De Cicco, Marcello; Dosio, Roberto; Gazzo, Paolo; Maso, Renzo; Roman, Alessandro; Ticha, Vladimira; Venier, Giacomo; Blackburn, Paul; Goossens, Godelieve A; Bowen Santolucito, Jamie; Stas, Marguerite; Van Boxtel, Ton; Vesely, Thomas M; de Lutio, Enrico

2011-01-01

326

Intracranial venous drainage through spinal veins.  

PubMed

There is extensive collateral networking at the craniocervical junction with a substantial anatomical and functional continuity between the veins, venous sinuses, and venous plexuses of the brain and spine. The predominant pathway for intracranial blood outflow may depend on the level and degree of obstruction. We are presenting an unusual case of predominant egress of intracranial blood through enlarged spinal canal venous collaterals due to thrombosis of the intracranial venous sinuses. Awareness of this unique pattern of venous drainage of the cranium is important and should be considered in the differential diagnosis of spinal arteriovenous malformation (AVM) or arteriovenous fistula (AVF). Magnetic Resonance Venography (MRV) of the brain should be considered to exclude intracranial thrombosis in these cases. PMID:25141475

Choudhary, Arabinda Kumar; Dias, Mark S; Iantosca, Mark

2014-06-01

327

Implications of cytogenetics for venous thromboembolism in acute myeloid leukaemia.  

PubMed

Due to the high risk of thrombocytopenia and haemorrhage, thrombotic complications have received little attention in patients with acute myeloid leukemia (AML). Furthermore, the predictive role of cytogenetics on venous thromboembolism (VTE) has largely been ignored. This study aimed to evaluate the incidence, risk factors, and prognostic aspects of VTE in AML. A total of 811 consecutive patients with AML were enrolled and analysed retrospectively. Cox time-dependent covariate regression analysis was used to identify the significant predictors of VTE development. To minimise potential confounding factors, we used propensity-score matching to compare overall survival between patients with and without VTE. The six-month and one-year cumulative incidences of VTE were 3.1?% (95?% confidence interval [CI], 2.0-4.7) and 3.9?% (95?% CI, 2.6-5.7), respectively. Of the 26 cases of VTE, 22 (85?%) developed within 6 months of leukemia diagnosis and 13 (50?%) were catheter-related. In multivariate analysis, advanced age (??65 years) (hazard ratio [HR], 2.70; p = 0.03) and increasing cytogenetic risk (common HR, 1.84; p = 0.05) were independent predictors of VTE. There was no significant association between VTE development and decreased survival (p = 0.32 for matched analysis). Advanced age and increasing cytogenetic risk, well-known predictors for clinical outcome in AML, were also independent risk factors of VTE development. Our results suggest that VTE does not hold prognostic implications for AML. PMID:25339605

Lee, Y-G; Kim, I; Kwon, J-H; Yoon, S S; Park, S; Song, L; Yoon, J-H; Shin, S-H; Min, W-S; Kim, H-J

2015-01-01

328

Venous thromboembolism in Thai children.  

PubMed

This is a retrospective study of 24 pediatric venous thromboembolism (VTE) patients with or without pulmonary embolism, conducted in Bangkok, Thailand, between 1981 and 2005. The incidence rate of VTE in Thai children was 3.9/10,000 hospital admissions per year. The median age was 11.7 years. Seventy-five percent of the patients had at least one associated medical condition accounting for the VTE; the two most common conditions, however, were infection and malignancy. Pulmonary embolism occurred in 29% of patients. Observed outcomes of VTE in this series included death (13%), postphlebitic syndrome (13%), and recurrence (26%). Genetic risk factors were explored in 19 patients, and no factor V Leiden or prothrombin 20210 mutations were detected. Protein C deficiency was found in 4 patients. PMID:17613867

Sirachainan, Nongnuch; Chuansumrit, Ampaiwan; Angchaisuksiri, Pantep; Pakakasama, Samart; Hongeng, Suradej; Kadegasem, Praguywan

2007-06-01

329

Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans  

NASA Technical Reports Server (NTRS)

Human venous compliance hypothetically decreases from upper to lower body as a mechanism for maintenance of the hydrostatic indifference level 'headward' in the body, near the heart. This maintains cardiac filling pressure, and thus cardiac output and cerebral perfusion, during orthostasis. This project entailed four steps. First, acute whole-body tilting was employed to alter human calf and neck venous volumes. Subjects were tilted on a tilt table equipped with a footplate as follows: 90 deg, 53 deg, 30 deg, 12 deg, O deg, -6 deg, -12 deg, -6 deg, O deg, 12 deg, 30 deg, 53 deg, and 90 deg. Tilt angles were held for 30 sec each, with 10 sec transitions between angles. Neck volume increased and calf volume decreased during head-down tilting, and the opposite occurred during head-up tilt. Second, I sought to cross-validate Katkov and Chestukhin's (1980) measurements of human leg and neck venous pressures during whole-body tilting, so that those data could be used with volume data from the present study to calculate calf and neck venous compliance (compliance = (Delta)volume/(Delta)pressure). Direct measurements of venous pressures during postural chances and whole-body tilting confirmed that the local changes in venous pressures seen by Katkov and Chestukhin (1980) are valid. The present data also confirmed that gravitational changes in calf venous pressure substantially exceed those changes in upper body venous pressure. Third, the volume and pressure data above were used to find that human neck venous compliance exceeds calf venous compliance by a factor of 6, thereby upholding the primary hypothesis. Also, calf and neck venous compliance correlated significantly with each other (r(exp 2) = 0.56). Fourth, I wished to determine whether human calf muscle activation during head-up tilt reduces calf venous compliance. Findings from tilting and from supine assessments of relaxed calf venous compliance were similar, indicating that tilt-induced muscle activation is relatively unimportant. Low calf venous compliance probably results from stiffer venous, skeletal muscle, and connective tissues, and better-developed local and central neural controls of venous distensibility. This research establishes that upper-to-lower body reduction of venous compliance can explain headward positioning of the hydrostatic indifference level in humans.

Watenpaugh, Donald E.

1996-01-01

330

Live volumetric imaging (LVI) intracardiac ultrasound catheter.  

PubMed

The Live Volumetric Imaging (LVI) catheter is capable of real-time 3D intracardiac echo (ICE) imaging, uniquely providing full volume sectors with deep penetration depth and high volume frame rate. The key enabling technology in this catheter is an integrated piezoelectric micromachined ultrasound transducer (pMUT), a novel matrix phased array transducer fabricated using semiconductor microelectromechanical systems (MEMS) manufacturing techniques. This technology innovation may enable better image guidance to improve accuracy, reduce risk, and reduce procedure time for transcatheter intracardiac therapies which are currently done with limited direct visualization of the endocardial tissue. Envisioned applications for LVI include intraprocedural image guidance of cardiac ablation therapies as well as transcatheter mitral and aortic valve repair. PMID:23773496

Dausch, David E; Castellucci, John B; Gilchrist, Kristin H; Carlson, James B; Hall, Stephen D; von Ramm, Olaf T

2013-01-01

331

Soft robotic concepts in catheter design: an on-demand fouling-release urinary catheter.  

PubMed

Infectious biofilms are problematic in many healthcare-related devices and are especially challenging and ubiquitous in urinary catheters. This report presents an on-demand fouling-release methodology to mechanically disrupt and remove biofilms, and proposes this method for the active removal of infectious biofilms from the previously inaccessible main drainage lumen of urinary catheters. Mature Proteus mirabilis crystalline biofilms detach from silicone elastomer substrates upon application of strain to the substrate, and increasing the strain rate increases biofilm detachment. The study presents a quantitative relationship between applied strain rate and biofilm debonding through an analysis of biofilm segment length and the driving force for debonding. Based on this mechanism, hydraulic and pneumatic elastomer actuation is used to achieve surface strain selectively within the lumen of prototypes of sections of a fouling-release urinary catheter. Proof-of-concept prototypes of sections of active, fouling-release catheters are constructed using techniques typical to soft robotics including 3D printing and replica molding, and those prototypes demonstrate release of mature P. mirabilis crystalline biofilms (e.g., ?90%) from strained surfaces. These results provide a basis for the development of a new urinary catheter technology in which infectious biofilms are effectively managed through new methods that are entirely complementary to existing approaches. PMID:24668920

Levering, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; López, Gabriel P

2014-10-01

332

[Venous angioma with associated cerebellar haemorrhage].  

PubMed

Venous angiomas are a developmental anomaly in which embryonic venous drainage is still present into adulthood. They are usually asymptomatic and benign course but they can cause seizures and less commonly bleeding, usually associated to cavernous malformation. Normally, treatment is not necessary although bleeding, severe clinical and lesions in which it is possible a favourable approach, we can consider treatment. We show a case of a 11 years old boy with acute decrease level of consciousness. We observed hematoma in the right cerebellar hemisphere with radial tubular structures consistent with developmental venous anomaly. The hematoma was evacuated without a demonstrable other reason justifying the bleeding. PMID:23218501

Sánchez Medina, Yanire; Pérez del Rosario, Pedro Antonio; Domínguez, Jaime; Millán, Ana

2013-01-01

333

Biocide Activity against Urinary Catheter Pathogens  

PubMed Central

Antimicrobial effects of essential oils against bacteria associated with urinary catheter infection was assessed. Tests were performed on 14 different bacterial species cultured either planktonically or as biofilms. Biofilms were found to be up to 8-fold more tolerant of the test agents. Higher antimicrobial tolerance was also evident in tests conducted in artificial urine. Eugenol exhibited higher antimicrobial effects against both planktonic cells and biofilms than did terpinen, tea tree oil, and cineole. PMID:24247129

Jordan, Rachael P. C.; Waters, Mark G. J.; Stickler, David J.; Williams, David W.

2014-01-01

334

Alternate energy sources for catheter ablation  

Microsoft Academic Search

Because of the limitations of conventional radiofrequency ablation in creating large or linear lesions, alternative energy\\u000a sources have been used as possible methods of catheter ablation. Modified radiofrequency energy, cryoablation, and microwave,\\u000a laser, and ultrasound technologies may be able to create longer, deeper, and more controlled lesions and may be particularly\\u000a suited for the treatment of ventricular tachycardias and for

Paul J. Wang; Munther K. Homoud; Mark S. Link; N. A. Mark Estes

1999-01-01

335

Cerebral Venous Congestion as Indication for Thrombolytic Treatment  

SciTech Connect

Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. Eight of these were diagnosed with dural sinus thrombosis only, and had a stable hospital course without worsening of symptoms. These patients also did not have imaging evidence of cerebral venous congestion. The remaining 2 patients had cerebral edema on the CT scan. One had only a small amount of edema in the right cerebellum, but the other had severe edema in the bilateral basal ganglia and thalamic areas. Nine of these patients had a stable hospitalization course and experienced a symptom-free recovery, but 1 died with severe cerebral edema and hemorrhage. Seven of the remaining 15 patients were initially treated with anticoagulation therapy for periods ranging from 2 days to 2 months (average 11 days). These 7 patients were considered to have failed anticoagulation therapy since they had worsening symptoms, and 5 of these had developed hemorrhage on subsequent CT or MR imaging scans. Five of the 7 then underwent thrombectomy with the administration of tPA. Of the remaining 2, 1 underwent thrombectomy alone without the administration of tPA, and the other was given 1 million units of urokinase instead of tPA. Three of these patients had a symptom-free recovery, but 2 had residual left-sided weakness, 1 patient had a minimal gait disturbance, and another patient developed a transverse sinus arteriovenous fistula 7 months after thrombolytic therapy. The remaining 8 patients did not receive anticoagulation therapy, and went straight to treatment with thrombectomy and administration of tPA. All of these presented with worsening clinical symptoms. Six had hemorrhage on their imaging studies, 1 had new edema on a subsequent CT scan, and 1 had edema along with the dural sinus thrombosis, but experienced worsening clinical symptoms consisting of headache and atypical dystonia. Five of these 8 patients experienced a symptom-free recovery, and 3 patients had mild residual weakness. Conclusion. In patients with acute dural sinus thrombosis, an indication for thrombectomy or thrombolytic therapy may be the development of cerebral venous conge

Tsai, Fong Y., E-mail: ftsai@uci.edu; Kostanian, Varoujan; Rivera, Monica [UCI Medical Center, Department of Radiological Sciences (United States); Lee, Kwo-Whie [Changhua Christian Hospital, Department of Radiology (China); Chen, Clayton C. [Taichung Veterans General Hospital, Department of Radiology (China); Nguyen, Thong H. [UCI Medical Center, Department of Radiological Sciences (United States)

2007-07-15

336

Flow Structure Associated with Hemodialysis Catheters  

NASA Astrophysics Data System (ADS)

Insertion of a hemodialysis catheter into the superior vena cava (SVC) gives rise to complex flow patterns, which arise from the simultaneous injection and extraction of blood through different holes (ports) of the catheter. Techniques of high-image-density particle image velocimetry are employed in a scaled-up water facility. This approach allows characterization of both the instantaneous and time-averaged flow structure due to generic classes of side hole geometries. The trajectory of the injection jet is related to the ratio of the initial jet velocity to the mainstream velocity through the SVC, and to the type of distortion of the jet cross-section. Furthermore, the mean and fluctuating velocity and vorticity fields are determined. Significant turbulent stresses develop rapidly in the injection jet, which can impinge upon the wall of the simulated SVC. Immediately downstream of the injection hole, a recirculation cell of low velocity exists adjacent to the catheter surface. These and other representations of the flow structure are first evaluated for a steady throughflow, then for the case of a pulsatile waveform in the SVC, which matches that of a normal adult.

Foust, Jason

2005-11-01

337

Venous Ulcers: New Options in Treatment: Minimally Invasive Vein Surgery  

PubMed Central

Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients. PMID:24527103

Poblete, Honesto; Elias, Steven

2009-01-01

338

Anatomy of the foot venous pump: physiology and influence on chronic venous disease.  

PubMed

The aim of this paper is to demonstrate the location of the venous foot pump using an anatomical study. Four hundred cadaveric feet were injected with green neoprene latex followed by a dissection. A coloured segmentation of the venous system was achieved. The Lejars' concept of the venous sole of the foot is incorrect: the true blood venous reservoir of the foot is located deeply in the plantar veins, between the plantar muscles. The medial and mostly lateral plantar veins converge into the plexus shaped calcaneal crossroad, where the blood is ejected upwards into the two posterior tibial veins. In addition, the several medial perforators of the foot directly connect the deep system (medial plantar veins) to the superficial venous system (medial marginal vein). This forms a true 'medial functional unit' which is unique in the limb given its directional flow is from deep to superficial. In conclusion, the plantar veins play an important role in the physiology of the venous return since a venous reservoir of 25 mL of blood is mobilized upwards with each step during walking. Therefore, the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency. PMID:22847928

Uhl, J-F; Gillot, C

2012-08-01

339

Debate: whether venous perforator surgery reduces recurrences.  

PubMed

Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice. PMID:25154966

Whiteley, Mark S; O'Donnell, Thomas F

2014-09-01

340

Penile strangulation and necrosis due to condom catheter.  

PubMed

Condom catheters are often used in the management of male urinary incontinence, and are considered to be safe. As condom catheters are placed on the male genitalia, sometimes adequate care is not taken after placement owing to poor medical care of debilitated patients and feelings of embarrassment and shame. Similarly, sometimes the correct size of penile sheath is not used. Strangulation of penis due to condom catheter is a rare condition; only few such cases have been reported in the literature. Proper application and routine care of condom catheters are important in preventing this devastating complication especially in a neurologically debilitated population. We present a case of penile necrosis due to condom catheter. We will also discuss proper catheter care and treatment of possible complications. PMID:23758994

Ozkan, Heval S; Irkoren, Saime; Sivrio?lu, Nazan

2013-06-11

341

[Deep venous insufficiency of the lower extremities].  

PubMed

Lower limbs chronic venous insufficiency (CVI) is a widespread pathologic condition. Prevalence of venous ulcer in Europe ranges between 0.5% and 1.0%. Venous ulceration can be due to insufficiency of the superficial system, although deep venous insufficiency is responsible for 75% of the cases. Morbidity and socio-economic costs are exceedingly high especially because of frequent recurrences. CVI recognises mainly two causes: 1) increased influx, due to arteriovenous fistulas; 2) difficult outflow usually secondary to postphlebitic or primitive valvular incompetence. The prevalence of CVI and venous ulceration is difficult to assess. Surgical treatment tends to cure the underlying hemodynamic problem. Homans in 1916 first introduced surgical treatment of CVI and venous ulceration: excision of the cutaneous lesion and ligature suprafascial of the communicating veins. Since then different various techniques have been introduced in the clinical practice: Linton in 1938 supported subfascial interruption of the perforating veins but still reported a recurrence rate of 47%. Stripping of internal saphenous vein associated with division of perforating veins is still controversial, because lacks evidence of its real effectiveness in preventing recurrences. Felder's surgical technique is preferred by some authors to Linton's technique, because of the possibility to divide and section incompetent perforating veins without a cutaneous incision in the severely diseased postphlebitic tissues. In personal experience (56 patients) treated by Felder's techniques, we reached a cutaneous ulceration healing rate of 36% has been obtained. Subfascial interruption of perforating veins under endoscopic vision associated to the stripping of the internal saphenous vein could be a valuable option in the treatment of CVI because of the shorter duration of the operation and hospital stay and lesser postoperative complications. Repair and/or replacement of deep venous valves, originally described by Kistner in 1968, could be curative of venous hypertension due to primitive valvular insufficiency (primitive or postphlebitic): the same author in 1975 reported positive results (80% at 5 years). Major advantages of indirect valvuloplastic surgical technique are: 1) venotomy is not necessary; 2) it does not introduce extraneous material in the vasal lumen; 3) clamping of the vein is avoided; 4) heparine or other antithrombotic measures are usually not necessary. Although preliminary encouraging results, subsequent clinical experiences have demonstrated that correction of the reflux of the main axial venous system alone is not curative and durable resolution of venous symptoms also depends on the concomitant correction of all incompetent perforating veins. Venous valves transplantation is theoretically good to correct the deep long reflux and to improve calf pump function, although clinical results are still limited and follow-up not prolonged enough in terms of symptoms resolution and complete ulcer healing. PMID:10207291

Sica, G S; Forlini, A; Sileri, P; Russo, F; Rulli, F; Gaspari, A L

1998-11-01

342

Stimulating Popliteal Catheters for Postoperative Analgesia After Hallux Valgus Repair  

Microsoft Academic Search

Stimulating catheters have been recently introduced in clinicalpractice.Weassessedtheefficacyofstimulating andnonstimulatingcatheterplacementforpaincontrol and local anesthetic requirements after hallux valgus repair with continuous sciatic popliteal nerve block in this comparative, randomized, blinded-to-observer study of 48 patients. A stimulating catheter was placed in groups S-125 and S-0625. The same catheter was in- serted without stimulation in group NS-125. An infu- sion of 0.125% levobupivacaine was

Manuel Taboada; Javier Carceller; Juan Lagunilla

2006-01-01

343

Peritoneal dialysis catheter placement—is laparoscopy an option?  

Microsoft Academic Search

\\u000a Abstract  Peritoneal dialysis (CAPD) is the preferred and gentlest type of dialysis in patients with end-stage renal disease (ESRD).\\u000a One of the most frequent complications following peritoneal dialysis catheter (P-catheter) placement is malfunction owing\\u000a to displacement, which frequently entails major problems for the patient, including reoperation and the risk of having to\\u000a switch to haemodialysis. Consequently, to ensure optimal P-catheter function

Lars Lund; Morten Jønler

2007-01-01

344

The chronic cerebrospinal venous insufficiency syndrome.  

PubMed

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials. PMID:21106999

Zamboni, P; Galeotti, R

2010-12-01

345

21 CFR 870.1290 - Steerable catheter control system.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a)...

2014-04-01

346

21 CFR 870.1350 - Catheter balloon repair kit.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1350 Catheter balloon repair kit. (a) Identification....

2013-04-01

347

21 CFR 870.1240 - Flow-directed catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1240 Flow-directed catheter. (a) Identification. A...

2014-04-01

348

21 CFR 870.1290 - Steerable catheter control system.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a)...

2013-04-01

349

21 CFR 870.1230 - Fiberoptic oximeter catheter.  

Code of Federal Regulations, 2013 CFR

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1230 Fiberoptic oximeter catheter. (a) Identification....

2013-04-01

350

21 CFR 870.1370 - Catheter tip occluder.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1370 Catheter tip occluder. (a) Identification. A...

2014-04-01

351

21 CFR 870.1230 - Fiberoptic oximeter catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1230 Fiberoptic oximeter catheter. (a) Identification....

2014-04-01

352

21 CFR 870.1330 - Catheter guide wire.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A...

2014-04-01

353

21 CFR 870.1210 - Continuous flush catheter.  

...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1210 Continuous flush catheter. (a) Identification. A...

2014-04-01

354

Remote control catheter navigation: options for guidance under MRI  

PubMed Central

Background Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI) is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. Steering catheters by remote control under MRI guidance offers unique challenges and opportunities. Methods In this review, the benefits and limitations of MRI-guided remote control intervention are addressed, and the tools for guiding such interventions in the magnetic environment are summarized. Designs for remote control catheter guidance include a catheter tip electromagnetic microcoil design, a ferromagnetic sphere-tipped catheter design, smart material-actuated catheters, and hydraulically actuated catheters. Remote control catheter guidance systems were compared and contrasted with respect to visualization, safety, and performance. Performance is characterized by bending angles achievable by the catheter, time to achieve bending, degree of rotation achievable, and miniaturization capacity of the design. Necessary improvements for furthering catheter design, especially for use in the MRI environment, are addressed, as are hurdles that must be overcome in order to make MRI guided endovascular procedures more accessible for regular use in clinical practice. Conclusions MR-guided endovascular interventions under remote control steering are in their infancy due to issues regarding safety and reliability. Additional experimental studies are needed prior to their use in humans. PMID:22655535

2012-01-01

355

Intravascular ultrasound in the diagnosis and treatment of chronic cerebrospinal venous insufficiency.  

PubMed

Multiple imaging modalities have been used for the evaluation of chronic cerebrospinal venous insufficiency (CCSVI). These include Doppler ultrasound, magnetic resonance venography, computed tomographic venography, and catheter venography. Although each of these tests is considered to contribute valuable information to the evaluation, each modality has deficiencies, which can impact treatment. Intravascular ultrasound (IVUS) has a role in this evaluation owing to its ability to accurately assess vessel circumference and cross-sectional area in real time. This can aid in identifying significant stenoses and optimizing balloon sizing during angioplasty. In addition, intraluminal abnormalities that may be difficult to see with venography can be identified with IVUS, which can further determine when angioplasty for CCSVI is indicated. Finally, IVUS can identify potential complications of angioplasty, including dissection and thrombus formation, allowing for rapid treatment. As a result, IVUS is an important part of an evaluation for CCSVI and, when available, should be used to identify patients who may benefit from endovascular treatment. PMID:22640502

Sclafani, Salvatore J A

2012-06-01

356

Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: A prospective observational study of 1,978 consecutive catheterizations  

Microsoft Academic Search

BACKGROUND: A central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and\\/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US)

Luigi Cavanna; Giuseppe Civardi; Daniele Vallisa; Camilla Di Nunzio; Lorella Cappucciati; Raffaella Bertè; Maria Rosa Cordani; Antonio Lazzaro; Gabriele Cremona; Claudia Biasini; Monica Muroni; Patrizia Mordenti; Silvia Gorgni; Elena Zaffignani; Massimo Ambroggi; Livia Bidin; Maria Angela Palladino; Carmelina Rodinò; Laura Tibaldi

2010-01-01

357

Venous thromboembolism in multiple myeloma.  

PubMed

As for other malignancies, multiple myeloma is associated with an increased risk of venous thromboembolism (VTE). The incidence of VTE is estimated as 8 to 22 per 1,000 person-years; risk factors can be patient related (advanced age, other risk factors shared with the general population), disease related, and treatment related. Disease-related risk factors can derive from the monoclonal component (rarely hyperviscosity or inhibition of natural anticoagulants) or hypercoagulability sustained by inflammatory cytokines (increased von Willebrand factor, factor VIII, fibrinogen levels, decreased protein S levels, acquired activated protein C resistance). The 1 to 2% baseline of incident VTE associated with conventional therapies as melphalan and prednisone is at least doubled by the use of doxorubicin or other chemotherapeutic agents. The VTE rate associated with thalidomide or lenalidomide as monotherapy is similar, whereas combination with high-dose dexamethasone or multiple chemotherapeutic agents induces a multiplicative effect on the VTE rate up to 25%. Low-molecular-weight heparin (LMWH), fixed low-dose warfarin, and aspirin are acceptable strategies for antithrombotic prophylaxis, reducing VTE to 5 to 8% in thalidomide-treated patients and 1 to 3% in lenalidomide-treated patients. LMWH shows an advantage in efficacy not statistically significant. Prophylaxis should be tailored considering individual risk factors for VTE, the stage of disease, the possible occurrence of thrombocytopenia, or renal insufficiency. PMID:24599441

De Stefano, Valerio; Za, Tommaso; Rossi, Elena

2014-04-01

358

21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.  

Code of Federal Regulations, 2011 CFR

...Subcutaneous, implanted, intravascular infusion port and catheter. 880.5965 Section...Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification...subcutaneous, implanted, intravascular infusion port and catheter is a device...

2011-04-01

359

21 CFR 880.5965 - Subcutaneous, implanted, intravascular infusion port and catheter.  

Code of Federal Regulations, 2010 CFR

...Subcutaneous, implanted, intravascular infusion port and catheter. 880.5965 Section...Subcutaneous, implanted, intravascular infusion port and catheter. (a) Identification...subcutaneous, implanted, intravascular infusion port and catheter is a device...

2010-04-01

360

Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting  

PubMed Central

Objective: To examine the validity of central venous oxygen saturation (ScvO2) as a numerical substitution of mixed venous oxygen saturation (SvO2) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG). Materials and Methods: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC) as a part of our routine intraoperative monitoring. SvO2 and ScvO2 were simultaneously measured 15 minutes (T1) and 30 minutes (T2) after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4), and 15 and 30 minutes after admission to intensive care unit (T5 and T6). Results: ScvO2 showed higher reading than SvO2 all through our study. Our results showed perfect positive statistically significant correlation between SvO2 and ScvO2 at all data points. Individual mean of difference (MOD) between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. Conclusions: In on pump beating CABG patients; ScvO2 and SvO2 are not interchangeable numerically. ScvO2 is useful in the meaning of trend; our data suggest that ScvO2 is equivalent to SvO2 , only in the course of clinical decisions as long as absolute values are not required. PMID:20927264

Alshaer, Ahmad; Abdel-Meguid, Mohamed Essam; Ibraheim, Osama; Fawzi, Khaled; AbdulSalam, Ibrahim; Sheta, Saad; Abdullah, Khaled M.; El-Demerdash, Ahmed; Al-Satli, Raed; AbdelAll, Mohamed; Bakir, Bakir M.; AlNahal, Nezar; Abdulrahman, Yasser; AlHamoud, Hanaa

2010-01-01

361

Surgical treatment for venous malformation.  

PubMed

Sclerotherapy is generally the preferred treatment for venous malformation (VM) with surgery usually playing an adjunctive role. This study presents our experience with surgical treatment of VMs. Consecutive patients were identified from our vascular anomalies database 1996-2011 and patient demographics, location of the lesion, type of tissue(s) affected and symptoms were analysed. The patients completed a questionnaire to assess the impact of surgery on the severity of symptoms, appearance, function and overall quality of life (QoL), using a visual analogue scale of 0 (no symptom) to 10 (maximal symptom). They also rated their overall satisfaction of treatment using a scale of 0 (complete dissatisfaction) to 10 (complete satisfaction). Fifty patients with VM underwent a total of 58 procedures. Complication occurred in six patients (9.7% of operations), including transient sensory loss (n=3) and permanent frontal branch palsy (n=1), haematoma formation (n=1) and minor wound dehiscence (n=1). At least 50% improvement in symptoms of background pain, acute episodic pain, contour deformity and skin discolouration occurred in 88.9%, 92.3%, 83.3% and 75.0% of patients, respectively. At least 50% improvement in the appearance, function and overall QoL occurred in 54.3%, 71.4% and 70.4% of patients, respectively. The mean overall patient satisfaction with the treatment was 8.9 (range, 1-10). Surgery remains an important treatment modality for selected patients with VM having low complication rates and high patient satisfaction. It improves the appearance, function and overall QoL for the majority of the patients by reducing the severity of pain, contour deformity and skin discolouration. PMID:24012651

Steiner, Frederica; FitzJohn, Trevor; Tan, Swee T

2013-12-01

362

Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations  

PubMed Central

Introduction While non-invasive ventilation aimed at avoiding intubation has become the modality of choice to treat mild to moderate acute respiratory acidosis, many severely acidotic patients (pH <7.20) still need intubation. Extracorporeal veno-venous CO2 removal (ECCO2R) could prove to be an alternative. The present animal study tested in a systematic fashion technical requirements for successful ECCO2R in terms of cannula size, blood and sweep gas flow. Methods ECCO2R with a 0.98 m2 surface oxygenator was performed in six acidotic (pH <7.20) pigs using either a 14.5 French (Fr) or a 19Fr catheter, with sweep gas flow rates of 8 and 16 L/minute, respectively. During each experiment the blood flow was incrementally increased to a maximum of 400 mL/minute (14.5Fr catheter) and 1000 mL/minute (19Fr catheter). Results Amelioration of severe respiratory acidosis was only feasible when blood flow rates of 750 to 1000 mL/minute (19Fr catheter) were used. Maximal CO2-elimination was 146.1?±?22.6 mL/minute, while pH increased from 7.13?±?0.08 to 7.41?±?0.07 (blood flow of 1000 mL/minute; sweep gas flow 16 L/minute). Accordingly, a sweep gas flow of 8 L/minute resulted in a maximal CO2-elimination rate of 138.0?±?16.9 mL/minute. The 14.5Fr catheter allowed a maximum CO2 elimination rate of 77.9 mL/minute, which did not result in the normalization of pH. Conclusions Veno-venous ECCO2R may serve as a treatment option for severe respiratory acidosis. In this porcine model, ECCO2R was most effective when using blood flow rates ranging between 750 and 1000 mL/minute, while an increase in sweep gas flow from 8 to 16 L/minute had less impact on ECCO2R in this setting. PMID:24942014

2014-01-01

363

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter  

SciTech Connect

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

Oh, Jung Suk, E-mail: oj-cumc@daum.net; Lee, Hae Giu, E-mail: hgleehfh@catholic.ac.kr; Chun, Ho Jong; Choi, Byung Gil [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Lee, Sang Hoon; Hahn, Seong Tai [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of); Ohm, Joon Young [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)] [Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology (Korea, Republic of)

2013-10-15

364

Engineering Considerations Of Catheters For Intravascular Ultrasonic Measurements  

NASA Astrophysics Data System (ADS)

The mechanical properties of commonly used fluid transfusion or pressure monitoring catheters are similar to the properties required of catheters which include sensing devices. Consequently, bending and torsional stiffness of commercial catheters and tubes were measured at both room and body temperature. Five of these usually placed with the aid of fluoroscopy had an average Young's modulus of 5714x101 dyne/cm at 21°C which decreased 29% at body temperature; a shear modulus of 70.5x101 dyne/cm 4 at 21°C which decreased 13% at body temperature, and plastic deformation of 8% when loaded for 1 minute at 37°. Four of these were composed of a composite material. Catheters which are balloon directed during insertion had moduli values approximately 1/3 of these or less. The drag forces produced on balloons used on such catheters were measured for fluid velocities ranging from 10-50 cm/sec. Using this information the average force applied to a balloon throughout a cardiac cycle was calculated; values of 1280 dynes for a .6 ml balloon and 2490 dynes for a 1 ml balloon were found. The maximum wall thicknesses to catheter radii for single lumen catheters were determined for various material moduli which would allow the catheter tip to be directed by a balloon during its passage into the right heart.

Martin, Roy W.; Johnson, Christopher C.

1989-08-01

365

An Alternate Technique to Determine Umbilical Arterial Catheter Length  

Microsoft Academic Search

Sick babies often have an umbilical artery catheter (UAC) inserted. To minimize risk to the baby, the catheter is inserted a distance calculated to place it either between the third and fifth lumbar vertebrae or between the sixth and 10th thoracic vertebrae when checked radiographically. The methods used to calculate this insertion distance require that length measurements of the baby

Bruce K. Rubin; Elizabeth McRobert; Michael B. ONeill

1986-01-01

366

A magnetic-resonance-imaging-compatible remote catheter navigation system.  

PubMed

A remote catheter navigation system compatible with magnetic resonance imaging (MRI) has been developed to facilitate MRI-guided catheterization procedures. The interventionalist's conventional motions (axial motion and rotation) on an input catheter - acting as the master - are measured by a pair of optical encoders, and a custom embedded system relays the motions to a pair of ultrasonic motors. The ultrasonic motors drive the patient catheter (slave) within the MRI scanner, replicating the motion of the input catheter. The performance of the remote catheter navigation system was evaluated in terms of accuracy and delay of motion replication outside and within the bore of the magnet. While inside the scanner bore, motion accuracy was characterized during the acquisition of frequently used imaging sequences, including real-time gradient echo. The effect of the catheter navigation system on image signal-to-noise ratio (SNR) was also evaluated. The results show that the master-slave system has a maximum time delay of 41 ± 21 ms in replicating motion; an absolute value error of 2 ± 2° was measured for radial catheter motion replication over 360° and 1.0 ± 0.8 mm in axial catheter motion replication over 100 mm of travel. The worst-case SNR drop was observed to be 2.5%. PMID:23192485

Tavallaei, Mohammad Ali; Thakur, Yogesh; Haider, Syed; Drangova, Maria

2013-04-01

367

Venous stasis and routine hematologic testing.  

PubMed

Prolonged venous stasis, as generated by a long tourniquet placement, produces spurious variations in several measurable analytes. To verify to what extent venous stasis influences routine hematologic testing, we assessed routine hematologic parameters, including hemoglobin, hematocrit, red blood cell count (RBC), main cell hemoglobin (MHC), main cell volume (MCV), platelet count (PLT), main platelet volume (MPV), white blood cell count (WBC) and WBC differential on the Advia 120 automated hematology analyzer in 30 healthy volunteers, either without venous stasis (no stasis) or after application of a 60 mmHg standardized external pressure by a sphygmomanometer, for 1 (1-min stasis) and 3 min (3-min stasis). Although the overall correlation between measures was globally acceptable, the mean values for paired samples were significantly different in all parameters tested, except MCV, MHC, PLT, MPV, eosinophils, basophils and large unstained cells after 1-min stasis and all parameters except MCV, MHC, MPV and basophils after 3-min venous stasis. As expected RBC, hemoglobin and hematocrit displayed a significant trend towards increase, whereas WBC and the WBC subpopulations were decreased. Difference between measurements by Bland and Altman plots exceeded the current analytical quality specifications for desirable bias for WBC, RBC, hemoglobin, hematocrit, lymphocytes and monocytes in samples collected after either 1- and 3-min stasis. These results provide clear evidence that venous stasis during venipuncture might produce spurious and clinically meaningful biases in the measurement of several hematologic parameters, prompting further considerations on the usefulness of adopting appropriate preventive measures for minimizing such influences. PMID:16999725

Lippi, G; Salvagno, G L; Montagnana, M; Franchini, M; Guidi, G C

2006-10-01

368

Catheter-Based Sensing In The Airways  

NASA Astrophysics Data System (ADS)

Studies attempting to define the role of the respiratory tract in heating and humidifying inspired air point to the need for sensing many variables including airway wall and airstream temperatures, humidity, and surface fluid pH and osmolarity. In order to make such measurements in vivo in human volunteers, catheter based technologies must be exploited both to assure subject safety and subject comfort. Miniturization of the electrodes or sensors becomes a top priority. This paper describes the use of thin-film microelectronic technology to fabricate a miniature, flexible sensor which can be placed directly onto the surface of the airway to measure the electrical conductance of the fluids present. From this information the osmolarity of the surface fluid was calculated. Physiologic evaluation of the device and corroboration of the calculations was performed in mongrel dogs. We also describe the successful application of current thermistor technology for the thermal mapping of the airways in humans in order to characterize the dynamic intrathoracic events that occur during breathing. The thermal probe consisted of a flexible polyvinyl tube that contained fourteen small thermistors fixed into the catheter. Data have been obtained in dozens of people, both normal subjects and asthmatic patients, under a variety of interventions. These data have substantively advanced the study of asthma, a particularly troublesome chronic obstructive pulmonary disorder.

Fouke, J. M.; Saunders, K. G.

1988-04-01

369

Evaluation of a Continuous Blood Glucose Monitoring System Using Central Venous Microdialysis  

PubMed Central

Background Glycemic control in critically ill patients has been shown to be beneficial. In this prospective study, we evaluated the accuracy and technical feasibility of a continuous glucose monitoring system using intravascular microdialysis. Method Fifty patients undergoing cardiac surgery were monitored using a 4 Fr intravenous microdialysis catheter (Eirus SLC™, Dipylon Medical AB, Solna, Sweden) percutaneously placed with the tip of the catheter positioned in the superior vena cava. The catheter was connected to the Eirus™ monitoring system, and the patients were monitored for up to 48 h postoperatively in the intensive care unit (ICU). As reference, arterial blood samples were taken every hour and analyzed in a blood gas analyzer. Results Data were available from 48 patients. A total of 994 paired (arterial blood gas microdialysis) samples were obtained. Glucose correlation coefficient (R2) was 0.85. Using Clarke error grid analysis, 100% of the paired samples were in region AB, and 99% were in region A. Mean glucose level was 8.3 mmol/liter (149 mg/dl), mean relative difference was 0.2%, and mean absolute relative difference was 5%. A total of 99.2% of the paired samples were correct according to International Organization for Standardization (ISO) criteria. Bland-Altman analysis showed that bias ± limits of agreement were 0.02 ± 1.1 mmol/liter (0.36 ± 20 mg/dl). Conclusions Central venous microdialysis using the Eirus monitoring system is a highly accurate and reliable method for continuous blood glucose monitoring up to 48 h in ICU patients undergoing cardiac surgery. The system may thus be useful in critically ill ICU patients. PMID:23294781

Schierenbeck, Fanny; Franco-Cereceda, Anders; Liska, Jan

2012-01-01

370

Medical catheters thermally manipulated by fiber optic bundles  

DOEpatents

A maneuverable medical catheter comprising a flexible tube having a functional tip. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts.

Chastagner, Philippe (608 Aumond Rd., Augusta, GA 30909)

1992-01-01

371

[Obstructive pyelonephritis by ureteral orifice catheterization with a bladder catheter].  

PubMed

This article reports a rare case of acute pyelonephritis secondary to left ureteral obstruction by a bladder catheter. The patient was 93years old man hospitalized in the hospital emergency department with a 39°C fever and pyuria from an indwelling catheter. Blood test found hyperleukocytosis, inflammatory syndrome and acute renal failure. Diagnosis was confirmed by non-contrast abdominal CT scan showing distal part of the catheter inside left ureteral orifice with ureterohydronephrosis. Treatment consisted in replacing the catheter by a three-way catheter for irrigation and parenteral antibiotics therapy. Clinico-biological evolution was successful and a urinary tract CT scan could be realized at day 9. The left upper urinary tract function was recovered. With a short review of the literature we propose to describe the different procedures to manage those obstructions. PMID:25288585

Arnaud, P; Carpentier, X; Pedulla, F; Sandid, M; Pernin, F

2014-12-01

372

Peritoneal dialysis catheter implantation: avoiding problems and optimizing outcomes.  

PubMed

The success of peritoneal dialysis (PD) as renal replacement therapy is dependent upon the patient having a functional long-term peritoneal access. There are a number of identified best practices that must be adhered to during PD catheter placement to achieve a durable and infection-resistant access. The clinical setting, available resources, and the employed catheter insertion method may not always permit complete adherence to these practices; however, an attempt should be made to comply with them as closely as possible. Although omission of any one of the practices can lead to catheter loss, departures from some are committed more frequently, manifesting as commonly occurring clinical problems, such as drain pain, catheter tip migration, omental entrapment, pericatheter leaks and hernias, and poor exit-site location. Understanding the technical pitfalls in PD catheter placement that lead to these problems, enable the provider to modify practice habits to avoid them and optimize outcomes. PMID:25338661

Crabtree, John H

2015-01-01

373

Medical catheters thermally manipulated by fiber optic bundles  

DOEpatents

A maneuverable medical catheter comprising a flexible tube having a functional tip is described. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts. 10 figs.

Chastagner, P.

1992-10-06

374

Factors influencing peritoneal catheter survival in continuous ambulatory peritoneal dialysis.  

PubMed Central

The success of continuous ambulatory peritoneal dialysis (CAPD) is to a great extent determined by the survival of the peritoneal catheter. The aim of this study was to identify technical factors which influence CAPD catheter survival. A total of 453 CAPD catheters inserted into 310 patients over an 8-year period were analysed. Access to the peritoneum was gained either by an open surgical technique (n = 290) or by a closed technique using a trocar and introducer (n = 163). Data relating to a number of potentially significant risk/benefit factors were analysed using multiple regression analysis (proportional hazards method of Cox). Three factors were found to be independently associated with improved catheter survival. They were: using an open surgical insertion technique, performing a partial omentectomy at the time of catheter insertion and the procedure being performed by a consultant. PMID:2241055

Nicholson, M. L.; Donnelly, P. K.; Burton, P. R.; Veitch, P. S.; Walls, J.

1990-01-01

375

Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb  

PubMed Central

In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area’s regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion. PMID:24495850

2014-01-01

376

Prevalence of detectable venous pressure drops expected with venous needle dislodgement.  

PubMed

Venous needle dislodgement (VND) is a potentially fatal complication during hemodialysis (HD) treatment and the venous pressure monitor is the most widely used device for its detection. VND can only be detected by the venous sensor if the resulting pressure drop exceeds the difference between the actual venous pressure and the lower alarm limit. In clinical practice, the lower alarm limit is usually set 30-40 mmHg below the actual venous pressure to avoid a disproportionate high number of nuisance alarms. The aim of this study was to quantify the number of fistulas and grafts in a group of HD patients where venous pressure monitoring can be expected to detect VND. We determined intra-access pressures in 99 chronic HD patients. Sixty-five (65.7%) had a fistula and 34 (34.3%) had a prosthetic graft as a vascular access. Mean intra-access pressure (Pa ) in fistulas was 32.6 ± 23.5 mmHg, whereas in grafts mean Pa was 60.9 ± 19.5 mmHg. Nineteen (29.2%) of the fistulas and 32 (94.1%) of the grafts exhibited an intra-access pressure above 40 mmHg. Therefore, in our study nearly all grafts but only 29% of fistulas would fulfill the requirement for venous pressure monitoring to detect VND. PMID:24341865

Ribitsch, Werner; Schilcher, Gernot; Hafner-Giessauf, Hildegard; Krisper, Peter; Horina, Jörg H; Rosenkranz, Alexander R; Schneditz, Daniel

2014-01-01

377

Comparison of Interstitial Fluid pH, PCO2, PO2 with Venous Blood Values During Repetitive Handgrip Exercise  

NASA Technical Reports Server (NTRS)

We evaluated the use of a small, fiber optic sensor to measure pH, PCO2 and PO2 from forearm muscle interstitial fluid (IF) during handgrip dynamometry. PURPOSE: Compare pH, PCO2 and PO2 values obtained from venous blood with those from the IF of the flexor digitorum superficialis (FDS) during three levels of exercise intensity. METHODS: Six subjects (5M/1F), average age 29+/-5 yrs, participated in the study. A venous catheter was placed in the retrograde direction in the antecubital space and a fiber optic sensor (Paratrend, Diametrics Medical, Inc.) was placed through a 22 G catheter into the FDS muscle under ultrasound guidance. After a 45 min rest period, subjects performed three 5-min bouts of repetitive handgrip exercise (2s contraction/1 s relaxation) at attempted levels of 15%, 30% and 45% of maximal voluntary contraction. The order of the exercise bouts was random with the second and third bouts started after blood lactate had returned to baseline. Venous blood was sampled every minute during exercise and analyzed with an I-Stat CG-4+ cartridge, while IF fiber optic sensor measurements were obtained every 2 s. Change from pre-exercise baseline to end of exercise was computed for pH, PCO2 and PO2. Blood and IF values were compared with a paired t-test. RESULTS: Baseline values for pH, PCO2 and PO2 were 7.37+/-0.02, 46+/-4 mm Hg, and 36+/-6 mm Hg respectively in blood and 7.39+/-0.02, 44+/-6 mm Hg, and 35+/-14 mm Hg in IF. Average changes over all exercise levels are noted in the Table below. For each parameter the exercise-induced change was at least twice as great in IF as in blood. In blood and IF, pH and PCO2 increases were directly related to exercise intensity. Change in venous PO2 was unrelated to exercise intensity, while IF PO2 decreased with increases in exercise intensity. CONCLUSIONS: Measurement of IF pH, PCO2 and PO2 is more sensitive to exercise intensity than measurement of the same parameters in venous blood and provides continuous assessment during and after exercise.

Hagan, Ronald Donald; Soller, Babs R.; Shear, Michael; Walz, Matthias; Landry, Michelle; Heard, Stephen

2006-01-01

378

Risk Factors of Catheter-Related Thrombosis (CRT) in Cancer Patients: A Patient-Level Data (IPD) Meta-Analysis of Clinical Trials and Prospective Studies  

PubMed Central

Background Knowledge of independent, baseline risk factors of catheter-related thrombosis (CRT) may help select adult cancer patients at high risk to receive thromboprophylaxis. Objectives We conducted a meta-analysis of individual patient-level data to identify these baseline risk factors. Patients/Methods MEDLINE, EMBASE, CINAHL, CENTRAL, DARE, Grey literature databases were searched in all languages from 1995-2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient-level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Results A total sample of 5636 subjects from 5 RCTs and 7 prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICC), decreased CRT risk (OR = 0.43; 95% CI, 0.23-0.80), whereas past history of deep vein thrombosis (DVT) (OR = 2.03; 95% CI, 1.05-3.92), subclavian venipuncture insertion technique (OR = 2.16; 95% CI, 1.07-4.34), and improper catheter tip location (OR = 1.92; 95% CI, 1.22-3.02), increased CRT risk. Conclusions CRT risk is increased with using PICC catheters, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings. PMID:21040443

Saber, W.; Moua, T.; Williams, E. C.; Verso, M.; Agnelli, G.; Couban, S.; Young, A.; De Cicco, M.; Biffi, R.; van Rooden, C. J.; Huisman, M. V.; Fagnani, D.; Cimminiello, C.; Moia, M.; Magagnoli, M.; Povoski, S. P.; Malak, S. F.; Lee, A. Y.

2010-01-01

379

Ultrasound-Guided (Needle In-Plane) Perineural Catheter Insertion: The Effect of Catheter Insertion Distance on Postoperative Analgesia  

PubMed Central

Background When using ultrasound guidance to place a perineural catheter for a continuous peripheral nerve block, keeping the needle-in plane and nerve in short-axis results in a perpendicular needle-to-nerve orientation. Many have opined that when placing a perineural catheter via the needle, the acute angle may result in the catheter bypassing the target nerve when advanced beyond the needle tip. Theoretically, greater catheter tip-to-nerve distances result in less local anesthetic-to-nerve contact during the subsequent perineural infusion, leading to inferior analgesia. While a potential solution may appear obvious—advancing the catheter tip only to the tip of the needle, leaving the catheter tip at the target nerve—this technique has not been prospectively evaluated. We therefore hypothesized that during needle in-plane ultrasound-guided perineural catheter placement, inserting the catheter a minimum distance (0-1 cm) past the needle tip is associated with improved postoperative analgesia compared with inserting the catheter a more-traditional 5-6 cm past the needle tip. Methods Preoperatively, subjects received a popliteal-sciatic perineural catheter for foot or ankle surgery using ultrasound guidance exclusively. Subjects were randomly assigned to have a single-orifice, flexible catheter inserted either 0-1 (n=50) or 5-6 cm (n=50) past the needle tip. All subjects received a single-injection mepivacaine (40 mL of 1.5% with epinephrine) nerve block via the needle, followed by catheter insertion and a ropivacaine 0.2% infusion (basal 6 mL/h, bolus 4 mL, 30 min lockout), through at least the day following surgery. The primary end point was average surgical pain as measured with a 0-10 numeric rating scale the day following surgery. Secondary end points included time for catheter insertion, incidence of catheter dislodgement, maximum (“worst”) pain scores, opioid requirements, fluid leakage at the catheter site, and the subjective degree of an insensate extremity. Results Average pain scores the day following surgery for subjects of the 0-1 cm group was a median (interquartile) of 2.5 (0.0-5.0), compared with 2.0 (0.0-4.0) for subjects of the 5-6 cm group (p=0.42). Similarly, among the secondary end points, no statistically significant differences were found between the two treatment groups. There was a trend of more catheter dislodgements in the minimum-insertion group (5 vs. 1; p=0.20). Conclusions This study did not find evidence to support the hypothesis that for popliteal-sciatic perineural catheters placed using ultrasound guidance and a needle in-plane technique, inserting the catheter a minimum distance (0-1 cm) past the needle tip improves (or worsens) postoperative analgesia compared with inserting the catheter a more-traditional distance (5-6 cm). Caution is warranted if extrapolating these results to other catheter designs, ultrasound approaches, or anatomic insertion sites. PMID:21519311

Ilfeld, Brian M.; Sandhu, NavParkash S.; Loland, Vanessa J.; Madison, Sarah J.; Suresh, Preetham J.; Mariano, Edward R.; Bishop, Michael L.; Schwartz, Alexandra K.; Lee, Daniel K.

2011-01-01

380

Percutaneous transpenile and retrograde venous occlusion for the treatment of venous leak impotence.  

PubMed

In 17 patients percutaneous transpenile venous occlusion was performed for the treatment of so-called venous leak impotence. Because of primary failure, the procedure was repeated in 5 patients. On four occasions, it was combined with a retrograde venous occlusion via the internal iliac vein. Within a rather short follow-up period of 23 months maximum, the overall success rate is 65%. Six patients are able to have intercourse and 5 others need additional intracavernous injections. Complications of the procedure were not observed. PMID:2022211

Müller, S C; Schild, H; Fritz, T; Witzsch, U

1991-01-01

381

Comparison of Heparin-Coated and Conventional Split-Tip Hemodialysis Catheters  

SciTech Connect

Catheter coatings have the potential to decrease infection and thrombosis in patients with chronic dialysis catheters. We report our midterm experience with a heparin-coated dialysis catheter. This retrospective, case-control study was approved by our Institutional Review Board. A total of 88 tunneled dialysis catheters were inserted over a 13-month period via the internal jugular vein. Thirty-eight uncoated split-tip catheters and 50 heparin-coated catheters were inserted. Primary catheter patency was compared between the two groups using the log rank test, with infection and/or thrombosis considered as catheter failures. Dialysis parameters during the first and last dialysis sessions, including pump speed, actual blood flow, and arterial port pressures, were compared using unpaired t-tests. Primary patency of the uncoated catheters was 86.0 {+-} 6.5% at 30 days and 76.1 {+-} 8.9% at 90 days. Primary patency of heparin-coated catheters was 92.0 {+-} 6.2% at 30 days and 81.6 {+-} 8.0% at 90 days (p = 0.87, log rank test). Infection requiring catheter removal occurred in four patients with uncoated catheters and two patients with heparin-coated catheters (p = 0.23). Catheter thrombosis requiring catheter replacement or thrombolysis occurred in one patient with an uncoated catheter and two patients with heparin-coated catheters (p = 0.9). No differences in catheter function during hemodialysis were seen between the two groups. In conclusion, the heparin-coated catheter did not show a significantly longer patency compared to the uncoated catheter. The flow characteristics of this device were comparable to those of the conventional uncoated catheter. A demonstrable benefit of the heparin-coated catheter in randomized trials is needed before a recommendation for routine implementation can be made.

Clark, Timothy W. I., E-mail: timothy.clark@nyumc.org; Jacobs, David; Charles, Hearns W.; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph [New York University School of Medicine, Section of Vascular and Interventional Radiology, Department of Radiology (United States); Benstein, Judith A. [New York University School of Medicine, Division of Nephrology, Department of Medicine (United States)

2009-07-15

382

Full and Broad-Spectrum In Vivo Eradication of Catheter-Associated Biofilms Using Gentamicin-EDTA Antibiotic Lock Therapy  

PubMed Central

Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection. However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks. Metal-binding chelators have emerged as potential adjuvants due to their dual anticoagulant/antibiofilm activities, but studies investigating their efficiency were mainly in vitro or else focused on their effects in prevention of infection. To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa. We demonstrate that use of tetrasodium EDTA (30 mg/ml) as a supplement to the gentamicin (5 mg/ml) antibiotic lock solution associated with systemic antibiotics completely eradicated Gram-positive and Gram-negative bacterial biofilms developed in totally implantable venous access ports. Gentamicin-EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment. Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin-EDTA lock is able to eradicate the biofilm formed by a gentamicin-resistant strain of methicillin-resistant S. aureus. This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution. PMID:23027191

Chauhan, Ashwini; Lebeaux, David; Ghigo, Jean-Marc

2012-01-01

383

Endovascular Retrograde Cortical Venous Approach to Disconnect Retrograde Leptomeningeal Venous Reflux in a Patient with Dural AVF  

PubMed Central

Summary We report a case of dural arteriovenous fistual (DAVF) with cortical venous reflux in whom disconnection of the refluxing cortical vein was achieved by using a retrograde transcortical venous approach through the cortical vein itself. PMID:20670511

Goyal, M.; TerBrugge, K.; Farb, R.

1999-01-01

384

Patient ethnicity and use of venous thromboembolism prophylaxis  

Microsoft Academic Search

Objective. Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic sur- gery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity. Design. Retrospective cohort study, 1998-2002. Setting. Tertiary care, university-affiliated hospital in Hawaii. Study participants. 1811 adults (1085

REBECCA P. GELBER; TODD B. SETO

2006-01-01

385

Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation  

PubMed Central

AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation. METHODS: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure. RESULTS: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications. CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation. PMID:24009817

Kettering, Klaus; Gramley, Felix

2013-01-01

386

Tunneling and Suture of Thoracic Epidural Catheters Decrease the Incidence of Catheter Dislodgement  

PubMed Central

Background. Dislocation of epidural catheters (EC) is associated with early termination of regional analgesia and rare complications like epidural bleeding. We tested the hypothesis that maximum effort in fixation by tunneling and suture decreases the incidence of catheter dislocation. Methods. Patients scheduled for major surgery (n = 121) were prospectively randomized in 2 groups. Thoracic EC were subcutaneously tunneled and sutured (tunneled) or fixed with adhesive tape (taped). The difference of EC length at skin surface level immediately after insertion and before removal was determined and the absolute values were averaged. Postoperative pain was evaluated by numeric rating scale twice daily and EC tips were screened microbiologically after removal. Results. Both groups did not differ with respect to treatment duration (tunneled: 109 hours ±46, taped: 97 ± 37) and postoperative pain scores. Tunneling significantly reduced average extent (tunneled: 3?mm ±7, taped: 10 ± 18) and incidence of clinically relevant EC dislocation (>20?mm, tunneled: 1/60, taped: 9/61). Bacterial contamination showed a tendency to be lower in patients with tunneled catheters (8/59, taped: 14/54, P = 0.08). Conclusion. Thorough fixation of EC by tunneling and suturing decreases the incidence and extent of dislocation and potentially even that of bacterial contamination. PMID:25140337

Schmitz, Andrea; Weiss, Martin; Rabenalt, Stefanie; MacKenzie, Colin

2014-01-01

387

Distributed parameter statics of magnetic catheters.  

PubMed

We discuss how to use special Cosserat rod theory for deriving distributed-parameter static equilibrium equations of magnetic catheters. These medical devices are used for minimally-invasive diagnostic and therapeutic procedures and can be operated remotely or controlled by automated algorithms. The magnetic material can be lumped in rigid segments or distributed in flexible segments. The position vector of the cross-section centroid and quaternion representation of an orthonormal triad are selected as DOF. The strain energy for transversely isotropic, hyperelastic rods is augmented with the mechanical potential energy of the magnetic field and a penalty term to enforce the quaternion unity constraint. Numerical solution is found by 1D finite elements. Material properties of polymer tubes in extension, bending and twist are determined by mechanical and magnetic experiments. Software experiments with commercial FEM software indicate that the computational effort with the proposed method is at least one order of magnitude less than standard 3D FEM. PMID:22256282

Tunay, Ilker

2011-01-01

388

Initial characterization of Ikari Guide catheter for transradial coronary intervention.  

PubMed

Ikari is a new guide catheter for transradial intervention (TRI) that produces stronger back-up force by utilizing an unfavorable angle between the subclavian and brachiocephalic arteries. We report the initial results of the Ikari guide catheter based on the experience of a single center. Six operators performed a total of 102 coronary interventions for 91 patients using the Ikari guide catheter, while 101 interventions were performed with the transfemoral approach (TFI) during the same period. A left Ikari catheter was used in 63 procedures, and a right Ikari catheter was used in 39. The success rate for the procedure was 97% with a 6 French Ikari catheter. All failures were due to tortuous brachiocephalic arteries. For the Ikari procedure, the average fluorescence time was 14.5 9.5 minutes and the dye volume used was 153 53 ml; these results were equal to or better than those of TFI during the same period (20.1 12.2 minutes and 184 61 ml, respectively). These preliminary data suggest that an acceptable success rate can be achieved in TRI using appropriate guides, such as an Ikari catheter. PMID:14760193

Ikari, Yuji; Nakajima, Hiroyoshi; Iijima, Raisuke; Aoki, Jiro; Tanabe, Kengo; Nakayama, Tomohiro; Miyazawa, Akiyoshi; Hatori, Mitsuharu; Kyouno, Hiroyuki; Tanimoto, Shuzou; Amiya, Eisuke; Nakazawa, Gaku; Onuma, Yoshinobu; Hara, Kazuhiro

2004-02-01

389

Designing and testing of backflow-free catheters.  

PubMed

Convection-enhanced delivery (CED) is a drug delivery technique used to target specific regions of the central nervous system (CNS) for the treatment of neurodegenerative diseases and cancer while bypassing the blood-brain barrier (BBB). The application of CED is limited by low volumetric flow rate infusions in order to prevent the possibility of backflow. Consequently, a small convective flow produces poor drug distribution inside the treatment region, which can render CED treatment ineffective. Novel catheter designs and CED protocols are needed in order to improve the drug distribution inside the treatment region and prevent backflow. In order to develop novel backflow-free catheter designs, the impact of the micro-fluid injection into deformable porous media was investigated experimentally as well as numerically. Fluid injection into the porous media has a considerable effect on local transport properties such as porosity and hydraulic conductivity because of the local media deformation. These phenomena not only alter the bulk flow velocity distribution of the micro-fluid flow due to the changing porosity, but significantly modify the flow direction, and even the volumetric flow distribution, due to induced local hydraulic conductivity anisotropy. These findings help us to design backflow-free catheters with safe volumetric flow rates up to 10 ?l/min. A first catheter design reduces porous media deformation in order to improve catheter performance and control an agent volumetric distribution. A second design prevents the backflow by reducing the porosity and hydraulic conductivity along a catheter's shaft. A third synergistic catheter design is a combination of two previous designs. Novel channel-inducing and dual-action catheters, as well as a synergistic catheter, were successfully tested without the occurrence of backflow and are recommended for future animal experiments. PMID:21744923

Ivanchenko, O; Ivanchenko, V

2011-06-01

390

Antibiofilm surface functionalization of catheters by magnesium fluoride nanoparticles  

PubMed Central

The ability of bacteria to colonize catheters is a major cause of infection. In the current study, catheters were surface-modified with MgF2 nanoparticles (NPs) using a sonochemical synthesis protocol described previously. The one-step synthesis and coating procedure yielded a homogenous MgF2 NP layer on both the inside and outside of the catheter, as analyzed by high resolution scanning electron microscopy and energy dispersive spectroscopy. The coating thickness varied from approximately 750 nm to 1000 nm on the inner walls and from approximately 450 nm to approximately 580 nm for the outer wall. The coating consisted of spherical MgF2 NPs with an average diameter of approximately 25 nm. These MgF2 NP-modified catheters were investigated for their ability to restrict bacterial biofilm formation. Two bacterial strains most commonly associated with catheter infections, Escherichia coli and Staphylococcus aureus, were cultured in tryptic soy broth, artificial urine and human plasma on the modified catheters. The MgF2 NP-coated catheters were able to significantly reduce bacterial colonization for a period of 1 week compared to the uncoated control. Finally, the potential cytotoxicity of MgF2 NPs was also evaluated using human and mammalian cell lines and no significant reduction in the mitochondrial metabolism was observed. Taken together, our results indicate that the surface modification of catheters with MgF2 NPs can be effective in preventing bacterial colonization and can provide catheters with long-lasting self-sterilizing properties. PMID:22419866

Lellouche, Jonathan; Friedman, Alexandra; Lahmi, Roxanne; Gedanken, Aharon; Banin, Ehud

2012-01-01

391

Reducing Inappropriate Urinary Catheter Use: A Statewide Effort  

PubMed Central

Background Indwelling urinary catheters may lead to both infectious and non-infectious complications and are often used in the hospital setting without an appropriate indication. The objective of this study was to evaluate the results of a statewide quality improvement effort to reduce inappropriate urinary catheter use. Methods Retrospective analysis of data collected between 2007 and 2010 as part of a statewide collaborative initiative before, during, and after an educational intervention-promoting adherence to appropriate urinary catheter indications. The data was collected from 163 inpatient units in 71 participating Michigan hospitals. The intervention consisted of engaging clinicians about the appropriate indications for urinary catheter use and promoting the daily assessment of urinary catheter necessity during daily nursing rounds. The main outcome measures were change in prevalence of urinary catheter use and adherence with appropriate indications. We used flexible generalized estimating equation (GEE) and multilevel methodology to estimate rates over time while accounting for the clustering of patients within hospital units. Results The urinary catheter utilization rate decreased from 18.1% (95% CI: 16.8–19.6) at baseline to 13.8% (95% CI: 12.9–14.8) at end of year 2 (p <0.001). The proportion of catheterized patients with appropriate indications increased from 44.3% (95% CI: 40.3–48.4) to 57.6% (95% CI: 51.7–63.4) by the end of year 2 (p = 0.005). Conclusions A statewide effort to reduce inappropriate urinary catheter utilization was associated with a significant reduction in catheter use and improved compliance with appropriate use. The effect of the intervention was sustained for at least 2 years. Word count: 249 PMID:22231611

Fakih, Mohamad G.; Watson, Sam R; Greene, M. Todd; Kennedy, Edward H.; Olmsted, Russell N.; Krein, Sarah L.; Saint, Sanjay

2013-01-01

392

Arterial and venous blood gas analyses.  

PubMed

Arterial and venous blood gases provide useful information regarding pulmonary function as well as acid-base balance. The goal of this article is to discuss the collection of blood gases, common errors in analysis, and what information can be gleaned from a blood gas analysis. PMID:24182995

Rieser, Teresa M

2013-08-01

393

[Portal pulmonary venous anastomosis and portal hypertension].  

PubMed

The authors report two cases of portopulmonary anastomosis to show the value of multidetector CT with MPR MIP reformations in the diagnosis of portopulmonary venous anastomosis. This diagnosis has consequences in the treatement of hypoxemia in patients with chronic liver disease and embolization of bleeding esophageal varices in these patients. PMID:12469015

Masi, L; André, A; Rémy-Jardin, M; Rémy, J

2002-11-01

394

Venous congestive myelopathy: a mimic of neoplasia  

Microsoft Academic Search

Venous congestive myelopathy is a progressive disorder frequently associated with arteriovenous fistulas, usually dural. By causing diffuse spinal cord enlargement and enhancement on imaging, it may simulate a neoplasm and prompt a biopsy. We evaluated the biopsy findings in seven such patients (M=5, F=2, mean age 59±11 years) who presented variably with progressive lower extremity weakness (86%), bowel and bladder

Fausto J Rodriguez; Brian A Crum; William E Krauss; Bernd W Scheithauer; Caterina Giannini

2005-01-01

395

Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure  

SciTech Connect

Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

Burton, Kirsteen R. [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada); Guo, Lancia L. Q. [University of Calgary, Department of Radiology (Canada); Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.on.ca [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada)

2012-12-15

396

Novel Balloon Catheter Technologies for Pulmonary Vein\\/Antrum Isolation  

Microsoft Academic Search

\\u000a We describe novel balloon catheter technologies for pulmonary vein (PV)\\/antrum isolation using three different energy sources\\u000a (high-intensity focused ultrasound, laser energy and cryothermia). 1) A High-intensity focused ultrasound (HIFU) balloon catheter\\u000a is designed to focus HIFU energy circumferentially outside the PV (PV antrum). The catheter has two non-compliant balloons\\u000a and a 9MHz ultrasound crystal is located with the distal bal

Hiroshi Nakagawa; Katsuaki Yokoyama; Hiroshi Aoyama; Sara Foresti; Jan V. Pitha; Ralph Lazzara; Andrea Natale; Warren M. Jackman

397

Ion beam sputter-etched ventricular catheter for hydrocephalus shunt  

NASA Technical Reports Server (NTRS)

A cerebrospinal fluid shunt in the form of a ventricular catheter for controlling the condition of hydrocephalus by relieving the excessive cerebrospinal fluid pressure is described. A method for fabrication of the catheter and shunting the cerebral fluid from the cerebral ventricles to other areas of the body is also considered. Shunt flow failure occurs if the ventricle collapse due to improper valve function causing overdrainage. The ventricular catheter comprises a multiplicity of inlet microtubules. Each microtubule has both a large openings at its inlet end and a multiplicity of microscopic openings along its lateral surfaces.

Banks, B. A. (inventor)

1983-01-01

398

Epidural catheter design: history, innovations, and clinical implications.  

PubMed

Epidural catheters have evolved during the past several decades, as clinicians and manufacturers have sought to influence the quality of analgesia and anesthesia and reduce the incidence of catheter-related complications. This evolution has allowed a transformation from single-shot to continuous-infusion techniques and resulted in easier passage into the epidural space, more extensive medication distribution, and ultimately, improved patient satisfaction. Particular catheter features, including the materials used, tip design, and orifice number and arrangement, have been associated with specific outcomes and provide direction for future development. PMID:24681579

Toledano, Roulhac D; Tsen, Lawrence C

2014-07-01

399

Real time conductance catheter system based on FPGA.  

PubMed

This paper presents a digital conductance catheter system based on FPGA (Field Programmable Gate Arrays) to measure real time ventricular volumes for experimental use. The system performance is realized in three stages: a) conductance measurements using a well-known set of resistance connected to each catheter section; b) volumes measurements in glass containers of well-known geometry that contain a solution with a resistivity similar to the blood, and c) comparison between the previous analog conductance catheter system and this novel FPGA based system. PMID:21096437

Gómez López, María de Los A; Olivera, Juan M; Herrera, Myriam C

2010-01-01

400

Efficient, Long-term Hepatic Gene Transfer Using Clinically Relevant HDAd Doses by Balloon Occlusion Catheter Delivery in Nonhuman Primates  

PubMed Central

Helper-dependent adenoviral vectors (HDAd) are devoid of all viral coding sequences and are thus an improvement over early generation Ad because they can provide long-term transgene expression in vivo without chronic toxicity. However, high vector doses are required to achieve efficient hepatic transduction by systemic intravenous injection, and this unfortunately results in dose-dependent acute toxicity. To overcome this important obstacle, we have developed a minimally invasive method to preferentially deliver HDAd into the liver of nonhuman primates. Briefly, a balloon occlusion catheter was percutaneously positioned in the inferior vena cava to occlude hepatic venous outflow. HDAd was injected directly into the occluded liver via a percutaneously placed hepatic artery catheter. Compared to systemic vector injection, this approach resulted in substantially higher hepatic transduction efficiency using clinically relevant low vector doses and was accompanied by mild-to-moderate acute but transient toxicities. Transgene expression was sustained for up to 964 days. These results suggest that our minimally invasive method of delivery can significantly improve the vector's therapeutic index and may be a first step toward clinical application of HDAd for liver-directed gene therapy. PMID:19050700

Brunetti-Pierri, Nicola; Stapleton, Gary E; Law, Mark; Breinholt, John; Palmer, Donna J; Zuo, Yu; Grove, Nathan C; Finegold, Milton J; Rice, Karen; Beaudet, Arthur L; Mullins, Charles E; Ng, Philip

2008-01-01

401

The post-occipital spinal venous sinus of the Nile crocodile Crocodylus niloticus: its anatomy and use for blood sample collection and intravenous infusions.  

PubMed

The post-occipital sinus of the spinal vein is often used for the collection of blood samples from crocodilians. Although this sampling method has been reported for several crocodilian species, the technique and associated anatomy has not been described in detail in any crocodilian, including the Nile crocodile (Crocodylus niloticus). The anatomy of the cranial neck region was investigated macroscopically, microscopically, radiographically and by means of computed tomography. Latex was injected into the spinal vein and spinal venous sinus of crocodiles to visualise the regional vasculature. The spinal vein ran within the vertebral canal, dorsal to and closely associated with the spinal cord and changed into a venous sinus cranially in the post-occipital region. For blood collection, the spinal venous sinus was accessed through the interarcuate space between the atlas and axis (C1 and C2) by inserting a needle angled just off the perpendicular in the midline through the craniodorsal cervical skin, just cranial to the cranial borders of the first cervical osteoderms. The most convenient method of blood collection was with a syringe and hypodermic needle. In addition, the suitability of the spinal venous sinus for intravenous injections and infusions in live crocodiles was evaluated. The internal diameter of the commercial human epidural catheters used during these investigations was relatively small, resulting in very slow infusion rates. Care should be taken not to puncture the spinal cord or to lacerate the blood vessel wall using this route for blood collection or intravenous infusions. PMID:24831995

Myburgh, Jan G; Kirberger, Robert M; Steyl, Johan C A; Soley, John T; Booyse, Dirk G; Huchzermeyer, Fritz W; Lowers, Russel H; Guillette, Louis J

2014-01-01

402

Partial aortic occlusion and cerebral venous steal: venous effects of arterial manipulation in acute stroke.  

PubMed

Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and "luxury perfusion" in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifested by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution analogous to positive end-expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs. PMID:21441149

Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S

2011-05-01

403

High-sensitivity detection and monitoring of microcirculation using cutaneous and catheter probes for Doppler optical coherence tomography  

NASA Astrophysics Data System (ADS)

Background: Currently clinical Doppler ultrasound cannot detect microvascular blood flow and it is difficult to provide depth discrimination using laser Doppler flowmetry. Doppler optical coherence tomography (DOCT) is a novel technique for noninvasive subsurface imaging of microcirculation and tissue structure. Aims: To design handheld and catheter-based DOCT probes for clinical cutaneous and endoscopic imaging. To develop signal processing techniques for real-time detection and quantification of microvascular blood flow. Methods: A DOCT system, with interchangeable cutaneous and catheter probes, was developed. The axial spatial resolution was 10 ?m, and the velocity resolution was 20 ?m/s, using a 1300 nm broadband infrared light. The system achieved real-time imaging with frame rates up to 32 Hz at 512 x 256 pixels per frame. We used the system to detect microcirculation in human skin and rat esophagus, and to monitor microvascular responses to photodynamic therapy (PDT) in a rat tumor model. Results: We present experimental results from in vivo DOCT imaging of microcirculation in human skin arterio-venous malformations (AVM), normal rat esophagus, and a rat gliosarcoma PDT model. In the PDT model, we followed microvascular responses to PDT and observed differences in the microcirculation during and after therapy, which can have important implications for PDT dosimetry and treatment optimization. Conclusions: To our knowledge, this is the first demonstration of endoscopic catheter-based DOCT detection of microcirculation in vivo. In addition, AVM can be detected using handheld cutaneous DOCT probes under clinical settings. DOCT may serve as a real-time monitoring tool for PDT dosimetry, especially for vascular targeting photosensitizers.

Yang, Victor X.; Gordon, M. L.; Qi, B.; Yue, E. Seng; Tang, S.; Bisland, Stuart K.; Pekar, J.; Lo, S.; Marcon, Norman E.; Wilson, B.; Vitkin, Alex

2003-07-01

404

Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER)  

PubMed Central

Aims Although acute venous thrombo-embolism (VTE) often afflicts patients with advanced age, the predictors of in-hospital mortality for elderly VTE patients are unknown. Methods and results Among 1247 consecutive patients with acute VTE from the prospective SWIss Venous ThromboEmbolism Registry (SWIVTER), 644 (52%) were elderly (?65 years of age). In comparison to younger patients, the elderly more often had pulmonary embolism (PE) (60 vs. 42%; P< 0.001), cancer (30 vs. 20%; P< 0.001), chronic lung disease (14 vs. 8%; P= 0.001), and congestive heart failure (12 vs. 2%; P< 0.001). Elderly VTE patients were more often hospitalized (75 vs. 52%; P< 0.001), and there was no difference in the use of thrombolysis, catheter intervention, or surgical embolectomy between the elderly and younger PE patients (5 vs. 6%; P= 0.54), despite a trend towards a higher rate of massive PE in the elderly (8 vs. 4%; P= 0.07). The overall in-hospital mortality rate was 6.6% in the elderly vs. 3.2% in the younger VTE patients (P= 0.033). Cancer was associated with in-hospital death both in the elderly [hazard ratio (HR) 4.91, 95% confidence interval (CI) 2.32–10.38; P< 0.001] and in the younger patients (HR 4.90, 95% CI 1.37–17.59; P= 0.015); massive PE was a predictor of in-hospital death in the elderly only (HR 3.77, 95% CI 1.63–8.74; P= 0.002). Conclusion Elderly patients had more serious VTE than younger patients, and massive PE was particularly life-threatening in the elderly. PMID:22036872

Spirk, David; Husmann, Marc; Hayoz, Daniel; Baldi, Thomas; Frauchiger, Beat; Engelberger, Rolf; Amann-Vesti, Beatrice; Baumgartner, Iris; Kucher, Nils

2012-01-01

405

Use of intermediate guide catheters as an adjunct in extracranial embolization to avoid onyx reflux into the anastomotic vasculature. A technical note.  

PubMed

Onyx is a non-adhesive polymer used for embolization of arteriovenous malformations and dural arteriovenous fistulas (DAVFs). The limiting factor for Onyx embolization is usually the amount of microcatheter reflux, which can be safely tolerated. The dual microcatheter technique, compliant balloon use proximally and the use of the dual lumen Scepter balloon have been described to prevent and limit proximal Onyx reflux. We describe the use the Navien 058 intermediate guide catheter to accept the Onyx reflux in its lumen and possibly also serve as a mechanical barrier to avoid reflux into the anastomotic channel connecting the occipital artery to the vertebral artery during DAVF embolization via the occipital artery. Complete embolization of the DAVF was achieved using the lumen of the Navien catheter to accept aggressive Onyx reflux. Complete cure of the DAVF was obtained with Onyx cast filling the entire venous pouch. Besides providing distal access support, intermediate guide catheters can also prevent embolic material reflux by accepting reflux into the lumen and providing a mechanical barrier. PMID:25207904

Puri, Ajit S; Kühn, Anna L; Hou, Samuel Y; Wakhloo, Ajay K

2014-01-01

406

Catheter selection for ablation of the cavotricuspid isthmus for treatment of typical atrial flutter  

Microsoft Academic Search

Radiofrequency catheter ablation (RFA) represents the first line therapy of the cavotricuspid isthmus-dependent atrial flutter\\u000a (CTI-AFL) with a high efficacy and low secondary effects. RFA of CTI-dependent AFL can be performed by using various types\\u000a of ablation catheters. Recent evaluations comparing externally cooled tip RFA (ecRFA) catheters and large-tip (8 mm) catheters\\u000a have revealed that these catheters have a higher efficacy

Antoine Da Costa; Yann Jamon; Cécile Romeyer-Bouchard; Jérôme Thévenin; Marc Messier; Karl Isaaz

2006-01-01

407

Randomized comparison of split tip versus step tip high-flow hemodialysis catheters  

Microsoft Academic Search

Randomized comparison of split tip versus step tip high-flow hemodialysis catheters.BackgroundOur purpose was to compare the function and complications of two high-flow polyurethane hemodialysis catheters.MethodsThis prospective, randomized trial compared the Ash-Split (MedComp) and Opti-Flow (Bard Access Systems) catheters. All patients referred for tunneled hemodialysis catheter placement were offered entry in the study, provided they met inclusion criteria. Catheters were placed

Scott O Trerotola; Michael Kraus; Himanshu Shah; Jan Namyslowski; Matthew S Johnson; Michael S Stecker; Iftikhar Ahmad; Gordon Mclennan; Nilesh H Patel; Elaine O'Brien; Walter T Ambrosius

2002-01-01

408

21 CFR 876.5010 - Biliary catheter and accessories.  

Code of Federal Regulations, 2010 CFR

... A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic...

2010-04-01

409

Effects of urinary catheter education for patients undergoing prostatectomy.  

PubMed

In a nonrandomized prospective study, significant decreases in patient anxiety with home urinary catheter management and in length of stay were reported when patients attended the preoperative prostatectomy class with standard postoperative education versus standard postoperative education. PMID:24592522

Inman, Diane M; Jacobson, Therese M; Maxson, Pamela M; Wang, Huey; Lohse, Christine M

2013-01-01

410

21 CFR 882.5150 - Intravascular occluding catheter.  

Code of Federal Regulations, 2010 CFR

...catheter with an inflatable or detachable balloon tip that is used to block a blood vessel to treat malformations, e.g., aneurysms (balloonlike sacs formed on blood vessels) of intracranial blood vessels. (b) Classification. Class III...

2010-04-01

411

21 CFR 882.5150 - Intravascular occluding catheter.  

...catheter with an inflatable or detachable balloon tip that is used to block a blood vessel to treat malformations, e.g., aneurysms (balloonlike sacs formed on blood vessels) of intracranial blood vessels. (b) Classification. Class III...

2014-04-01

412

21 CFR 882.5150 - Intravascular occluding catheter.  

Code of Federal Regulations, 2013 CFR

...catheter with an inflatable or detachable balloon tip that is used to block a blood vessel to treat malformations, e.g., aneurysms (balloonlike sacs formed on blood vessels) of intracranial blood vessels. (b) Classification. Class III...

2013-04-01

413

21 CFR 882.5150 - Intravascular occluding catheter.  

Code of Federal Regulations, 2011 CFR

...catheter with an inflatable or detachable balloon tip that is used to block a blood vessel to treat malformations, e.g., aneurysms (balloonlike sacs formed on blood vessels) of intracranial blood vessels. (b) Classification. Class III...

2011-04-01

414

21 CFR 882.5150 - Intravascular occluding catheter.  

Code of Federal Regulations, 2012 CFR

...catheter with an inflatable or detachable balloon tip that is used to block a blood vessel to treat malformations, e.g., aneurysms (balloonlike sacs formed on blood vessels) of intracranial blood vessels. (b) Classification. Class III...

2012-04-01

415

Electrophysiological Study and Catheter Ablation with 3D Mapping  

MedlinePLUS

... many of the techniques and many of the technology used to perform these procedures. Dr. Interian? 00: ... area of the atrial flutter circuit. Now, the technology for these catheters has advanced tremendously over the ...

416

Urinary catheter with polyurethane coating modified by ion implantation  

NASA Astrophysics Data System (ADS)

A low friction urinary catheter that could be used without a lubricant is proposed in this work. A polyurethane coating was synthesised on the surface of a metal guide wire catheter. Ion implantation was applied to surface modify the polyurethane coating. FTIR ATR, wetting angle, AFM and friction tests were used for analysis. Low friction was found to be provided by the formation of a hard carbonised layer on the polyurethane surface.

Kondyurina, I.; Nechitailo, G. S.; Svistkov, A. L.; Kondyurin, A.; Bilek, M.

2015-01-01

417

Catheter closure of the arterial duct in preterm infants  

PubMed Central

Background When medical treatment of a symptomatic arterial duct in a preterm infant fails, management is surgical. Patients and Methods 10 preterm neonates referred to a tertiary cardiac centre for treatment of a symptomatic patent arterial duct who underwent cardiac catheterisation with the intention of device closure. Results Successful catheter device closure of the arterial duct in nine preterm infants is described. Conclusion In selected cases, catheter device closure may offer an alternative to thoracotomy and surgical ligation. PMID:16920755

Roberts, Philip; Adwani, Satish; Archer, Nick; Wilson, Neil

2007-01-01

418

Topical honey: for bears, not for ICU catheters?  

PubMed Central

Catheters are most often colonized and become infected via the skin and their external surfaces in the ICU. Therefore, topical antimicrobials, including medical honey, placed at the insertion site should decrease skin colonization and catheter infections. This commentary reviews the main studies on, and the possible reasons of, topical antimicrobial failure in ICUs compared to the reported efficacy of chlorhexidine-impregnated dressings. PMID:23320929

2013-01-01

419

[Calcification of a double-J ureteral catheter].  

PubMed

Two cases of stone formation on double J ureteral catheter are described. Resolution was achieved by ESWL in one and by simple endoscopic removal in the other case with calcification in the distal J. The appearance of calcareous encrustation is frequent and depends on various factors especially the length of time the catheter is left indwelling, urinary stasis and infection. The efficacy of extracorporeal lithotripsy in resolving this complication is discussed. PMID:1772283

Regué Aldosa, R M; Prats López, J; Serrate Aguilera, R G

1991-01-01

420

Evaluation of the catheter positioning for neurally adjusted ventilatory assist  

Microsoft Academic Search

Purpose  During neurally adjusted ventilatory assist (NAVA) the ventilator is driven by the patients electrical activation of the diaphragm\\u000a (EAdi), detected by a special esophageal catheter. A reliable positioning of the EAdi-catheter is mandatory to trace a representative\\u000a EAdi signal. We aimed to determine whether a formula that is based on the measurement from nose to ear lobe to xiphoid process

Jürgen Barwing; Markus Ambold; Nadine Linden; Michael Quintel; Onnen Moerer

2009-01-01

421

Cryo-balloon catheter localization in fluoroscopic images  

NASA Astrophysics Data System (ADS)

Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

2013-03-01

422

New materials and devices for preventing catheter-related infections  

PubMed Central

Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies. PMID:21906266

2011-01-01

423

Post-procedural evaluation of catheter contact force characteristics  

NASA Astrophysics Data System (ADS)

Minimally invasive catheter ablation of electric foci, performed in electrophysiology labs, is an attractive treatment option for atrial fibrillation (AF) - in particular if drug therapy is no longer effective or tolerated. There are different strategies to eliminate the electric foci inducing the arrhythmia. Independent of the particular strategy, it is essential to place transmural lesions. The impact of catheter contact force on the generated lesion quality has been investigated recently, and first results are promising. There are different approaches to measure catheter-tissue contact. Besides traditional haptic feedback, there are new technologies either relying on catheter tip-to-tissue contact force or on local impedance measurements at the tip of the catheter. In this paper, we present a novel tool for post-procedural ablation point evaluation and visualization of contact force characteristics. Our method is based on localizing ablation points set during AF ablation procedures. The 3-D point positions are stored together with lesion specific catheter contact force (CF) values recorded during the ablation. The force records are mapped to the spatial 3-D positions, where the energy has been applied. The tracked positions of the ablation points can be further used to generate a 3-D mesh model of the left atrium (LA). Since our approach facilitates visualization of different force characteristics for post-procedural evaluation and verification, it has the potential to improve outcome by highlighting areas where lesion quality may be less than desired.

Koch, Martin; Brost, Alexander; Kiraly, Atilla; Strobel, Norbert; Hornegger, Joachim

2012-03-01

424

Role of biofilm in catheter-associated urinary tract infection  

PubMed Central

The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a “biofilm.” A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized. PMID:15153930

Trautner, Barbara W.; Darouiche, Rabih O.

2010-01-01

425

Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.  

PubMed

Intrathecal catheter placement into the lumbar cistern has varied indications, including drug delivery and CSF diversion. These Silastic catheters are elastic and durable; however, catheter-associated malfunctions are well reported in the literature. Fractured catheters are managed with some variability, but entirely intradural retained fragments are often managed conservatively with observation. The authors describe a case of a 70-year-old man with an implanted intrathecal morphine pump for failed back surgery syndrome who presented to an outside hospital with a history of headache, neck pain, nausea, and photophobia of 3 days' duration. He also described mild weakness and intermittent numbness of both legs. Unenhanced head CT demonstrated subarachnoid hemorrhage (SAH). A right C-5 hemilaminectomy was performed. This case is unique in that there was no indication that the lumbar intrathecal catheter had fractured prior to the patient's presentation with SAH. This case demonstrates that intrathecal catheter fragments are mobile and can precipitate intracranial morbidity. Extrication of known fragments is safe and should be attempted to prevent further neurosurgical morbidity. PMID:25360531

Hnenny, Luke; Sabry, Hatem A; Raskin, Jeffrey S; Liu, Jesse J; Roundy, Neil E; Dogan, Aclan

2015-01-01

426

Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?  

PubMed Central

Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and increase in transluminal pressure with large volume lesions. The secondary involvement of dural venous sinuses may represent a mechanism for refractory intracranial hypertension. PMID:24920987

Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

2014-01-01

427

Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study  

PubMed Central

Background There is no established noninvasive or invasive diagnostic imaging modality at present that can serve as a ‘gold standard’ or “benchmark” for the detection of the venous anomalies, indicative of chronic cerebrospinal venous insufficiency (CCSVI). We investigated the sensitivity and specificity of 2 invasive vs. 2 noninvasive imaging techniques for the detection of extracranial venous anomalies in the internal jugular veins (IJVs) and azygos vein/vertebral veins (VVs) in patients with multiple sclerosis (MS). Methods The data for this multimodal imaging comparison pilot study was collected in phase 2 of the “Prospective Randomized Endovascular therapy in Multiple Sclerosis” (PREMiSe) study using standardized imaging techniques. Thirty MS subjects were screened initially with Doppler sonography (DS), out of which 10 did not fulfill noninvasive screening procedure requirements on DS that consisted of ?2 venous hemodynamic extracranial criteria. Accordingly, 20 MS patients with relapsing MS were enrolled into the multimodal diagnostic imaging study. For magnetic resonance venography (MRV), IJVs abnormal findings were considered absent or pinpoint flow, whereas abnormal VVs flow was classified as absent. Abnormalities of the VVs were determined only using non-invasive testing. Catheter venography (CV) was considered abnormal when ?50% lumen restriction was detected, while intravascular ultrasound (IVUS) was considered abnormal when ?50% restriction of the lumen or intra-luminal defects or reduced pulsatility was found. Non-invasive and invasive imaging modality comparisons between left, right and total IJVs and between the VVs and azygos vein were performed. Because there is no reliable way of non-invasively assessing the azygos vein, the VVs abnormalities detected by the non-invasive testing were compared to the azygos abnormalities detected by the invasive testing. All image modalities were analyzed in a blinded manner by more than one viewer, upon which consensus was reached. The sensitivity and specificity were calculated using contingency tables denoting the presence or absence of vein-specific abnormality findings between all imaging modalities used individually as the benchmark. Results The sensitivity of CV?+?IVUS was 68.4% for the right and 90% for the left IJV and 85.7% for the azygos vein/VVs, compared to venous anomalies detected on DS. Compared to the venous anomalies detected on MRV, the sensitivity of CV?+?IVUS was 71.4% in right and 100% in left IJVs and 100% in the azygos vein/VVs; however, the specificity was 38.5%, 38.9% and 11.8%, respectively. The sensitivity between the two invasive imaging techniques, used as benchmarks, ranged from 72.7% for the right IJV to 90% for the azygos vein but the IVUS showed a higher rate of venous anomalies than the CV. There was excellent correspondence between identifying collateral veins on MRV and CV. Conclusions Noninvasive DS screening for the detection of venous anomalies indicative of CCSVI may be a reliable approach for identifying patients eligible for further multimodal invasive imaging testing of the IJVs. However, the noninvasive screening methods were inadequate to depict the total amount of azygos vein/VVs anomali