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Nursing care and Hickman's catheter: the search for evidence El cuidado de enfermeria y el catéter Hickman: la búquela de evidencias O cuidado de enfermagem e o cateter de Hickman: a busca de evidências  

Microsoft Academic Search

Background: Patients submitted to Bone Marrow Transplantation (BMT) need a safe venous access for the infusion of bone marrow. The implantation of a central venous catheter is a part of therapy, with Hickman's catheter as the most commonly used type; however, its presence entails risks, the most preoccupying of which is infection. Objective: Integrative literature review aimed to look for

Renata Cristina de Campos; Pereira Silveira; Cristina Maria Galvão



Microsoft Academic Search

UNI TERMO S: Ca te te r de Hi ck ma n -Br ovi a c. Equ i pe de en fe r ma ge m. Cu id a d o d e e n fer ma ge m. ABSTRACT. Caring the patient with Hickman-Broviac catheter: a case study. The authors make a shori literature review about the Hickman-Broviac catheter

Luciana Monteiro Mendes Martins; Alessandra Rocha Lima


Comparison of complication rates of Hickman(®) catheters versus peripherally inserted central catheters in patients with acute myeloid leukemia undergoing induction chemotherapy.  


Central venous access devices (CVADs) are used for intravenous therapy in patients with hematological malignancies. There are limited data comparing catheter outcomes in patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. A retrospective review comparing the incidence of early and late CVAD-associated complications and their effect on CVAD removal was performed in patients with AML undergoing induction chemotherapy between 2007 and 2011. Overall, 64 Hickman(®) catheters and 84 peripherally inserted central catheters (PICCs) were inserted. There was a trend toward increasing use of PICCs. The rate of CVAD occlusion was higher in PICCs compared to Hickman catheters (48.2% vs. 3.2%), for a rate of 20.43 vs. 1.25 per 1000 CVAD-days (p = 0.0001). There was no significant difference in the rates of CVAD-associated thrombosis, premature removal, blood stream infection (BSI) and CVAD-related BSI. Importantly, there was no significant difference in the rate of CVAD removal between Hickman catheters and PICCs for the duration that the CVADs were in place. The choice of type of CVAD inserted into patients with newly diagnosed AML will depend on ease of catheter placement, cost, perception of frequency and severity of complications, and clinician preference. PMID:23088670

Lim, Ming Y; Al-Kali, Aref; Ashrani, Aneel A; Begna, Kebede H; Elliott, Michelle A; Hogan, William J; Hook, C Christopher; Kaufmann, Scott H; Letendre, Louis; Litzow, Mark R; Patnaik, Mrinal S; Pardanani, Animesh; Tefferi, Ayalew; Wolanskyj, Alexandra P; Grill, Diane E; Pruthi, Rajiv K



Central venous catheter use  

Microsoft Academic Search

Central venous catheters (CVCs) are used with increasing frequency in the intensive care unit and in general medical wards. Catheter infection, the most frequent complication of CVC use, is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonisation and bloodstream infection include patient factors (increased risk associated with malignancy, neutropenia, and

K. H. Polderman; A. R. J. Girbes



Central venous catheter use  

Microsoft Academic Search

Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. This review will focus on short- and medium-term mechanical complications of catheter placement; infectious complications will be discussed in a separate article. The most important risk factors are patient characteristics (morbidity, underlying disease and local

Kees H. Polderman; Armand R. J. Girbes



Mycobacterium neoaurum infection of a Hickman catheter in an immunosuppressed patient.  


Mycobacterium neoaurum is a rapidly growing mycobacterium that has only once before been reported as a cause of bacteremia in an immunocompromised patient. We report on a patient who developed bacteremia after an allogeneic bone marrow transplantation and from whose blood (taken via a Hickman catheter) M. neoaurum was isolated on three separate occasions. There was a clinical response to therapy with ticarcillin/clavulanate and tobramycin, and the organism appeared to be susceptible to the former in vitro. The Hickman catheter was removed because of persistence of the organism in cultures of blood taken from the catheter. M. neoaurum may be a rare cause of infections in immunocompromised patients and should not be dismissed as an environmental contaminant. PMID:8086527

Holland, D J; Chen, S C; Chew, W W; Gilbert, G L



Use of central venous catheters for prolonged venous access in cancer chemotherapy.  


A preliminary experience in the use of central venous catheters, including Hickman (15), subclavian jugular (Desseret) (50) and Secalon Hydrocath (3), in cancer chemotherapy is presented. There were no technical complications and no mortality attributable to catheterisation. Infections formed the major complication in Hickman (30%) and subclavian jugular (Desseret) (36%) catheters, while the use of Secalon Hydrocath was event-free. The commonest organism isolated was P aeruginosa (60%), followed by staphylococci (30%). Prolonged venous access was achieved with minimum morbidity. It is concluded that central venous catheters are safe and convenient both for the patient and the treating team, and should be used in all patients undergoing protracted chemotherapy and supportive care. PMID:2387816

Rajoor, B G; Charak, B S; Banavali, S D; Iyer, R S; Saikia, T K; Gopal, R; Advani, S H



Right phrenic nerve palsy as a complication of indwelling central venous catheters  

Microsoft Academic Search

Five cases are reported of patients who developed a raised right hemidiaphragm while an indwelling central venous catheter was in situ. The patients were being treated with protracted venous infusions of chemotherapy for colorectal carcinoma. All five patients had a chest radiograph following insertion of the Hickman line which showed normal diaphragmatic positions. A mean of 93 days later (range

A. Rigg; P. Hughes; A. Lopez; J. Filshie; D. Cunningham; M. Green



Management of indwelling central venous catheters in pediatric cancer patients with fever and neutropenia.  


This prospective study comprises 97 episodes of fever and neutropenia in children with cancer and central venous access. In 76% of episodes, patients had a Broviac-Hickman-like catheter, and in 24% a totally implanted venous access chamber system. The need for catheter removal during a febrile infection was 0.32/1000 catheter days, and the documented sepsis rate was 0.59/1000 catheter days. Our data indicate that 94% of episodes of fever and neutropenia in total, 78% of documented septicemias, and 97% of fevers of unknown origin were curable with broad-coverage antimicrobial therapy without removing the central venous line. Totally implanted chambers had a lower infection rate than catheters of Broviac-Hickman type. PMID:8362233

Riikonen, P; Saarinen, U M; Lähteenoja, K M; Jalanko, H



Aromatherapy treatment for patients with Hickman line infection following high-dose chemotherapy  

Microsoft Academic Search

Eighty patients with breast cancer were treated with high-dose chemotherapy and stem cell rescue. This required that every patient had central venous access established using a Hickman catheter. N total of 16 patients suffered infection at the Hickman Line exit site, six of which were treated with an aromatherapy preparation and 10 with conventional topical antiseptic. No differences were demonstrated

Peter Gravett



Transfemoral Repositioning of Malpositioned Central Venous Catheters  

SciTech Connect

Purpose: To determine the efficacy of the transfemoral vein approach to repositioning malpositioned central venous catheters. Methods: During a 41/2-year period, malpositioned central venous catheters were repositioned 91 times in 83 patients via the transfemoral vein approach. All repositioning was initially attempted with a Grollman catheter or other pigtail catheter and a tip-deflecting wire. If these techniques failed or the venous anatomy was unfavorable, gooseneck or long loop snares were used. Results: During 48 repositionings, rotating a pigtail-type catheter alone was used successfully in 39 (81%). In 6 of 9 failures, the addition of a tip-deflecting wire also failed. A Grollman catheter and tip-deflecting wire were used initially in 39 repositionings (6 failures; 85% success). Successful repositioning required a snare in 8 (4 as the primary repositioning technique) and a long-loop technique in 5. All repositionings were ultimately successful and there were no complications. Conclusion: Central venous catheters can be repositioned consistently by the transfemoral route. Pigtail catheters or tip-deflecting wires alone are successful in over 80% of cases.

Hartnell, George Gordon; Gates, Julia; Suojanen, James Norman; Clouse, Melvin Eugene [Department of Radiological Sciences, Deaconess Hospital and Harvard Medical School, 1 Deaconess Road, Boston, MA 02215 (United States)



Central venous catheter related infections.  


Infusion therapy carries a substantial risk of producing iatrogenic sepsis, bacteremia or fungemia originating from the device used for vascular access or from the contaminated infusate. This study, a semiquantitative assay of the central venous catheter tips (CVC) was carried out and correlated with the blood culture results to determine the probable cause of sepsis in our post operated patients. One thousand six hundred and thirty one surgeries were performed in the Institute of Cardio-Vascular Diseases from January to December 1997. We received 150 CVC tips which were in place for more than five days for culture. Fifty one (51) CVC tips showed growth in either contents or roll. There was associated blood stream infection in 23 patients. The age groups of patients ranged from two months to 67 years and male to female ratio was 109:41. Children below the age of 12 years were 62 in number. Candida spp. (32.4%) and Staphylococcus spp. (33.9%) formed the predominant isolates from the CVC tips. PMID:10810578

Verghese, S; Padmaja, P; Sudha, P; Sorna, E; Johni, D; Vasu, S



Lymphatic Leak Complicating Central Venous Catheter Insertion  

Microsoft Academic Search

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

Alex M. Barnacle; Tricia M. Kleidon



Lymphatic Leak Complicating Central Venous Catheter Insertion  

SciTech Connect

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

Barnacle, Alex M., E-mail:; Kleidon, Tricia M. [Great Ormond Street Hospital for Children, Department of Radiology (United Kingdom)



Repositioning and Leaving In Situ the Central Venous Catheter During Percutaneous Treatment of Associated Superior Vena Cava Syndrome: A Report of Eight Cases  

SciTech Connect

Purpose: To describe a combined procedure of repositioning and leaving in situ a central venous catheter followed by immediate percutaneous treatment of associated superior vena cava syndrome (SVCS). Methods: Eight patients are presented who have central venous catheter-associated SVCS (n = 6 Hickman catheters, n = 2 Port-a-cath) caused by central vein stenosis (n = 4) or concomitant thrombosis (n = 4). With the use of a vascular snare introduced via the transcubital or transjugular approach, the tip of the central venous catheter could be engaged, and repositioned after deployment of a stent in the innominate or superior vena cava. Results: In all patients it was technically feasible to reposition the central venous catheter and treat the SVCS at the same time. In one patient flipping of the Hickman catheter in its original position provoked dislocation of the released Palmaz stent, which could be positioned in the right common iliac vein. Conclusion: Repositioning of a central venous catheter just before and after stent deployment in SVCS is technically feasible and a better alternative than preprocedural removal of the vascular access.

Stockx, Luc; Raat, Henricus [Department of Radiology, Catholic University of Leuven, University Hospitals, Herestraat 49, B-3000 Leuven (Belgium); Donck, Jan [Department of Nephrology, Catholic University of Leuven, University Hospitals, Herestraat 49, B-3000 Leuven (Belgium); Wilms, Guy; Marchal, Guy [Department of Radiology, Catholic University of Leuven, University Hospitals, Herestraat 49, B-3000 Leuven (Belgium)



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

SciTech Connect

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

McBride, Kieran D. [Royal Hallamshire Hospital NHS Trust, Department of Radiology (United Kingdom); Fisher, Ross [Royal Hallamshire Hospital NHS Trust, Department of Surgery (United Kingdom); Warnock, Neil [Royal Hallamshire Hospital NHS Trust, Department of Radiology (United Kingdom); Winfield, David A. [Royal Hallamshire Hospital NHS Trust, Department of Hematology (United Kingdom); Reed, Malcolm W. [Royal Hallamshire Hospital NHS Trust, Department of Surgery (United Kingdom); Gaines, Peter A. [Royal Hallamshire Hospital NHS Trust, Department of Radiology (United Kingdom)



Cardiac tamponade from central venous catheters  

Microsoft Academic Search

Background: This retrospective study was undertaken to determine the mechanism by which cardiac tamponade (CT) occurs after placement of central venous catheters (CVC), and to determine if physicians are aware of this potentially lethal complication.Materials and Methods: Twenty-five previously unreported cases of CT from CVC were reviewed. The chest radiographs and postmortem records were reviewed when available. Two hundred physicians

Paul E. Collier; Sterling H. Blocker; Daniel M. Graff; Peter Doyle



Central venous catheter infections: Concepts and controversies  

Microsoft Academic Search

Central venous catheters (CVCs) are widely used in critically ill patients in intensive care units. However, infectious complications are common and may limit their utility. We critically review the literature to determine the impact of CVC design amd composition, insertion site selection, insertion procedures, care and removal of temporary CVCs on infectious complications. Relevant articles were identified and selected for

C. R. Reed; C. N. Sessler; F. L. Glauser; B. A. Phelan



Central venous catheter-related Rhodotorula rubra fungemia.  


With the increased use of indwelling central venous catheters, increasing numbers of cases of Rhodotorula fungemia have been observed in patients with neoplasia and neutropenia. In most patients with catheter-related Rhodotorula fungemia, the condition has been treated with broadspectrum antibiotics. We report two cases of central venous catheter-related Rhodotorula rubra fungemia that occurred in patients with acute myeloblastic leukemia. Both patients were in a state of neutropenia. One patient was treated with amphotericin B and his central venous catheter was removed, but he died of Klebsiella pneumoniae bacteremia. The other patient was treated with amphotericin B and discharged, with a central venous catheter, after recovery from neutropenia. Although the management of catheter-related Rhodotorula fungemia infections remains controversial, resolution of the underlying disease is more important than catheter removal for recovery from Rhodotorula rubra fungemia. PMID:11957131

Chung, Jin-Won; Kim, Baek-Nam; Kim, Yang Soo



Complications and risks of central venous catheter placement in children  

Microsoft Academic Search

Background: Since Aubaniac's first description in 1952, the use of central venous catheters has increased dramatically; they are now considered commonplace. Placement of these catheters, however, has an associated risk of morbidity and mortality. In most cases, this risk is outweighed by the benefit gained, especially when long-term access to the central venous system is needed for multiple transfusions, chemotherapy,

Eric M. Johnson; Daniel A. Saltzman; Gina Suh; Rachel A. Dahms; Arnold S. Leonard



Central venous catheter-related Rhodotorula rubra fungemia  

Microsoft Academic Search

With the increased use of indwelling central venous catheters, increasing numbers of cases of Rhodotorula fungemia have been observed in patients with neoplasia and neutropenia. In most patients with catheter-related Rhodotorula fungemia, the condition has been treated with broadspectrum antibiotics. We report two cases of central venous catheter-related\\u000a Rhodotorula rubra fungemia that occurred in patients with acute myeloblastic leukemia. Both

J.-W. Chung; B.-N. Kim; Y. S. Kim



Extensive thrombosis of the caval venous system after central venous catheters in severely burned patients.  


Central venous thrombosis is a rare but extremely dangerous complication following central venous catheter placement. Two cases of massive central venous thrombosis in severely burned patients are reported. The clinical course, diagnostic problems and treatment options are described and discussed. From these cases we conclude that central venous catheter thrombosis should be included early in the differential diagnosis of trunk and extremity oedema in patients with indwelling central venous catheters and that thrombolytic therapy is safe and effective even in the severely burned patient. PMID:7546266

Germann, G; Kania, N M



Radiological Interventions for Correction of Central Venous Port Catheter Migrations  

SciTech Connect

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

Gebauer, Bernhard, E-mail:; Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland [Charite, Universitaetsmedizin-Berlin, Campus Virchow-Klinikum, Department of Radiology (Germany)



Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients  

Microsoft Academic Search

Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study

Wang-Huei Sheng; Wen-Je Ko; Jann-Tay Wang; Shan-Chwen Chang; Po-Ren Hsueh; Kwen-Tay Luh



Paradoxical air embolism following central venous catheter removal.  


Central venous catheters are commonly used in the management of critically ill patients. This case report described a rare but potentially fatal complication of central venous catheter use. A 52-year-old man underwent mechanical aortic valve replacement for infective endocarditis. On day 8 postoperatively he accidentally removed his catheter and collapsed with symptoms and signs suggestive of a cerebral air embolism. A transthoracic echocardiogram showed air bubbles in both the right and left ventricles of the heart confirming the presence of a paradoxical air embolism. PMID:24072837

Khan, Hiba; Zaidi, Afzal



Multilumen Central Venous Catheters Increase Risk for Catheter-Related Bloodstream Infection: Prospective Surveillance Study  

Microsoft Academic Search

Background: Catheter-related bloodstream infections (CRBSI) are a leading cause of nosocomial infections associated with significant mortality and costs. The objective of this study was to determine the rate of CRBSI in two large Swiss hospitals and to identify risk factors for this condition. Patients and Methods: During 1 year all central venous catheter (CVC)-inserted in patients admitted for visceral, orthopedic

A. Templeton; M. Schlegel; F. Fleisch; G. Rettenmund; B. Schöbi; S. Henz; G. Eich



[Retrograde cavernous sinus air embolism after central venous catheter removal].  


Air embolism is a rare, but occasionally fatal complication of peripheral and central venous catheterization. We present a case of an 89-year-old female, who had a central venous catheter placed in her right jugular vein during the perioperative period for right femoral subtrochanteric fracture. On the day following her operation, level of consciousness worsened a few minutes after the catheter was removed. CT scan showed air bubbles in bilateral cavernous sinuses and brachiocephalic vein. Administration of 100% oxygen was started, and she regained consciousness a few hours later, finally air bubbles disappeared on a CT scan performed 10 hours after onset. Air embolism should be taken into consideration when treating venous catheters, and appropriate O? administration and radiological examinations must be performed immediately if level of consciousness or vital signs deteriorate. PMID:23100388

Yamanaka, Takumi; Miyazaki, Yuko; Sato, Masaharu



Unanticipated complication of a malpositioned central venous catheter  

Microsoft Academic Search

We report an unusual complication that occurred late in the postoperative period, due to a damaged and malpositioned peripherally\\u000a inserted central catheter (PICC) used for central venous pressure monitoring during esophagocoloplasty and for postoperative\\u000a parenteral nutrition. On the seventh postoperative day, the development of a leak from the neck wound coincided with the administration\\u000a of intravenous fluids via the PICC.

Pankaj Kundra; Bathala V. Sai Chandran; Kasturi S. V. K. Subbarao



[Air embolism after removal of central venous catheter].  


Placement and removal of central venous catheters (CVC) are routine procedures in anesthesiology and on the intensive care unit. There are numerous possible complications associated with those interventions. Here, we report on a patient who developed respiratory failure immediately after removal of a CVC. The proof of air bubbles in echocardiography confirmed the diagnosis of air embolism. In this article we describe causes, symptoms and therapy of air embolism. PMID:23364821

Wild, Ursula; Defosse, Jerome M; Wappler, Frank; Sakka, Samir G



Novel approach to investigate a source of microbial contamination of central venous catheters  

Microsoft Academic Search

The potential route of contamination by skin microorganisms onto the distal tip of central venous catheters during insertion was investigated. Thirty patients undergoing cardiac surgery who required a central venous catheter (CVC) as part of their clinical management were studied. Following catheter placement, the device insertion equipment and the skin at the insertion site were sampled for microorganisms. The distal

T. S. J. Elliott; H. A. Moss; S. E. Tebbs; I. C. Wilson; R. S. Bonser; T. R. Graham; L. P. Burke; M. H. Faroqui



Pulmonary venous air embolism following accidental patient laceration of a hemodialysis catheter  

Microsoft Academic Search

As the number of patients at home with indwelling central venous catheters increases, more complications from their use will present to the emergency department. We report a case of pulmonary venous air embolism after a patient inadvertently severed the distal few centimeters of an indwelling central venous catheter.

Irene Y Tien; Michael J Drescher



Performance of Twin Central Venous Catheters: Influence of the Inversion of Inlet and Outlet on Recirculation  

Microsoft Academic Search

Background: The use of a central venous catheter as a permanent vascular access is constantly growing. The recirculation rate in this type of vascular access varies depending on the site of insertion, the length of the catheter, the blood flow and the time elapsed since catheter insertion. When the in\\/out flow of the lumens of the catheter is reduced, it

Catherine Lasseur; Philippe Chauveau; Hervé Bonarek; Luc Perrault; Christian Combe



Systematic review of emergency department central venous and arterial catheter infection  

Microsoft Academic Search

Background  There is an extensive critical care literature for central venous catheter and arterial line infection, duration of catheterization,\\u000a and compliance with infection control procedures. The emergency medicine literature, however, contains very little data on\\u000a central venous catheters and arterial lines. As emergency medicine practice continues to incorporate greater numbers of critical\\u000a care procedures such as central venous catheter placement, infection

Christopher H. LeMaster; Ashish T. Agrawal; Peter Hou; Jeremiah D. Schuur



Serial Surveillance Cultures of Skin and Catheter Hub Specimens from Critically Ill Patients with Central Venous Catheters: Molecular Epidemiology of Infection and Implications for Clinical Management and Research  

Microsoft Academic Search

A prospective study of 45 central venous catheters was conducted to assess, by strain delineation, the turnover of skin and catheter hub (superficial) colonization and the relative contributions of catheter hub and skin colonization to catheter tip colonization. Serial quantitative cultures of skin and catheter hub were performed. Catheter tip, blood, and specimens for culture from targeted superficial sites (TSSs)




Catheter-related bloodstream infections: a prospective observational study of central venous and arterial catheters.  


Abstract Background: Catheter-related bloodstream infections (CRBSIs) can lead to increased morbidity and length of stay (LOS) in the intensive care unit (ICU). The purpose of this study was to analyse the incidence of catheter-related bloodstream infection associated with central venous catheters (CVCs) and arterial catheters (ACs) and to identify risk factors for CRBSIs in our ICU. Methods: This was a prospective observational study in a 17-bed medical-surgical ICU of a 715-bed university hospital. Patients admitted to the ICU for ? 24 h between 1 September 2007 and 30 April 2008, who received a CVC or AC, were included in the study. Results: A total of 219 patients with 258 CVCs and 336 ACs were included in the study and observed for a combined total of 3172 catheter-days. The CRBSI incidence density was 1.2 per 1000 catheter-days for CVCs and 2.1 per 1000 catheter-days for ACs. The mean LOS (p = 0.003), the number of days a catheter remained in situ (p = 0.001), and the length of pre-ICU in-hospital stay (p = 0.031) were significantly higher in the CRBSI group. Risk factor analysis was not reliable due to the low number of CRBSIs. Conclusion: The incidence of AC- and CVC-related CRBSIs was comparable to the incidence reported in the literature. However, the incidence for ACs was higher than for CVCs. In addition to CVCs, ACs should be considered a possible cause of catheter-related infections and both should be replaced when CRBSI is suspected. PMID:23826790

Wittekamp, Bastiaan H; Chalabi, Myriam; van Mook, Walther N K A; Winkens, Bjorn; Verbon, Annelies; Bergmans, Dennis C J J



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


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

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



Cost-Effectiveness of a Central Venous Catheter Care Bundle  

PubMed Central

Background A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. Methods and Findings A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. Conclusions A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.

Halton, Kate A.; Cook, David; Paterson, David L.; Safdar, Nasia; Graves, Nicholas



Perforation by central venous catheters: a new testament to an old test.  


Perforation by central venous catheters into the extravascular space is a rare complication of central venous lines that may explain new onset shortness of breath in hospitalized patients. We found that lowering bottles containing infusate and looking for return of venous blood is a highly specific test for this problem. Using Bayes' Theorem we calculated that for prior probabilities of catheter perforation of 0.01 and 0.05, corresponding posterior probabilities ranged from 0.1 to 0.15 and 0.35 to 0.49 respectively. This test should be used in all patients with new shortness of breath who have central venous catheters. PMID:2761070

Malenka, D J; Ross, J M


Mini-review: Antimicrobial central venous catheters – recent advances and strategies  

Microsoft Academic Search

Central venous catheters (CVCs) nowadays constitute critical devices used in medical care, namely in intensive care units. However, CVCs also represent one of the indwelling medical devices with enhanced risk of nosocomial device-related infection. Catheter-related infections (CRIs) are a major cause of patient morbidity and mortality, often justifying premature catheter removal and an increase in costs and use of resources.

Cláudia Sousa; Mariana Henriques; Rosário Oliveira



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

SciTech Connect

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

Suojanen, James Norman; Brophy, David Paul; Nasser, Imad [Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215 (United States)



Acute mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter.  


Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. An 83-year-old man who had mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter is presented. The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery. PMID:22751374

Marín, Miguel Ruiz; Rodríguez, Maria Encarnación Tamayo; Buleje, Jorge Alejandro Benavides; Valverde, Francisco Miguel González; Martínez, Marcelino Méndez; Pérez, Patricia Pastor; Ruiz, María Vicente; Rodríguez, Ana Ruiz; Sales, Alejandro Puerta; Rodríguez, Pedro Marín; Blázquez, Antonio Albarracín Marín



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


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

Ash, Stephen R; Ugianskis, Erika J



Effective flow performances and dialysis doses delivered with permanent catheters: a 24-month comparative study of permanent catheters versus arterio-venous vascular accesses  

Microsoft Academic Search

Background. Permanent venous catheters have emerged as a long-term vascular access option for renal replacement therapy in end-stage renal disease patients. The design and venous location of catheter devices bear intrinsic flow limitations that may negatively affect the adequacy of dialysis and the patient outcome. There is limited data comparing the long-term dialysis adequacy delivered with permanent catheters vs arterio-venous

Bernard Canaud; Helene Leray-Moragues; Nadia Kerkeni; Jean-Yves Bosc; Katja Martin


The Vanishing Veins: Difficult Venous Access in a Patient Requiring Translumbar, Transhepatic, and Transcollateral Central Catheter Insertion  

PubMed Central

Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.

Yaacob, Yazmin; Zakaria, Rozman; Mohammad, Zahiah; Ralib, Ahmad Razali MD; Muda, Ahmad Sobri



The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications  

Microsoft Academic Search

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter,

H. Hirschmann; L. Fux; J. Podusel; K. Schindler; M. Kundi; M. Rotter



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


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



Percutaneous retrieval of a central venous catheter sutured to the wall of the right atrium.  


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. PMID:9929552

Neuerburg, J M; Günther, R W; Chalabi, K; Hunter, D



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)



Cardiac Arrhythmias During Central Venous Catheter Procedures in Acute Renal Failure: A Prospective ?2  

Microsoft Academic Search

To define the frequency and risk factors of cardiac arrhythmias during central venous catheter proce- dures in acute renal failure, continuous electrocardio- graphic monitoring with permanent recording was performed before and during 201 guidewire inser- tions in 171 patients requiring a central venous cath- eter for parenteral nutrition and\\/or dialysis access (121 procedures in 107 patients with acute renal failure;

Enrico Fiaccadori; Gianluca Gonzi; Paolo Zambrelli; Giovanni Tortorella


Pericardial tamponade secondary to perforation by central venous catheters in orthopaedic patients.  


Pericardial tamponade from an indwelling central venous catheter developed in four orthopaedic patients. Two of these patients died acutely, and the other two sustained severe anoxic brain injury. The early signs of tamponade include tachycardia, hypotension, and increased central venous pressure. The outcome most often is fatal. When a central venous catheter has been placed incorrectly or has migrated, it can perforate the heart and produce pericardial tamponade. To avoid this complication, the tip of the catheter must be placed within the superior vena cava rather than the right atrium, and the position of the catheter must be ascertained with a radiograph of the chest. Prompt recognition and treatment of pericardial tamponade are imperative if a disastrous outcome is to be prevented. PMID:1748699

Kalen, V; Medige, T A; Rinsky, L A



Comparison of bacterial colonization rates of antiseptic impregnated and pure polymer central venous catheters in the critically ill.  


A study was performed on critically ill patients to evaluate the rate of colonization and catheter-related sepsis using antiseptic bonded (Arrowguard Arrow International) versus smooth pure polymer (Infectguard MedexMedical Ltd) central venous catheters. Two hundred and thirty-two catheters were inserted into 181 patients. Indications for removal included local or systemic infection, the catheter was no longer required and patient death. No statistical difference in colonization rate was found between the two types of catheter. PMID:12473479

Theaker, C; Juste, R; Lucas, N; Tallboys, C; Azadian, B; Soni, N



Special article: retained guidewires after intraoperative placement of central venous catheters.  


Guidewire retention is a rare complication of central venous catheter placement, and has been related to operator fatigue, inexperience, and inattention, and inadequate supervision of trainees. The true incidence of guidewire loss after intraoperative placement of central venous catheters is unknown. We report 4 cases of guidewire loss after central venous access procedures performed by anesthesia providers in the operating room. Worsening of patients' clinical condition during catheter placement and complex procedures necessitating more than one guidewire insertion are recurring scenarios in cases involving guidewire loss. Over 6 years at our institution, intraoperative wire loss occurred at a rate of 1:3291 procedures (95% confidence interval of 1/10,000 to 8/10,000). PMID:22669345

Vannucci, Andrea; Jeffcoat, Alicia; Ifune, Catherine; Salinas, Christian; Duncan, James R; Wall, Michael



Internal jugular venous catheter-related bacteremia according to central and posterior accesses  

Microsoft Academic Search

Background  Although there are many studies about central venous catheter-related infection, we have not found any analysis of the incidence\\u000a of internal jugular venous catheter-related bacteremia associated with different accesses.\\u000a \\u000a \\u000a \\u000a Objective  The objective of this study was to test whether the position of the internal jugular venous catheter, central or posterior,\\u000a influences the incidence of bacteremia.\\u000a \\u000a \\u000a \\u000a Design  A cohort study.\\u000a \\u000a \\u000a \\u000a Setting  A 12-bed polyvalent medical–surgical intensive

Leonardo Lorente; Alejandro Jiménez; Juan Castedo; Ramón Galván; Carolina García; María M. Martín; María L. Mora



Leukemic dermal infiltrates as a complication of central venous catheter placement.  


A leukemic dermal infiltrate at the site of a central venous catheter placement was the first manifestation of relapse in a 58-year-old woman in clinical remission of acute myelomonocytic leukemia. The patient developed a large hematoma around the site of an unsuccessful attempt to place a central venous (CV) catheter. Although the hematoma resolved completely by the time that complete remission was achieved, an indurated, erythematous mass subsequently developed, which when biopsied revealed leukemic cells in the dermis. The patient had a relapse in her peripheral blood shortly thereafter. The authors reviewed recent literature and their own experience with CV catheters and report on localized dermal relapse as a previously unpublished risk of CV catheter placement. They also speculate on the role of the dermis as a sanctuary for leukemic cells and a potential source for relapsing disease. PMID:3179936

Amiraian, R; Penn, T E; Hamann, S; Asbury, R F; Boros, L; Markowitch, W; Goodman, T L



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


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

Khoo, A; Oziemski, P



Activity of antibacterial impregnated central venous catheters against Klebsiella pneumoniae  

Microsoft Academic Search

Objective: Antibiotically coated or impregnated catheters are effective in eliminating gram-positive bacteria from their surfaces. However, their activity against gram-negative bacteria is not well known. The aim of this study was to evaluate and compare the adherence, persistence and colonization of Klebsiella pneumoniae on catheter surfaces and also to assess bacteriostatic and bactericidal levels. Design: Randomized, controlled, laboratory study. Setting:

Kaya Yorganci; Candace Krepel; John A. Weigelt; Charles E. Edmiston



Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis  

Microsoft Academic Search

Background. The indwelling venous catheter such as Dual-Cath1 or Twin-Cath1 is widely used in haemo- dialysis. Although the manufacturer recommends fill- ing the catheter lumen with heparin after the dialysis session to prevent clotting, little is known about the systemic effects of such a procedure. Methods. Twenty haemodialysis patients with Dual- Cath1 were studied. Dialysis anticoagulation was achieved by injecting

Huseyin Karaaslan; Pierre Peyronnet; Daniel Benevent; Christian Lagarde; Michel Rince; Claude Leroux-Robert


Risk factors for central venous catheter-related bloodstream infection: a 1073-patient study  

Microsoft Academic Search

We intended to evaluate the risk factors for catheter-related bloodstream infection (CR-BSI) with central venous (CV) catheters.\\u000a For the hub of the CV line, we used three-way stopcocks in the first year of the study and closed needleless connectors (NCs)\\u000a in the second year. Background factors included the age and sex of patients; the ward; the specialty service; the CV

Junichi Yoshida; Toshiyuki Ishimaru; Michiko Fujimoto; Noriko Hirata; Nobuo Matsubara; Nobuhiro Koyanagi



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.

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



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

PubMed Central

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



Feasibility of the use of a reliable and valid central venous catheter blood draw bundle checklist.  


The primary objective of this study was to test the feasibility of creating a central venous catheter blood draw bundle checklist to ensure adherence to the evidence-based blood draw procedure. This study included establishing checklist reliability and validity and periodic observations in 2 inpatient pediatric oncology units. The findings provided support for the reliability and validity of this checklist based on content validity, test-retest reliability, interrater agreement, and internal consistency and reinforced the need for periodic observations to ensure consistency in proper central venous catheter blood draw procedures. PMID:22269906

Secola, Rita; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Doering, Lynn


Fatal Septic Internal Jugular Vein-Sigmoid Sinus Thrombosis Associated with a Malpositioned Central Venous Catheter  

PubMed Central

Septic internal jugular vein-sigmoid sinus thrombosis (IJV-SST) associated with a malpositioned central venous catheter is a rare condition. It is potentially life-threatening and necessitates early diagnosis and rapid administration of appropriate medications. Unfortunately, it is difficult to diagnose due to vague clinical presentations. Several studies such as CT, MRI, and cerebral angiography should be performed and carefully examined to help make the diagnosis. We report a case of septic IJV-SST due to a malpositioned central venous catheter.

Seung, Won-Bae; Kim, Dae-Yong; Kim, Jin-Wook



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

Microsoft Academic Search

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

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



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

Microsoft Academic Search

Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications\\u000a including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption\\u000a caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central\\u000a neck and femoral veins due to

Ulf Karl-Martin Teichgräber; Florian Streitparth; Bernhard Gebauer; Thomas Benter



Assessment of subclinical venous catheter-related diseases in horses and associated risk factors.  


A total of 102 horses that had a catheter introduced intravenously to facilitate treatment had the catheterised jugular vein and contralateral vein examined by ultrasound every 48 hours. Subclinical complications were defined by thrombus formation or thickening of the venous wall, and the data were analysed to establish risk factors for the development of these complications. The horses with a rectal temperature above 38.5 degrees C when the catheter was introduced were four times more likely to develop complications, than the horses with a lower temperature. The administration of a NSAID while the catheter was in place reduced the risk of complications developing. PMID:19234323

Geraghty, T E; Love, S; Taylor, D J; Heller, J; Mellor, D J; Hughes, K J



In vitro activity of daptomycin and vancomycin lock solutions on staphylococcal biofilms in a central venous catheter model  

Microsoft Academic Search

Background. Catheter lock solutions are used for prevention and management of catheter-related blood- stream infections. We investigated the activity of daptomycin and vancomycin lock solutions against Staphylococcus aureus and Staphylococcus epidermidis in an in vitro central venous catheter (CVC) model. Methods. Biofilm-producing reference strains of S. aureus and S. epidermidis were evaluated. After 24 h of bacterial growth in a

Kerry L. LaPlante; Leonard A. Mermel



The central venous catheter as a source of medical chaos in Munchausen syndrome by proxy  

Microsoft Academic Search

Purpose: The aim of this study was to determine what percentage of childhood central venous catheters (CVC) are placed in victims of Munchausen syndrome by proxy (MSBP) and to evaluate the clinical indications and complications of CVCs in MSBP.Methods: Study design was by retrospective chart review. Data were obtained from the regional children's hospital and regional child abuse consultation network.

Kenneth W Feldman; Robert O Hickman



Successful Catheter-Directed Venous Thrombolysis in an Ankylosing Spondylitis Patient with Phlegmasia Cerulea Dolens  

PubMed Central

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis.

Rokni Yazdi, Hadi; Rostami, Nematollah; Hakimian, Homa; Mohammadifar, Mehdi; Ghajarzadeh, Mahsa



Hydrophilic surface coatings with embedded biocidal silver nanoparticles and sodium heparin for central venous catheters  

Microsoft Academic Search

Central venous catheters (CVCs) have become indispensable in the treatment of neonates and patients undergoing chemotherapy or hemodialysis. A CVC provides easy access to the patient’s circulation, thus enabling facile monitoring of hemodynamic parameters, nutritional support, or administration of (cytostatic) medication. However, complications with CVCs, such as bacterial bloodstream infection or thromboembolism, are common. Bloodstream infections, predominantly caused by Staphylococcus

Kris N. J. Stevens; Sander Croes; Rinske S. Boersma; Ellen E. Stobberingh; Cees van der Marel; Frederik H. van der Veen; Menno L. W. Knetsch; Leo H. Koole



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

PubMed Central

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

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



Central venous catheter-associated Leifsonia aquatica bacteremia in a hemodialysis-dependent patient  

Microsoft Academic Search

Infections associated with Leifsonia aquatica are particularly uncommon. We describe a central venous catheter-associated L. aquatica bacteremia in a hemodialysis-dependent patient. A review of the literature revealed only 1 other case report involving 10 hemodialysis patients with documented L. aquatica bacteremia.

Jeff Sulpher; Marc Desjardins; B. Craig Lee



Central venous catheter-associated Leifsonia aquatica bacteremia in a hemodialysis-dependent patient.  


Infections associated with Leifsonia aquatica are particularly uncommon. We describe a central venous catheter-associated L. aquatica bacteremia in a hemodialysis-dependent patient. A review of the literature revealed only 1 other case report involving 10 hemodialysis patients with documented L. aquatica bacteremia. PMID:18243628

Sulpher, Jeff; Desjardins, Marc; Lee, B Craig



Simulation and patient safety: evaluative checklists for central venous catheter insertion  

Microsoft Academic Search

In the advent of concerns for patient safety, simulation training is emerging as a method to train healthcare providers to perform invasive procedures such as central venous catheter (CVC) insertion while minimising harmful complications to the patient. New technologies in medical simulation have begun to shift research attention to the performance component of clinical competency. Accurate assessment of healthcare provider

Leigh V Evans; Kelly L Dodge



Placement of a port catheter through collateral veins in a patient with central venous occlusion.  


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. PMID:19504152

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



How correct is the correct length for central venous catheter insertion  

PubMed Central

Background and Aim: Central venous catheters (CVC) are important in the management of critically ill patients. Incorrect positioning may lead to many serious complications. Chest radiograph is a convenient means of determining the correct position of the catheter tip. The present study was designed to evaluate the depth of CVC placed through the right and left internal jugular vein (IJV) in order to achieve optimum placement of the catheter tip. Materials and Methods: A total of 107 patients in whom CVCs were put through either the right or left IJV through a central approach were included in this prospective study. Catheter tip position was observed in the post procedure chest radiograph. It was considered correct if the tip was just below the carina in the left-sided catheters and just above carina in the right-sided catheters. The catheters were repositioned based on the chest radiographs. The catheter depth leading to optimum tip placement was noted. Results: In males, catheter repositioning was required in 13 of 58 patients (22.41%) in the right IJV catheters, whereas in 2 of 13 patients (15.38%) in the left IJV catheters. In females, repositioning was required in 12 of 25 patients (48%) in the right IJV catheters and 2 of 11 patients (18.18%) in the left IJV catheters. Repositioning rate was higher in females (14/36) compared with males (15/71), which was statistically significant (P = 0.05, 95% CI). Repositioning rates were significantly higher in females (12/25) as compared with males (13/58) in the right IJV catheters (P = 0.019, 95% CI). Conclusion: By cannulating the IJV through a central approach, the catheters can be fixed at a length of 12-13 cm in males and 11-12 cm in females in the right IJV and at a length of 13-14 cm in males and 12-13 cm in females in the left IJV in order to achieve correct positioning.

Kujur, Rash; Manimala Rao, S.; Mrinal, M.



Do dressings with increased permeability reduce the incidence of central venous catheter related sepsis?  


The incidence of catheter-related sepsis associated-with the use of Tegaderm or Opsite IV3000 dressings on 100 critically ill patients with liver disease was studied. All the patients had central venous catheters in situ and they were randomly assigned to one of the two dressings. In this study the sites of insertion were assessed at each dressing change, together with any fluid under the dressing. No statistically significant difference between the two dressings was found in accumulation of fluid, skin microbial colonization, local infection or systemic infection of patients in our sample. There was no apparent advantage to using the more permeable Opsite IV3000 dressing. PMID:9095879

Reynolds, M G; Tebbs, S E; Elliott, T S



Central venous catheter related thrombosis in children: Analysis of the Canadian Registry of Venous Thromboembolic Complications  

Microsoft Academic Search

Background: Central venous lines (CVLs) are frequently associated with deep venous thrombosis (DVT) in children; however, little is known about the epidemiologic characteristics or outcome of CVL-related DVT. Methods: The Canadian Childhood Thrombophilia Registry monitored 244 consecutive patients with objectively diagnosed CVL-related DVT for a median duration of 24 months (range 3 months to 7 years). Results: The incidence of

M. Patricia Massicotte; David Dix; Paul Monagle; Margaret Adams; Maureen Andrew



Morbidity associated with central venous catheter-use in a cohort of 212 hospitalized subjects with HIV infection  

Microsoft Academic Search

Technical complications and nosocomial bloodstream infections associated with short-term central venous catheterization remain a heavy burden in terms of morbidity, mortality and cost in HIV-positive subjects. Between 1994 and 1997, 327 central venous catheters (CVCs) inserted in 212 patients for a total of 5005 catheter days were investigated. Forty-two technical complications (13%) occurred in 40 patients. Logistic regression analysis revealed

E. Tacconelli; M. Tumbarello; K. de Gaetano Donati; S. Bertagnolio; M. Pittiruti; F. Leone; G. Morace; R. Cauda



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:; 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)



Central venous catheter-related infection in a prospective and observational study of 2,595 catheters  

PubMed Central

Introduction Central venous catheterization is commonly used in critically ill patients and may cause different complications, including infection. Although there are many studies about CVC-related infection, very few have analyzed it in detail. The objective of this study was to analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites. Methods This is a prospective and observational study, conducted in a 24-bed medical surgical intensive care unit of a 650-bed university hospital. All consecutive patients admitted to the ICU during 3 years (1 May 2000 and 30 April 2003) were included. Results The study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005). Conclusion Our results suggest that the order for punction, to minimize the CVC-related infection risk, should be subclavian (first order), jugular (second order) and femoral vein (third order).

Lorente, Leonardo; Henry, Christophe; Martin, Maria M; Jimenez, Alejandro; Mora, Maria L



Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study  

Microsoft Academic Search

BACKGROUND: Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. METHODS: In this study traditional semiquantitative culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with

Mette KS Larsen; Trine R Thomsen; Claus Moser; Niels Høiby; Per H Nielsen



Isolation of Staphylococcus epidermidis intermediately resistant to vancomycin in a case of central venous catheter-associated bloodstream infection.  


The emergence and spread of vancomycin resistance among staphylococci, although rarely described in Japan to date, are major clinical concerns. We describe a case of central venous catheter-associated bloodstream infection in which Staphylococcus epidermidis intermediately resistant to vancomycin (minimum inhibitory concentration, 8 ?g/ml) was isolated. The patient fully recovered with removal of the intravenous catheter. PMID:23377556

Nakajima, Jun; Hitomi, Shigemi; Koganemaru, Hiroshi; Nakai, Yasunobu



Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients  

Microsoft Academic Search

Summary Central venous catheters (CVC) are an important source of nosocomial infection in intensive care units. The unnecessary removal of CVC suspected to be infected can probably be minimized. In order to test the accuracy of non-invasive methods for predicting catheter colonization, we prospectively compared the results of 50 consecutive CVC tip cultures, with cultures of the CVC hub and

B. Guidet; J. M. Gabillet; E. Snoey; G. Offenstadt; I. Nicola; V. Barakett; J. C. Petit



Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.  

PubMed Central

Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized. Images Fig. 1A. Fig. 1B. Fig. 2. Fig. 3. Fig. 4.

Brismar, B; Hardstedt, C; Jacobson, S



The experiences of patients and nurses with a nurse-led peripherally inserted central venous catheter line service  

Microsoft Academic Search

Nurse-led Peripherally Inserted Central Venous Catheter (PICC) services are becoming commonplace in cancer centres across the UK. Research has shown that these services are cost-effective and are associated with fewer catheter-related complications, including infection and thrombosis, than skin-tunnelled catheters. This exploratory study aimed to explore patients' and nurses' experiences of a nurse-led PICC line service. Recorded interviews were conducted with

Catherine Oakley; Elizabeth Wright; Emma Ream



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



Simultaneous in vivo comparison of two-versus three-wavelength mixed venous (S vo 2 ) oximetry catheters  

Microsoft Academic Search

Objective. Venous oximetry catheters provide useful realtime information about mixed venous hemoglobin saturation (Svo\\u000a 2). Currently available systems utilize either two or three wavelengths of light to obtain these measurements. Previous animal\\u000a and clinical studies have attempted to compare the accuracy of these two devices under similar circumstances. However, the\\u000a relative accuracy of the two-wavelength versus three-wavelength systems has never

Fred Bongard; Tai-Shion Lee; Thomas Leighton; Se-Yuan Liu



Accurate placement of central venous catheters in pediatric patients using endocavitary electrocardiography: Reassessment of a personal technique  

Microsoft Academic Search

To avoid the need for radiological control in the assessment of the proper location of central venous catheters (CVC), a particular use of endocavitary electrocardiography (EC-ECG) was proposed 10 years ago. The aim of this study is to reassess our experience with this method. EC-ECG assumes that the CVC, when filled with normosaline and connected to a standard electrocardiograph, behaves

Gian Battista Parigi; Giovanni Verga



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

SciTech Connect

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

Rivero, Maria A.; Shaw, Dennis W.W. [Department of Radiology CH-69, Children's Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105 (United States); Schaller, Robert T. Jr. [Department of Surgery, Children's Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105 (United States)



Use of Pulsed Field Gel Electrophoresis to Determine the Source of Microbial Contamination of Central Venous Catheters  

Microsoft Academic Search

Microorganisms detected in situ on the distal tip of central venous catheters (CVC) within 90 min of insertion were investigated using pulsed-field gel electrophoresis to analyse genomic fragments obtained with the SmaI restriction enzyme. Thirty patients received a triple lumen CVC, which was inserted directly through the skin using the Seldinger technique. In a further 30 patients a triple lumen

M. A. Livesley; S. E. Tebbs; H. A. Moss; M. H. Faroqui; P. A. Lambert; T. S. J. Elliott



Demonstration of antibiofilm and antifungal efficacy of chitosan against candidal biofilms, using an in vivo central venous catheter model.  


Candida species are a major cause of catheter infections. Using a central venous catheter Candida albicans biofilm model, we demonstrated that chitosan, a polymer isolated from crustacean exoskeletons, inhibits candidal biofilm formation in vivo. Furthermore, chitosan statistically significantly decreased both the metabolic activity of the biofilms and the cell viability of C. albicans and Candida parapsilosis biofilms in vitro. In addition, confocal and scanning electron microscopic examination demonstrated that chitosan penetrates candidal biofilms and damages fungal cells. Importantly, the concentrations of chitosan that were used to evaluate fungal biofilm susceptibility were not toxic to human endothelial cells. Chitosan should be considered for the prevention or treatment of fungal biofilms on central venous catheters and perhaps other medical devices. PMID:20331379

Martinez, Luis R; Mihu, Mircea Radu; Tar, Moses; Cordero, Radames J B; Han, George; Friedman, Adam J; Friedman, Joel M; Nosanchuk, Joshua D



Preventing catheter-associated bloodstream infections: A survey of policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program  

Microsoft Academic Search

objective. To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care. design. A 9-page written survey of practices and policies for nontunneled

David K. Warren; Deborah S. Yokoe; Michael W. Climo; Loreen A. Herwaldt; Gary A. Noskin; Gianna Zuccotti; Jermone I Tokars; Trish M. Perl; Victoria J. Fraser



Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection.  


A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve. PMID:24163455

Kale, Suresh Babu; Raghavan, Jagannathan



Chlorhexidine versus povidone-iodine for central venous catheter site care in children.  


The number of children receiving central venous catheters (CVCs) for the administration of medications is at an all-time high. Unfortunately, placement of these CVCs is not without risks. Infection of CVC insertion sites is one of the most common, yet often preventable, causes of nosocomial bacteremia in both children and adults worldwide. Throughout the years, multiple practice recommendations have been made regarding the proper site care of CVCs. The most popular antimicrobial solution used for site care has traditionally been povidone-iodine. Chlorhexidine gluconate solution, however, has been shown to be more effective than povidone-iodine in preventing CVC-related infections in adults. There continues to be controversy regarding the efficacy and safety of antimicrobial solutions for pediatric CVC site care. An evidence-based approach was used to determine current recommendations for CVC site care in children. PMID:14963875

Carson, Sheri M



Migration patterns of peripherally inserted central venous catheters at 24 hours postinsertion in neonates.  


Objective Migration of peripherally inserted central venous catheters (PICCs) is known to happen in neonates with changes in position of the upper limb. The aim of this study is to document the migration pattern of PICCs at 24 hours postinsertion, while controlling for arm position.Study Design This was a single-centered prospective study of 100 consecutively placed PICCs in a level III neonatal intensive care unit (NICU). All PICCs were inserted by one of two certified NICU nurses in either upper or lower limb. An X-ray was obtained immediately after insertion and again at 24 hours postinsertion; both were reviewed by a single pediatric radiologist.Results Of the PICCs placed in basilic veins, 35.5% migrated toward the heart, 14.5% migrated away from the heart, and 50% did not change in position. Of the PICCs placed in cephalic veins, 21% migrated toward the heart, 15.7% migrated away from the heart, and 63.3% did not change in position. None of the PICCs placed in the saphenous veins migrated.Conclusion After controlling for arm position, 47% of PICCs placed in the upper limb migrated at 24 hours postinsertion with 32.6% migrating toward the heart. We recommend a follow-up X-ray at 24 hours postinsertion for all catheters placed in the upper limb. PMID:23381907

Srinivasan, Hari B; Tjin-A-Tam, Ansel; Galang, Rupernina; Hecht, Alan; Srinivasan, Gopal



Cardiac catheters for diagnosis and treatment of venous air embolism: a prospective study in man.  


One hundred consecutive patients undergoing neurosurgical procedures in the seated position were monitored for venous air embolism with a Swan-Ganz pulmonary artery (PA) catheter, precordial Doppler ultrasound device, and continuous end-tidal CO2 (FETCO2) analysis. Simultaneous determinations of right atrial and pulmonary capillary wedge pressures were also performed during each operation. Although 80 episodes of air embolism were detected by changes in Doppler sounds, only 36 were associated with increased PA pressure, and only 30 developed a decrease in FETCO2. Changes in PA pressure and FETCO2 agreed closely (r = 0.86), and only marked changes were associated with systemic hypotension. Air was recovered from the right atrium and PA only in small amounts (2 to 20 ml) during air embolism, although it was possible to aspirate large quantities of blood. Twenty-nine patients were found to have right atrial pressures that were higher than pulmonary capillary wedge pressures. Paradoxical air embolism from a probe-patent foramen ovale was possible in these patients, and one developed signs and symptoms of systemic air embolism postoperatively. We conclude that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism. The unique advantage of Swan-Ganz monitoring, however, is that it permits identification of patients who may sustain paradoxical air embolism, and that it differentiates the hemodynamic effects of brain-stem manipulation from those caused by air embolism. PMID:6792326

Bedford, R F; Marshall, W K; Butler, A; Welsh, J E



Hickman, Kentucky - Dyersburg, Tennessee Railroad Improvement Program.  

National Technical Information Service (NTIS)

This report evaluates the feasibility of operating the Dyersburg, Tennessee to Hickman, Kentucky line as a short line railroad, and updating earlier studies, as well as defining the current status of the various issues affecting the line. Of these, the re...



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:; Chakraverty, Sam, E-mail:; Zealley, Ian, E-mail: [Ninewells Hospital and Medical School, Department of Clinical Radiology, NHS Tayside (United Kingdom)



Adverse events and technical complaints related to central venous catheters marketed in Brazil  

PubMed Central

Aim The objective of this study was to critically analyze data of the National Notification System for Adverse Events and Technical Complaints (Notivisa) related to central venous catheters, through an evaluation of the description of notifications recorded between 2006 and 2009. Methods Notifications were categorized and evaluated to: (i) determine the number of adverse events and technical complaints, (ii) verify compliance with the classification criteria defined by the legislation, (iii) reclassify notifications, when necessary, in order for them to fit in with the legal definitions, (iv) verify registered companies in Brazil, (v) quantify the notifications according to the registered company and product lot, and (vi) identify the country of original of the notified product. Microsoft Excel(r) 2010 was used to categorize and systematize the data. Results Some conceptual errors and incomplete records were found. Altogether, 228 notifications of technical complaints and 119 of adverse events were identified. Some notifications on guidewires and broken catheters were reported which led to the necessity of duplicating some medical procedures and to the occurrence of lesions/lacerations of vessels and tissue injury. Forty-seven percent of companies presented at least one notification in Notivisa and in all, 38 product lots had more than one notification. Conclusion These data support a necessity for cooperation between all entities of the National Health Surveillance System to check compliance of this type of product and to properly report adverse events and technical complaints. It is also important to incorporate minimum standards for the management of technologies in health services, including in the acquisition of products and training of staff.

Morais, Luciene de Oliveira; Friedrich, Karen; Melchior, Stela Candioto; Silva, Michele Feitoza; Gemal, Andre Luis; Delgado, Isabella Fernandes



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

SciTech Connect

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

Vik, Anders, E-mail: anders.vik@unn.n [University Hospital of North Norway, Department of Medicine (Norway); Holme, Pal Andre [Rikshospitalet University Hospital, Division of Haematology, Medical Department (Norway); Singh, Kulbir [University Hospital of North Norway, Department of Radiology (Norway); Dorenberg, Eric [Rikshospitalet University Hospital, Department of Radiology (Norway); Nordhus, Kare Christian; Kumar, Satish [University Hospital of North Norway, Department of Radiology (Norway); Hansen, John-Bjarne [University Hospital of North Norway, Department of Medicine (Norway)



Phrenic nerve injury after image-guided insertion of a tunnelled right internal jugular central venous catheter.  


Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve. PMID:22057361

Shawyer, Andrew; Chippington, Samantha; Quyam, Sadia; Schulze-Neick, Ingram; Roebuck, Derek



Pulmonary Artery Versus Central Venous Catheter Monitoring in the Outcome of Patients Undergoing Bilateral Total Knee Replacement  

Microsoft Academic Search

Bilateral total knee replacement (BTKR) has been associated with a higher incidence of fat embolism (FES) compared to single\\u000a knee replacement. Consequently, intraoperative monitoring with a pulmonary artery catheter (PAC) has been recommended. This\\u000a study compares clinical outcome in BTKR patients monitored with central venous pressure versus PAC. A retrospective chart\\u000a review of 249 consecutive patients undergoing BTKR, 132 of

Kethy M. Jules-Elysee; Jacques T. YaDeau; Michael K. Urban



Non-catheter associated venous thrombosis in hemophilia A and B. A critical review of all reported cases  

Microsoft Academic Search

All reported cases of non-catheter induced venous thrombosis in patients with hemophilia A or B have been carefully evaluated.\\u000a A total of 27 cases were reported,12 patients with hemophilia A and 15 patients with hemophilia B. The age of patients varied\\u000a between 9 and 67 years. There were 10 cases of deep vein thrombosis, 8 patients with pulmonary embolism accompanied

Antonio Girolami; Raffaella Scandellari; Ezio Zanon; Roberto Sartori; Bruno Girolami



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



Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study  

PubMed Central

Background Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. Methods In this study traditional semiquantitative culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ hybridization. Results In accordance with previous studies, the cultivation of central venous catheters from 18 patients revealed that S. epidermidis and other coagulase-negative staphylococci were most abundant and that a few other microorganisms such as P. aeruginosa and K. pneumoniae occasionally were found on the catheters. The molecular analysis using clone libraries and sequencing, denaturant gradient gel electrophoresis and sequencing provided several important results. The species found by cultivation were confirmed by molecular methods. However, many other bacteria belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were also found, stressing that only a minor portion of the species present were found by cultivation. Some of these bacteria are known to be pathogens, some have not before been described in relation to human health, and some were not closely related to known pathogens and may represent new pathogenic species. Furthermore, there was a clear difference between the bacterial species found in biofilm on the external (exluminal) and internal (luminal) side of the central venous catheter, which can not be detected by Maki's method. Polymicrobial biofilms were observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. Conclusion The results show that diagnosis based on molecular methods improves the detection of microorganisms involved in central catheter-related infections. The importance of these microorganisms needs to be investigated further, also in relation to contamination risk from improper catheter handling, as only in vivo contaminants are of interest. This information can be used for development of fast and more reliable diagnostic tools, which can be used in combination with traditional methods.

Larsen, Mette KS; Thomsen, Trine R; Moser, Claus; H?iby, Niels; Nielsen, Per H



Predictive Factors for Usefulness of Fiberoptic Pulmonary Artery Catheter for Continuous Oxygen Saturation in Mixed Venous Blood Monitoring in Cardiac Surgery  

Microsoft Academic Search

The main goal of this prospective study was to identify among cardiac surgery patients, usually monitored through a standard pulmonary artery catheter (PAC), those in whom a fiberoptic catheter oximeter to meas- ure oxygen saturation in mixed venous blood (Svo,PAC) would be most useful. Data from 286 pa- tients who underwent coronary artery bypass graft (50%) or valvular surgery were

Catherine Vedrinne; Olivier Bastien; Roland De Varax; Pascale Blanc; Pierre-Georges Durand; Bernard Du Gres; Helene Bouvier; Christine Saroul; Jean-Jacques Lehot



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


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



Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery  

PubMed Central

Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

Hussain, Nasir; Shattuck, Paul Eric; Senussi, Mourad Hussein; Velasquez Kho, Erwin; Mohammedabdul, Mubeenkhan; Sanghavi, Devang K.; Mustafa, Usman; Balavenkataraman, Arvind; Obradovic, Dragic M.



Learning why patients with central venous catheters resist permanent access placement.  


Central venous catheters (CVCs) are a well-known risk to patients on hemodialysis due to their higher morbidity and mortality compared to fistulas or grafts. One factor in the prevalence of CVCs is patients eligible for permanent access who refuse referral and permanent access placement. Objectives of this study were to identify reasons patients resist permanent access placement and develop potential strategies for intervention. A survey was distributed to Fresenius Medical Care North America (FMCNA) outpatient dialysis facilities (approximately 1600 facilities) requesting voluntary participation in documenting reasons given by patients for resisting permanent access placement. From the patient survey results, responses were collected and ranked from most frequent response to least frequent response. A collaborative workgroup of nephrology nurses and social workers reviewed the survey results. The patient survey provided 1573 responses. The three most frequently provided reasons were 1) a previous negative surgical experience, 2) having a permanent access placed in the past that did not work, and 3) cannulation fear and/or pain concerns. The workgroup identified best practices from clinics with low CVC rates and reviewed professional literature as a guide for development of potential strategies for intervention by the nephrology nurses and interdisciplinary team. Using a patient survey as a means to learn reasons why patients resist permanent access placement can be of value to the healthcare team in the development of potential strategies for interventions to reduce CVC utilization and thereby improve patient outcomes. PMID:22690442

Axley, Billie; Rosenblum, Alex


Prophylactic Administration of Doxycycline Reduces Central Venous Catheter Infections in Patients Undergoing Hematopoietic Cell Transplantation  

PubMed Central

Hematopoietic stem cells are generally transfused through a central venous catheter (CVC), which also facilitates administration of medications and intravenous fluids. We had observed a high rate of CVC infections at our Bone Marrow Transplantation (BMT) unit. Accordingly, we evaluated the impact of administration of doxycycline as a prophylactic strategy to reduce CVC infection rates. Data was collected retrospectively on 54 consecutive patients, 26 who received doxycycline (doxycycline group), and we compared their outcomes to a previous cohort of 28 subjects who did not receive doxycycline (comparison group). The groups were comparable in regards to age, gender, transplant type, and CD34 cell dose. No (0%) CVC infection was observed in the doxycycline group, while 5 infection episodes (18%) occurred in 4 patients in the comparison group (p<0.001). Isolated organisms included: Escherichia-coli (EC)=1, coagulase-negative Staphylococcus-spp (CNSS)=2, both EC & CNSS=1. Notwithstanding the non-randomized comparative nature of our study, results suggest that CVC infection rate was reduced significantly after adding doxycycline for prophylaxis. A randomized controlled study is warranted to confirm these findings.

Baydoun, Mohamed; Otrock, Zaher K.; Okaily, Samar; Nehme, Rita; Abu-Chahine, Racha; Hamdan, Ali; Noureddine, Samar; Kanj, Souha; Kanafani, Zeina; Bazarbachi, Ali; Kharfan-Dabaja, Mohamed A.



Ultraviolet-C Irradiation for Prevention of Central Venous Catheter Related Infections: An In-vitro Study  

PubMed Central

Central venous catheters (CVC) are widely used in the United States and are associated with 250,000 to 500,000 CVC-related infections in hospitals annually. We used a catheter made from ultraviolet-C (UVC) transmissive material to test whether delivery of UVC from the lumen would allow inactivation of microorganisms on the outer surface of CVC. When the catheter was exposed to UVC irradiation from a cold cathode fluorescent lamp (CCFL) inside the catheter lumen at a radiant exposure of 3.6 mJ/cm2, more than 6-log10 of drug-resistant Gram-positive bacteria adhered to the outer surface of the catheter were inactivated. Three to 7-log10 of drug-resistant Gram-negative bacteria and 2.8 log10 of fungi were inactivated at a radiant exposure of 11 mJ/cm2. UVC irradiation also offered a highly selective inactivation of bacteria over keratinocytes under exactly comparable conditions. After 11 mJ/cm2 UVC light had been delivered, over 6 log10 of bacteria were inactivated while the viability loss of the keratinocytes was only about 57%.

Dai, Tianhong; Tegos, George P.; St. Denis, Tyler G.; Anderson, Don; Sinofsky, Ed; Hamblin, Michael R.



Comparison of the Roll Plate Method to the Sonication Method To Diagnose Catheter Colonization and Bacteremia in Patients with Long-Term Tunnelled Catheters: a Randomized Prospective Study?  

PubMed Central

Diagnosing catheter-related bloodstream infection (CRBSI) still often involves tip culture. The conventional method is the semiquantitative roll plate method. However, the use of a quantitative sonication technique could have additional value, as it may detect endoluminal microorganisms more easily. Because endoluminal infection tends to occur in long-term central venous catheters, we compared both techniques for patients with long-term tunnelled catheters. For 313 consecutive Hickman catheter tips from 279 hematological patients, colonization detection rates were compared by performing both techniques in a random order, using conventional detection cutoffs. Additionally, for the subgroup of patients with clinical suspicion of CRBSI (n = 89), the diagnostic values of both techniques were compared. The overall tip colonization rate was 25%. For each technique, the detection rate tended to be better if that technique was performed first. The diagnostic performance for the subgroup of patients with clinical suspicion of CRBSI was limited and not different for both methods. Sensitivity and specificity were 45% and 84%, respectively, for sonication versus 35% and 90%, respectively, for the roll plate technique. The fact that 35 of 40 patients with CRBSI received antimicrobial therapy before catheter removal and tip culture, in an attempt to salvage the catheter, may partly explain this poor performance. No differences were observed when catheters were stratified according to in situ time below or above the median of 4 weeks. The sonication culture technique was not better than the roll plate method to diagnose tip colonization or CRBSI in patients with long-term tunnelled catheters.

Slobbe, Lennert; el Barzouhi, Abdelilah; Boersma, Eric; Rijnders, Bart J. A.



Molecular investigation of bacterial communities on the inner and outer surfaces of peripheral venous catheters.  


Peripheral venous catheters (PVCs) are some of the most widely used medical devices in hospitals worldwide. PVC-related infections increase morbidity and treatment costs. The inner surfaces of PVCs are rarely examined for the population structure of bacteria, as it is generally believed that bacteria at this niche are similar to those on the external surface of PVCs. We primarily test this hypothesis and also study the effect of antibiotic treatment on bacterial communities from PVC surfaces. The inner and outer surfaces of PVCs from 15 patients were examined by 454 GS FLX Titanium 16S rRNA sequencing and the culture method. None of the PVCs were colonised according to the culture method and none of the patients had a bacteraemia. From a total of 127,536 high-quality sequence reads, 14 bacterial phyla and 268 diverse bacterial genera were detected. The number of operational taxonomic units for each sample was in the range of 86-157, even though 60 % of patients had received antibiotic treatment. Stenotrophomonas maltophilia was the predominant bacterial species in all the examined PVC samples. There were noticeable but not statistically significant differences between the inner and outer surfaces of PVCs in terms of the distribution of the taxonomic groups. In addition, the bacterial communities on PVCs from antibiotic-treated patients were significantly different from untreated patients. In conclusion, the surfaces of PVCs display complex bacterial communities. Although their significance has yet to be determined, these findings alter our perception of PVC-related infections. PMID:23529345

Zhang, L; Morrison, M; Nimmo, G R; Sriprakash, K S; Mondot, S; Gowardman, J R; George, N; Marsh, N; Rickard, C M



Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature  

PubMed Central

Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.

Venugopal, Achuthan Nair; Koshy, Rachel Cherian; Koshy, Sumod M



Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy  

Microsoft Academic Search

Background  This study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC) placement\\u000a had on institution-wide central line associated bloodstream infections (CLABSI). We therefore investigated the rate of CLABSI\\u000a per 1,000 line days during the 12 months before and after implementation of the policy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This is a retrospective analysis of prospectively collected data at an

Robert A Cherry; Cheri E West; Maria C Hamilton; Colleen M Rafferty; Christopher S Hollenbeak; Gregory M Caputo



Detection of viable but non-culturable staphylococci in biofilms from central venous catheters negative on standard microbiological assays.  


Viable bacteria were sought in 44 Maki-negative biofilms from central venous catheters (CVCs) using epifluorescence microscopy after live/dead staining. Thirty (77%) samples contained viable but non-culturable (VBNC) cells; the majority were positive on real-time PCR specific for Staphylococcus epidermidis (one also for Staphylococcus aureus). Viable cells were significantly (p<0.01) associated with CVCs from febrile patients, three of whom showed S. epidermidis-positive blood cultures, suggesting that CVC-associated biofilms can be reservoirs for staphylococci in the VBNC state. The possible role of VBNC staphylococci in persistent infections related to medical devices requires further investigation. PMID:22578149

Zandri, G; Pasquaroli, S; Vignaroli, C; Talevi, S; Manso, E; Donelli, G; Biavasco, F



Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices  

Microsoft Academic Search

Goals  Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients.\\u000a A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this\\u000a study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare\\u000a device-specific complications in a

Leon J. Worth; John F. Seymour; Monica A. Slavin



Evaluation of Central Venous Catheter Associated Blood Stream Infections: A Microbiological Observational Study  

PubMed Central

There are substantial morbidity and mortality associated with vascular catheter use among crictically ill patients. The attributable mortality is 10% to 25% which is associated with bacteremia among those who are hospitalized. This study was undertaken to identify catheter related blood stream infections, to isolate pathogenic microorganisms present in intravascular catheter related local infections, exit site infections, and to determine the predisposing factors for the development of such infections and antibiotic sensitivity pattern of the isolated organisms in tertiary care hospital.

Khanna, Vinay; Mukhopadhayay, Chiranjay; K. E., Vandana; Verma, Murlidhar; Dabke, Partha



Estimation of heparin leak into the systemic circulation after central venous catheter heparin lock  

Microsoft Academic Search

Background. Although most catheter problems in haemodialysis are related to infection or clotting, bleeding associated with the heparin lock is of clinical importance especially during peri-operative conditions. The objective of this in vitro study is to estimate the volume of heparin that may leak into the circulation immediately after performing a catheter lock. Methods. Different volumes (ml) of a dextrose

Mohsen Agharazii; Isabelle Plamondon; Marcel Lebel; Pierre Douville; Simon Desmeules


Central venous catheter-associated bloodstream infection and colonisation of insertion site and catheter tip. What are the rates and risk factors in haematology patients?  


Skin colonisation is an important source for central venous catheter (CVC) colonisation and infection. This study intended to identify risk factors for skin colonisation prior to CVC placement (baseline colonisation) and within 10 days after CVC insertion (subsequent colonisation), for CVC-tip colonisation and for bloodstream infection (BSI). Within a randomised clinical trial, data of 219 patients with haematological malignancies and inserted CVC (with a total of 5,501 CVC-days and 4,275 days at risk) in two university hospitals were analysed. Quantitative skin cultures were obtained from the insertion site before CVC placement and at regular intervals afterwards. CVC-tip cultures were taken on CVC removal and data collection was performed. Statistical analysis included linear and logistic regression models. Age was an independent risk factor for colonisation prior to CVC placement (baseline colonisation). Independent risk factors for subsequent colonisation were baseline colonisation and male gender. High level of subsequent skin colonisation at the insertion site was a predictor of CVC-tip colonisation, and a predictor of BSI. High level of skin colonisation predicts catheter tip colonisation and possibly subsequent infection. Sustained reduction of bacterial growth at the CVC insertion site is therefore indispensable. Male patients are at particular risk for skin colonisation and may be a target population for additional insertion-site care before and during catheterisation. PMID:20532506

Luft, Dirk; Schmoor, Claudia; Wilson, Christine; Widmer, Andreas F; Bertz, Hartmut; Frei, Reno; Heim, Dominik; Dettenkofer, Markus



Bilateral Pneumothoraces in a Pediatric Patient Undergoing Hickman Catheter Placement  

Microsoft Academic Search

se of the laryngeal mask airway (LMA; Laryn- geal Mask Company, Henley-on-Thames, UK) in adults and children is widespread in the field of anesthesia. LMA provides an excellent airway in individuals not requiring the placement of a tracheal tube. Complications arising from the use of the LMA are typically mild and correctable, although more se- rious complications have been described.

G. Brent Shulman; Neil Roy Connelly



Accurate placement of central venous catheters in pediatric patients using endocavitary electrocardiography: reassessment of a personal technique.  


To avoid the need for radiological control in the assessment of the proper location of central venous catheters (CVC), a particular use of endocavitary electrocardiography (EC-ECG) was proposed 10 years ago. The aim of this study is to reassess our experience with this method. EC-ECG assumes that the CVC, when filled with normosaline and connected to a standard electrocardiograph, behaves like an exploring electrode. The approach of the catheter tip to the right atrium is then detected by a slightly increasing negative P wave. When the tip reaches the exact level of the sinus node, the P wave suddenly deepens. After a preliminary test of the reliability of the technique versus the standard method in 50 CVC placements verified by both EC-ECG and chest x-ray, we have placed 807 CVCs in children using EC-ECG only. There have been no false-positive and one false-negative test result (lead connector misplacement). In 17 cases in which intrinsic deflection was not detected, the catheter tip was found to be wrongly positioned; all the remainder CVCs have been successfully positioned. For 10 years this technique has proved to be a simple, safe, quick, inexpensive and highly reliable method to assess the correct positioning of the CVC. PMID:9269975

Parigi, G B; Verga, G



Central Venous Catheter Complications: Parts 1-3 (VHS 1/2 inch) (Video).  

National Technical Information Service (NTIS)

The program addresses CVC complications, and how to avoid them. Part I deals with surgical landmarks; catheter selection; actual CVC placements. Part II - radiology case reviews; pathology reviews. Part III - infection control and aseptic techniques; peri...



Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial.  


To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC-associated infections. PMID:19686276

Dettenkofer, M; Wilson, C; Gratwohl, A; Schmoor, C; Bertz, H; Frei, R; Heim, D; Luft, D; Schulz, S; Widmer, A F



Evidence-Based EducationThe Use of a DVD to Educate Parents on the Care of a Central Venous Catheter  

Microsoft Academic Search

More than 5 million central venous catheters (CVCs) are placed each year, which results in more than 200 000 nosocomial blood stream infections. Many of these infections are attributed to improper placement or substandard care of the CVC. Limiting the number of infections with proper training will improve a child’s quality of life and outcome. Children and their caregivers need

Danielle K. Sebbens; Judith Kaufmann; Kristen L. Straka; Patricia R. Houck



Comparison of US and non-US central venous catheter infection rates: Evaluation of processes and indicators in infection control study  

Microsoft Academic Search

Objective: We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. Design: The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. Settings: The study took place in intensive care units

Ziad A. Memish; Yaseen Arabi; Gwen Cunningham; Stephen Kritchevsky; Barbara Braun; Cheryl Richards; Stefan Weber; Crèsio Romeu Pereira



[The visibility of a central venous catheter using digital luminescence radiography in intensive care radiology].  


The aim of the following study was to assess the impact of dose alterations on the detection of catheters. We compared the performance of well-exposed conventional and digital portable chest radiographs in the detection of thin catheters and tested the influences of dose alterations. Portable chest radiographs of 20 patients were obtained with conventional film/screen (FR) and with storage phosphors at 50% (SRL), 100% (SRN), and 250% (SRH) of the conventionally required exposure dose. The region of the mediastinum was subdivided into an average of 18 fields, 50% of which were superimposed with thin catheter segments. ROC analysis of 11,600 observations by 8 readers found only SRH equivalent to FR in catheter visualisation. Performance decreased significantly with SRN and SRL. Detection of low contrast catheters was found to be significantly decreased in storage phosphor radiographs obtained with standard exposure dose. A dose reduction is not feasible with current equipment if performance equivalent to conventional radiography is to be achieved. PMID:1733477

Galanski, M; Prokop, M; Thorns, E; Oestmann, J W; Reichelt, S; Haubitz, B; Milbradt, H; Gräser, A; Verner, L; Schaefer, C



Diagnosis of catheter-related bloodstream infection in a total parenteral nutrition population: inclusion of sepsis defervescence after removal of culture-positive central venous catheter.  


Defervescence of sepsis after removal of culture-positive central venous catheters (CVCs) has been advocated for diagnosis of catheter-related bloodstream infection (CRBSI) even without positive blood culture. However, most studies report CRBSI incidence only when blood cultures, and CVC tip, are positive (standard definition). We examined the effect of inclusion of defervescence criteria on CRBSI incidence in a total parenteral nutrition (TPN) population. The study was carried out in a 525 bed tertiary referral hospital for a period of 12 years. CRBSI incidence was compared between standard definition (positive CVC tip culture and positive blood culture) and when 'defervescence criteria' were included. Sepsis defervescence was defined as a fall in temperature, white cell count and sepsis resolution after CVC removal, with positive CVC tip culture, but negative blood cultures. CRBSI episodes in which a blood culture was omitted were excluded. The study population included 1365 patients in whom 2536 CVCs were used over a period of 15 234 CVC-days. There were 192 CRBSI episodes in 165 patients. In all, 152 CRBSI episodes met only the standard criteria for CRBSI whereas 40 episodes met the defervescence criteria. The standard definition alone resulted in a mean (+/- SD) incidence of 10.6+/-5.8 per 1000 CVC-days. This increased to 13+/-6.4 per 1000 CVC-days when defervescence criteria were included. Inclusion of defervescence criteria increased CRBSI incidence by a mean of 2.5+/-1.4 episodes per 1000 days or 27% (95% CI: 1.61-3.339; P<0.001). This study implies that the scale of CRBSI may be higher than is currently recognised and that the blood culture positivity rate for CRBSI is 79% (152/192). PMID:20554348

Walshe, C M; Boner, K S; Bourke, J; Hone, R; Phelan, D



Case report. Rhodotorula rubra fungaemia due to use of indwelling venous catheters.  


Rhodotorula has been an infrequent cause of infection in humans but there have been some case reports about this systemic yeast infection. In this article, a Rhodotorula rubra fungaemia due to an indwelling catheter in a 23-year-old woman who had been diagnosed with non-Hodgkin's lymphoma grade IV B is described. PMID:10948821

Kiraz, N; Gülbas, Z; Akgün, Y



Entrapped central venous catheter after mitral valve replacement and its surgical retrieval  

PubMed Central

Central venous pressure monitoring line insertion is routine prior to the conduct of cardiac surgery, and in rare instances, malposition can contribute to operative complications. We describe here how a central venous line lying in the right atrium became caught in a left atrial (LA) closure suture during a mitral valve replacement. The opening of the LA suture line is highly unsafe without cardiopulmonary bypass (CPB) because of the possibility of systemic air embolism, but by employing an ingenious method of suturing over and unravelling the continuous sutures closing the left atrium, it was possible to surgically retrieve it without the use of a CPB.

Nair, Hema C.; Banakal, Sanjay; Parachuri, V. Rao; Shetty, Devi Prasad



A new injection portal for brachially inserted central venous catheter. A multicenter study  

Microsoft Academic Search

Totally implantable portal systems are widely used for long-term central venous access. A new venous portal system inserted\\u000a via the brachial veins (P.A.S. Port™ system, Pharmacia Deltec Inc, U.S.A.) was studied in five centres.\\u000a \\u000a From January 1988 through May 1989 61 systems were implanted. Fifty-two patients had malignant diseases. Nine cases had non-malignant\\u000a disorders. The portals were implanted subcutaneously in

Hans Starkhammar; Mats Bengtsson; Thomas B. Gain; William Galen; Leif HÅKansson; John Hirsch; Brian Loggie; Earl S. Schuman; J. Michael Sterchi



Entrapped central venous catheter after mitral valve replacement and its surgical retrieval.  


Central venous pressure monitoring line insertion is routine prior to the conduct of cardiac surgery, and in rare instances, malposition can contribute to operative complications. We describe here how a central venous line lying in the right atrium became caught in a left atrial (LA) closure suture during a mitral valve replacement. The opening of the LA suture line is highly unsafe without cardiopulmonary bypass (CPB) because of the possibility of systemic air embolism, but by employing an ingenious method of suturing over and unravelling the continuous sutures closing the left atrium, it was possible to surgically retrieve it without the use of a CPB. PMID:22687430

Nair, Hema C; Banakal, Sanjay; Parachuri, V Rao; Shetty, Devi Prasad



Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting.  


Purpose: Central venous catheters (CVCs) are often placed to resuscitate unstable emergency department (ED) patients. In an observational study, we assessed intraosseous (IO) vascular access in the hospital, and compared results to published experiences with CVC placement. ?Methods: Patients who would typically receive a CVC were considered for the study. Vascular access was gained using a powered IO device. Data collection included placement success, placement time, ease-of-use, satisfaction with flow rates, complications and subsequent CVC placement. ?Results: A total of 105 cases were studied from six centers. Mean age was 48.0±28.0 years and 53% were men; 85% of the patients were medical cases, and 53% were in cardiac/respiratory arrest. Of those, 48% returned to spontaneous circulation. A total of 94% of placements were successful on the first attempt. Mean time to IO access was 103.6±96.2 seconds. There was one serious complication - a lower extremity compartment syndrome. IO access costs $100/patient.?Conclusions: The data revealed faster and more successful IO catheter placement than reported for CVCs, few complications and high user satisfaction. For simple placements, cost savings for IO access vs. CVCs was $195/procedure. If 20% of the 3.5 million CVCs placed annually were replaced with IO catheters, cost savings could approach $650 million/year. We conclude that IO access in place of CVCs delivers high value in terms of being a safe, fast and effective mode of vascular access for patients in the hospital setting, with potentially substantial cost savings. These data indicate that IO access is a cost effective and viable alternative to problematic CVC lines. PMID:23283646

Dolister, Michael; Miller, Stephen; Borron, Stephen; Truemper, Edward; Shah, Manoj; Lanford, Muriel R; Philbeck, Thomas E



[Post-traumatic fracture and migration in the pulmonary artery of the catheter of a totally implantable venous access device. Unusual complication].  


The case of a 59 year-old patient, who sustained a post-traumatic fracture of the silastic catheter of his totally implantable venous access device that migrated in the right pulmonary artery, is reported. The venous device was placed six months earlier for the treatment of metastatic spread of a primary unknown adenocarcinoma. The venous device was placed on the left side in consideration of a recent right supraclavicular node biopsy. The catheter was introduced through the left internal jugular vein and its peripheral end was positioned subcutaneously across the clavicle to be connected to the port chamber placed in the infraclavicular region. The accidental fracture of the catheter was attributed to a closed trauma occurred during the transport of a refrigerator on the homolateral shoulder. Treatment involved extraction of the migrated fragment through a percutaneous transfemoral angioradiological procedure. A few days later the chamber was removed and a new totally implantable venous access device was placed on the other side. PMID:11423798

Iannelli, A; Kianmanesh, R; Msika, S; Marano, A; Levesque, M; Grandjean, M; Hay, J M



[Impact of clinical practice guidelines on the incidence of bloodstream infections related to peripherally inserted central venous catheter in preterm infants].  


In our neonatal intensive care unit, the incidence density of infections related to central catheters, assessed retrospectively over 2 years, exceeded that described in the literature. To reduce this incidence density, clinical practice guidelines were implemented for the insertion and maintenance of central lines. The purpose of this study was to evaluate the impact of the protocol on the incidence density and the incidence rate of nosocomial bloodborne infections. This was a prospective study in a neonatal intensive care unit of the Fort-de-France University Hospital over 17 months, which included all premature infants with a central line. We studied the adherence to the protocol, possible complications related to the protocol, the characteristics of the population, the incidence rate, and the density of specific central catheter-related infections. There were 111 children, 122 catheters, and 2575 catheter days during period 1 and 101 children, 125 catheters, and 1631 catheter days during period 2. Gestational age and birth weight were significantly lower in period 2 (29.6±2.3 GW vs 27.3±1.9, P=0.001; 1239±379g vs 915±175g, P<0.001) and the catheterization duration differed between the 2 periods (20±11 days vs 13±6 days, P<0.0001). A trend for a lower incidence density of infection was observed in the second period (16 per 1000 catheter days vs 10 per 1000 catheter days, P=0.06). Although the 2 groups' baseline characteristics were different, this study suggests a positive impact of clinical practice guidelines for the insertion and maintenance of central venous catheters on the incidence of nosocomial infections related to central catheters. PMID:23245862

Boutaric, E; Gilardi, M; Cécile, W; Fléchelles, O



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


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



Lymphocutaneous Fistula As a Long-Term Complication of Multiple Central Venous Catheter Placement  

PubMed Central

We report a case of a lymphocutaneous fistula in a 19-month-old boy who had been a premature neonate, born in the 23rd week of gestation. The fistula, an apparent complication of central venous line placement during the patient's first 5 months of life, was composed of a distinct lymphatic vessel bundle in the right supraclavicular region, with its exit point at the posterior aspect of the right shoulder. The drainage ceased imme-diately after resection and repair of a 1-cm obstruction in the superior vena cava.

Scharff, Robert P.; Recto, Michael R.; Austin, Erle H.; Wilkerson, Shirley A.



Linezolid Compared with Eperezolid, Vancomycin, and Gentamicin in an In Vitro Model of Antimicrobial Lock Therapy for Staphylococcus epidermidis Central Venous Catheter-Related Biofilm Infections  

Microsoft Academic Search

Central venous catheter (CVC)-related infection (CVC-RI) is a common complication of CVC use. The most common etiological agents of CVC-RI are gram-positive organisms, in particular, staphylococci. An in vitro model for the formation of biofilms by Staphylococcus epidermidis ATCC 35984 on polyurethane coupons in a modified Robbins device was established. Biofilm formation was confirmed by electron microscopy and was quantified

John Curtin; Martin Cormican; Gerard Fleming; John Keelehan; Emer Colleran



Assessment of detection of Candida mannoproteinemia as a method to differentiate central venous catheter-related candidemia from invasive disease.  

PubMed Central

The proper management of candidemic patients is controversial because of the difficulties of an early differentiation of central venous catheter (CVC)-related candidemia from deep-seated invasive Candida infection. In particular, more information on possible markers of invasive disease is needed. We performed a retrospective, pilot investigation to assess the diagnostic potential of a dot immunobinding assay for Candida mannoprotein antigen in serial serum samples from 31 candidemic patients in the setting of hematologic malignancy. Mannoproteinemia (antigenemia) was detected in 1 of 14 (7.1%) patients with transient or CVC-related candidemia and in 13 of 17 (76.5%) patients with non-CVC-related persistent candidemia. Of the 11 subjects of this latter group with documented tissue invasion, 10 (91%) were antigenemic. The patients belonging to the different categories did not significantly differ in the duration of candidemia, nor was there any significant difference among the different groups of subjects either in the number of serum samples examined or in their collection time during candidemia. The day of the first antigenemic sample during candidemia greatly varied among subjects with invasive infection, although on average mannoproteinemia was detectable by the first week of candidemia. In summary, our data demonstrate a correlation between mannoproteinemia and tissue invasion by Candida spp. in candidemic patients and suggest that mannoprotein detection by our method has a potential for the diagnosis of invasive candidiasis in these subjects.

Girmenia, C; Martino, P; De Bernardis, F; Cassone, A



A novel electrospun nano-fabric graft allows early cannulation access and reduces exposure to central venous catheters.  


Purpose: The use of tunneled central venous catheters (CVC) as vascular access for hemodialysis treatment is increasing worldwide. We present a novel polycarbonate urethane nano-fabric graft, produced by electrospinning technology, which has self-sealing features that avoid seroma formation and allow puncturing within 48 hours. The aim of this study was to assess its advantages in a setting where late referral is common. ?Methods: A retrospective single center study assessed 24 implanted grafts in 24 patients with maximal follow-up of ?18 months; patency rates, time to first cannulation and post-operative complications were assessed. ?Results: Successful access was achieved in all 24 patients within 48 hours. In 50% of the patients cannulation was performed within 24 hours without increasing the complication rate. Twelve month primary and secondary patencies were 50% and 70.8%, respectively. Excluding early failures (within 30 days) because of surgical problems, 12 month primary and secondary patencies were 75% and 81.2% respectively. Complication and infection rates were 10.94 and 0.49/1000 dialysis procedures, respectively. No pseudoaneurysms or seromas were documented at 18 months.? Conclusions: Early cannulation was successful in all patients with good 12-month primary and secondary patency rates, compared to data reported by others on polytetrafluoroethylene (PTFE) grafts. The infection rate was substantially lower than in tunneled CVCs. Therefore, the AVflo graft may improve the clinical status of dialysis patients by decreasing the ?exposure to CVCs. PMID:23599141

Karatepe, Celalettin; Aitinay, Levent; Yetim, Tulin Durgun; Dagli, Celalettin; Dursun, Suat



The effectiveness of chlorhexidine-silver sulfadiazine impregnated central venous catheters in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation.  


Immuno-compromised patients are at high risk for all kind of infections. Unfortunately, they need central venous catheters (CVCs), which are associated with infectious complications. In this study we examined the effectiveness of chlorhexidine-silver sulfadiazine impregnated CVCs to prevent catheter-related infections in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation. This historical cohort study evaluated 139 patients of whom 70 patients were provided with non-impregnated CVCs and 69 patients with impregnated CVCs. Patients were treated for different diagnoses. The median number of days a CVC stayed in situ was 18 in the non-impregnated group and 16 in the impregnated group. The median duration of neutropenia of patients with non-impregnated CVCs was 9 days compared with 7 days of patients with impregnated CVCs. We found less catheter colonization (CC) in patients with chlorhexidine-silver sulfadiazine CVCs (RR 0.63, 95% CI 0.41-0.96; P = 0.03). Catheter-related blood stream infections (CR-BSI) were also diminished, but this result was not statistically significant (RR 0.15, 95% CI 0.02-1.15; P = 0.06). The reduction in CC and CR-BSI did not diminish the incidence of fever. We conclude that the use of chlorhexidine-silver sulfadiazine impregnated CVCs provide an important improvement in the attempt to reduce CC and CR-BSI. PMID:19453696

Maaskant, J M; De Boer, J P; Dalesio, O; Holtkamp, M J; Lucas, C



Chlorhexidine-silver sulfadiazine-impregnated central venous catheters: in vitro antibacterial activity and impact on bacterial adhesion.  


The aim of this study was to compare the in vitro activity and the impact on bacterial adhesion of two different catheters, one impregnated with chlorhexidine-silver sulfadiazine (C-SS) and the other not impregnated with antibacterial agents. The antimicrobial coating prevented the bacterial colonization by slime positive Staphylococcus epidermidis in the first two days. The antibacterial activity of the effluents from catheters impregnated with C-SS dissipated by day seven. Our results demonstrated that the surface treatment modified the composition of impregnated catheters and determined different contact angle values of the two catheters (impregnated and not impregnated). Examination of coated and uncoated catheter segments by scanning electron microscopy showed a good correlation with the results of adherence experiments. In conclusion, the findings suggest that C-SS coated catheters prevent in vitro bacterial adhesion. PMID:22707130

Monzillo, Vincenzina; Corona, Silvia; Lanzarini, Paolo; Dalla Valle, Claudia; Marone, Piero



Parenteral nutrition - ascites with acute renal failure as a complication from an umbilical venous catheter in an extremely low birth weight infant  

PubMed Central

Umbilical venous catheters (UVCs) are frequently used in the neonatal intensive care setting and play a crucial role in the management of extremely low birth weight (ELBW) infants. One very rare complication reported is parenteral nutrition (PN) ascites secondary to vessel perforation or hepatic erosion by PN at the tip of malpositioned UVCs with various hepatic lesions. We describe a case of early onset PN ascites with no obvious associated hepatic lesion but complicated by pre-renal acute renal failure in an ELBW infant with the tip positioned between the 10th and 11th thoracic vertebrae.

Egyepong, Jean; Jain, Amish; Chow, Peter; Godambe, Sunit



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


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



Prevention of catheter sepsis: The hub  

Microsoft Academic Search

The prevention of catheter sepsis lies in a sound understanding of the routes through which catheters get contaminated. The catheter hub has been recognized as a portal for microorganisms causing catheter sepsis, particularly in central venous catheters inserted for >1 wk. Bacteria and fungi may reach the internal surface of the catheter connector during manipulation by hospital staff and then

Antonio Sitges-Serra; R. Hernández; S. Maestro; T. Pi-Suñer; José M. Garcés; M. Segura



Catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route for acute portal venous thrombosis: report of two cases.  


Although acute portal venous thrombosis (PVT) is a potentially life-threatening complication that occurs after hepatobiliary surgery with portal vein (PV) reconstruction or splenectomy, no effective or universal treatments have yet been established. Transjugular or transhepatic catheter-directed thrombolysis has recently been reported to be effective for treating acute PVT. However, the efficiency of this treatment for complete PV occlusion might be limited because a poor portal venous flow prevents thrombolytic agents from reaching and dissolving thrombi. Moreover, the use of the transjugular or transhepatic route might not be suitable in patients who have undergone major hepatectomy or in those with ascites due to an increased risk of residual liver injury or intra-abdominal bleeding following puncture to the residual liver. We herein describe the cases of two patients with almost total PV occlusion caused by massive thrombi that formed after hepatobiliary surgery, who were successfully treated with catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route. This treatment should be considered beneficial for treating selected patients such as the two patients described herein. PMID:23007968

Miura, Kohei; Sato, Yoshinobu; Nakatsuka, Hideki; Yamamoto, Satoshi; Oya, Hiroshi; Hara, Yoshiaki; Kokai, Hidenaka; Hatakeyama, Katsuyoshi



Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report.  


A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause. PMID:22606393

Anvaripour, Abdorasoul; Yazdanian, Forouzan; Totonchi, Mohammad-Zia; Shahryari, Houshang



Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report  

PubMed Central

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

Anvaripour, Abdorasoul; Yazdanian, Forouzan; Totonchi, Mohammad-Zia; Shahryari, Houshang



A Controlled Study of Transesophageal Echocardiography to Guide Central Venous Catheter Placement in Congenital Heart Surgery Patients  

Microsoft Academic Search

Transesophageal echocardiography (TEE) and central ve- nous catheter (CVC) placement are often used during con- genital cardiac surgery. Complications of CVC placement include cardiac perforation, inadvertent arterial place- ment, and erroneous hemodynamic data from unrecog- nized malposition. In this study, we used a prospective, randomized, controlled design to evaluate the use of TEE to guide depth of insertion and confirm

Dean B. Andropoulos; Stephen A. Stayer; Sabrina T. Bent; Carlos J. Campos; Louis I. Bezold; Melquiades Alvarez; Charles D. Fraser



C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters  

SciTech Connect

C-arm cone beam computed tomography is an advanced 3D imaging technology that is currently available on state-of-the-art flat-panel-based angiography systems. The overlay of cross-sectional imaging information can now be integrated with real-time fluoroscopy. This overlay technology was used to guide the placement of three percutaneous translumbar inferior vena cava catheters.

Tam, Alda, E-mail: alda.tam@di.mdacc.tmc.ed [University of Texas M.D. Anderson Cancer Center, Division of Diagnostic Radiology, Section of Interventional Radiology, Unit 325 (United States); Mohamed, Ashraf [Siemens Corporate Research, Inc. (United States); Pfister, Marcus; Rohm, Esther [Siemens AG Healthcare Sector, AX Division (Germany); Wallace, Michael J. [University of Texas M.D. Anderson Cancer Center, Division of Diagnostic Radiology, Section of Interventional Radiology, Unit 325 (United States)



Continuous insulin administration via complex central venous catheter infusion tubing is another risk factor for blood glucose imbalance. A retrospective study  

PubMed Central

Background We assessed the potential impact of infusion tubing on blood glucose imbalance in ICU patients given intensive insulin therapy (IIT). We compared the incidence of blood glucose imbalance in patients equipped, in a nonrandomized fashion, with either conventional tubing or with a multiport infusion device. Methods We retrospectively analyzed the nursing files of 35 patients given IIT through the distal line of a double-lumen central venous catheter. A total of 1389?hours of IIT were analyzed for occurrence of hypoglycemic events [defined as arterial blood glucose below 90?mg/dL requiring discontinuation of insulin]. Results Twenty-one hypoglycemic events were noted (density of incidence 15 for 1000?hours of ITT). In 17 of these 21 events (81%), medication had been administered during the previous hour through the line connected to the distal lumen of the catheter. Conventional tubing use was associated with a higher density of incidence of hypoglycemic events than multiport infusion device use (23 vs. 2 for 1,000?hours of IIT; rate ratio = 11.5; 95% confidence interval, 2.71–48.8; p < 0.001). Conclusions The administration of on-demand medication through tubing carrying other medications can lead to the delivery of significant amounts of unscheduled products. Hypoglycaemia observed during IIT could be related to this phenomenon. The use of a multiport infusion device with a limited dead volume could limit hypoglycemia in patients on IIT.



Role of catheter colonization and infrequent hematogenous seeding in catheter-related infections  

Microsoft Academic Search

Adult cancer patients were prospectively studied to determine the relationship between ultrastructural and microbiologic catheter colonization and clinical catheter-related infections. Participants included 38 patients whose central venous catheters were removed because of suspected catheter infection (16 patients) or other noninfectious causes (22 controls). The presence of clinical infection was determined. Catheters were examined by microbiologic methods (sonication and roll-plate culture)

E. Anaissie; G. Samonis; D. Kontoyiannis; J. Costerton; U. Sabharwal; G. Bodey; I. Raad



Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter  

Microsoft Academic Search

Introduction:Cerebral Oximetry is an optical technique that allows for noninvasive and continuous monitoring of brain oxygenation by determining tissue oxygen saturation (SctO2). In conjunction with pulse oximetry, cerebral oximetry offers a promising method to estimate cerebral venous oxygen saturation (SvO2).Objective:The aim of this study was to validate the cerebral oximetry measurements with the cerebral oxygen saturation measured from blood drawn

K Rais-Bahrami; O Rivera; B L Short



Catheter-related Rahnella aquatilis bacteremia in a pediatric bone marrow transplant recipient.  

PubMed Central

Rahnella aquatilis, a rarely encountered member of the family Enterobacteriaceae, was twice isolated from the blood of a pediatric bone marrow transplant recipient. This is the first report of a pediatric case of R. aquatilis bacteremia, and it was probably related to inappropriate handling of a Hickman catheter.

Hoppe, J E; Herter, M; Aleksic, S; Klingebiel, T; Niethammer, D



Analysis of different genetic traits and their association with biofilm formation in Staphylococcus epidermidis isolates from central venous catheter infections.  


The aim of the present study was to characterize clinical isolates of Staphylococcus epidermidis, one of the bacterial species most often implicated in foreign-body-associated infections, for their ability to form biofilms and for the presence of mecA and IS256 element. Sixty-seven Staphylococcus epidermidis clinical isolates, obtained from implantable medical devices, were investigated. Overall, 70% of the strains were positive for ica operon genes, 85% possessed atlE, and 46% contained aap. In 89% of the population, the Congo red agar test confirmed the correlation between the presence of ica genes and slime expression. Almost all of the strains could be classified as biofilm producers by both the crystal violet assay and microscopy. The bacterial population studied showed a very high frequency of strains positive for mecA as well as for the IS256 element. Although well-structured biofilms have been previously observed only in those strains possessing genes belonging to the ica operon, this study demonstrates that strains lacking specific biofilm-formation determinants can be isolated from catheters and can form a biofilm in vitro. Hence, different and yet-to-be identified factors may work together in the formation and organization of complex staphylococcal microbial communities and sustain infections associated with implanted medical devices. PMID:17089093

Petrelli, D; Zampaloni, C; D'Ercole, S; Prenna, M; Ballarini, P; Ripa, S; Vitali, L A



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


ABSTRACT: 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

Kwakman, Paulus H; Müller, Marcella C; Binnekade, Jan M; van den Akker, Johannes P; de Borgie, Corianne A; Schultz, Marcus J; Zaat, Sebastian A



Analysis of Risk Factors for Central Venous Catheter-Related Complications: A Prospective Observational Study in Pediatric Patients With Bone Sarcomas.  


BACKGROUND:: The incidence of central venous catheter (CVC)-related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications. OBJECTIVE:: The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor. METHODS:: During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed. RESULTS:: Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed. CONCLUSIONS:: The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria. IMPLICATIONS FOR PRACTICE:: As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented. PMID:23782516

Abate, Massimo Eraldo; Sánchez, Olga Escobosa; Boschi, Rita; Raspanti, Cinzia; Loro, Loretta; Affinito, Domenico; Cesari, Marilena; Paioli, Anna; Palmerini, Emanuela; Ferrari, Stefano



'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.

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



Empiric antibiotic, mechanical ventilation, and central venous catheter duration as potential factors mediating the effect of a checklist prompting intervention on mortality: an exploratory analysis  

PubMed Central

Background Checklists are clinical decision support tools that improve process of care and patient outcomes. We previously demonstrated that prompting critical care physicians to address issues on a daily rounding checklist that were being overlooked reduced utilization of empiric antibiotics and mechanical ventilation, and reduced risk-adjusted mortality and length of stay. We sought to examine the degree to which these process of care improvements explained the observed difference in hospital mortality between the group that received prompting and an unprompted control group. Methods In the medical intensive care unit (MICU) of a tertiary care hospital, we conducted face-to-face prompting of critical care physicians if processes of care on a checklist were being overlooked. A control MICU team used the checklist without prompting. We performed exploratory analyses of the mediating effect of empiric antibiotic, mechanical ventilation, and central venous catheter (CVC)duration on risk-adjusted mortality. Results One hundred forty prompted group and 125 control group patients were included. One hundred eighty-three patients were exposed to at least one day of empiric antibiotics during MICU admission. Hospital mortality increased as empiric antibiotic duration increased (P<0.001). Prompting was associated with shorter empiric antibiotic duration and lower risk-adjusted mortality in patients receiving empiric antibiotics (OR 0.41, 95% CI 0.18-0.92, P=0.032). When empiric antibiotic duration was added to mortality models, the adjusted OR for the intervention was attenuated from 0.41 to 0.50, suggesting that shorter duration of empiric antibiotics explained 15.2% of the overall benefit of prompting. Evaluation of mechanical ventilation was limited by study size. Accounting for CVC duration changed the intervention effect slightly. Conclusions In this analysis, some improvement in mortality associated with prompting was explained by shorter empiric antibiotic duration. However, most of the mortality benefit of prompting was unexplained.



The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates - results of nation-wide cohort study in Germany  

PubMed Central

Background Very low birthweight (VLBW) newborns on neonatal intensive care units (NICU) are at increased risk for developing central venous catheter-associated bloodstream infections (CVC BSI). In addition to the established intrinsic risk factors of VLBW newborns, it is still not clear which process and structure parameters within NICUs influence the prevalence of CVC BSI. Methods The study population consisted of VLBW newborns from NICUs that participated in the German nosocomial infection surveillance system for preterm infants (NEO-KISS) from January 2008 to June 2009. Structure and process parameters of NICUs were obtained by a questionnaire-based enquiry. Patient based date and the occurrence of BSI derived from the NEO-KISS database. The association between the requested parameters and the occurrance of CVC BSI and laboratory-confirmed BSI was analyzed by generalized estimating equations. Results We analyzed data on 5,586 VLBW infants from 108 NICUs and found 954 BSI cases in 847 infants. Of all BSI cases, 414 (43%) were CVC-associated. The pooled incidence density of CVC BSI was 8.3 per 1,000 CVC days. The pooled CVC utilization ratio was 24.3 CVC-days per 100 patient days. A low realized staffing rate lead to an increased risk of CVC BSI (OR 1.47; p=0.008) and also of laboratory-confirmed CVC BSI (OR 1.78; p=0.028). Conclusions Our findings show that low levels of realized staffing are associated with increased rates of CVC BSI on NICUs. Further studies are necessary to determine a threshold that should not be undercut.



New technologies to prevent intravascular catheter-related bloodstream infections.  

PubMed Central

Most intravascular catheter-related infections are associated with central venous catheters. Technologic advances shown to reduce the risk for these infections include a catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine- impregnated catheters, minocycline-rifampin-impregnated catheters, and chlorhexidine- impregnated sponge dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during catheter insertion, specialized nursing teams, continuing quality improvement programs, and tunneling of short-term internal jugular catheters.

Mermel, L. A.



Catheter-related bloodstream infectio  

Microsoft Academic Search

Central venous catheters are associated with the vast majority of nosocomial, catheter-related bloodstream infections (CR-BSI).\\u000a Despite identification of multiple effective methods for preventing CR-BSI, it remains an important clinical problem. Catheters\\u000a coated with anti-infective substances, such as chlorhexidine and silver sulfadiazine or rifampin and minocycline, have shown\\u000a promising results in recent clinical trials, but confirmatory studies by different investigators are

David P. Calfee; Barry M. Farr



Central venous catheter - dressing change  


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


New Technologies to Prevent Intravascular Catheter-Related Bloodstream Infections  

Microsoft Academic Search

Most intravascular catheter-related infections are associated with central venous catheters. Technologic advances shown to reduce the risk for these infections include a catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine-impregnated catheters, minocycline- rifampin-impregnated catheters, and chlorhexidine-impregnated sponge dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during catheter insertion, specialized nursing teams, continuing quality improvement programs, and

Leonard A. Mermel



Cytotoxic therapy. Role of durable venous access.  


Aggressive chemotherapy regimens and supportive measures in haemato-oncology patients demand reliable venous access. Experience with this method in India has been limited. During a period of six months, we have used 42 subclavian indwelling catheters and 31 cubital Cavafix long lines. The mean age of patients in the two groups was 32 years and 7 years respectively. Subclavian catheters had a median duration of catheter placement of 46 days (range 4-145) and total 1494 catheter days, while cubital longlines yielded a median duration of insertion of 14 days (range 4-27) and total 508 catheter days. Catheter related complications were infection in 25% of patients, thrombophlebitis in 22%, blockade in 12% and misplacement in 17% in both groups taken together. The patients and families were extremely satisfied with the devices. Our experience supports further use of durable venous access in cancer patients. Implanted central venous catheters should be preferred whenever feasible. PMID:2096122

Rao, V K; Charak, B S; Giri, N K; Banavali, S D; Pai, S K; Pai, V R; Nadkarni, K S; Kurkure, P A; Saikia, T K; Gopal, R



Novel catheter-interventional strategy for intracardiac connecting of total anomalous pulmonary venous return in newborns with hypoplastic left heart-syndrome prior to hybrid approach.  


Total anomalous pulmonary venous return (TAPVR) associated with hypoplastic left heart-syndrome (HLHS) is a rare condition, and from the therapeutical point of view associated with a high Aristotle score and thus increased mortality. We report two newborns with HLHS, one with a supracardiac type of TAPVR and mildly obstructed left vertical vein, and the other with a supracardiac type of TAPVR in association with cor triatriatum and severely obstructed left-sided vertical vein. In both patients, radio frequency perforation from the pulmonary venous confluence to the systemic venous atrium was performed with consecutive gradual balloon dilatation, followed by stent placement in one. Hybrid stage I, and comprehensive stage II were successfully performed thereafter. Currently, both are awaiting their Fontan completion. Transcatheter intracardiac connecting of supracardiac type of TAPVR in newborns with HLHS is feasible and might render these children suitable candidates for further hybrid approach. © 2012 Wiley Periodicals, Inc. PMID:23255382

Schranz, Dietmar; Jux, Christian; Akintuerk, Hakan



Leaving previously implanted central venous catheters (ports) in place does not increase morbidity in patients undergoing autologous peripheral stem cell transplantation  

Microsoft Academic Search

We sought to assess if leaving in place a previously inserted noncolonized or infected implantable catheter (IC) is associated with an increase in morbidity in patients undergoing autologous peripheral stem cell transplantation (APSCT). Medical records from all patients between March 1997 and January 2002 undergoing APSCT with an IC in place were reviewed. Case group (IC in place) was compared

M H Miceli; L Dong; P Coria; A Vila; S Estrada; M C Garcia-Damiano; J Martinez-Rolón; G Milone; M C Dignani



A double lumen suprapubic urodynamic catheter.  


A 7.5 FG double lumen suprapubic urodynamic catheter has been developed to avoid the effects of urethral catheterization and provide reliable continuous pressure monitoring. The device is an adapted central venous catheter which is easily introduced through a peel-away sheath, after the insertion of a guide wire. PMID:7575301

Dewan, P A



Molecular-marker characterization of strawberry differential genotypes for race determination of isolates of Phytophthora fragariae var.fragariae Hickman  

Technology Transfer Automated Retrieval System (TEKTRAN)

Ten Fragaria L. (strawberry) differentials for race determination of isolates of Phytophthora fragariae C.J. Hickman var. fragariae, the causal organism of red stele root rot disease, were molecularly characterized with previously published polymerase chain reaction (PCR) based sequence-characterize...


Removal of Iatrogenic Foreign Bodies Within Cardiac Chambers with a New Snare Catheter  

PubMed Central

A technique for extracting an embolized venous catheter lodged in the pulmonary artery is described. A Deyhle-Seuberth catheter,* which is generally used to excise gastrointestinal polyps, was used successfully to accomplish the extraction. Images

Lijoi, Antonia; Barberis, Luca; Passerone, Gian Carlo; Venere, Giuseppe



Central venous catheterization in neonates: Comparison of complications with percutaneous and open surgical methods  

PubMed Central

Aim: To compare the complications of two methods of placement of central venous catheters. Materials and Methods: One hundred neonates had percutaneously inserted central venous catheters and another 100 had the catheters placed after surgical incision and vein location. Results No statistical difference was noted in the complication rate or efficacy Conclusions Both the methods are equally safe and effective.

Hosseinpour, Mehrdad; Mashadi, Mohammad Reza; Behdad, Samin; Azarbad, Zohre



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

PubMed Central

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

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



Critical appraisal of surgical venous access in children  

Microsoft Academic Search

Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems

M. A. Hollyoak; T. H. Ong; J. F. Leditschke



Recurrent catheter-related Rhodotorula rubra infection.  


A 34-year-old male receiving chronic parenteral nutrition for treatment of short bowel syndrome and intermittent immunosuppressive agents for juvenile rheumatoid arthritis developed recurrent, catheter-associated Rhodotorula rubra fungemia over a one-year period. Infection with this yeast is associated with insertion of central venous catheters. Recurrence of R. rubra infection is an unusual event that presumably occurred because of chronic skin colonization by the organism. PMID:14616717

Lo Re, V; Fishman, N O; Nachamkin, I



Catheter Ablation  


... radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe. Overview To understand catheter ...


Venobronchial fistula: a complication associated with central venous catheterization for chemotherapy.  


We report a case in which a venobronchial fistula developed 4 months after insertion of a silicone rubber chronic central venous catheter for chemotherapy administration. In retrospect, the tip of the catheter was in the azygous vein rather than in the superior vena cava. The suboptimal position of the catheter tip, in combination with the infusion of sclerosing chemotherapeutic agents and hyperalimentation solution, may have predisposed the patient to this complication. Accurate localization of the tip of central venous catheters at the time of placement should minimize catheter-related complications, including the rare complication of venobronchial fistula. After placement of chronic central venous catheters, biplanar chest X-rays should be obtained to determine catheter tip location prior to the instillation of chemotherapeutic agents. Any residual questions concerning the catheter tip location after biplanar X-rays should be addressed by prompt venography through the catheter. PMID:2306768

Beauregard, J F; Matsumoto, A H; Paul, M G; Holt, R W



Effects of thrombolysis and venous thrombectomy on valvular competence, thrombogenicity, venous wall morphology, and function  

Microsoft Academic Search

Purpose: The experiments were designed to compare the effects of thrombolytic therapy (TL) and balloon-catheter thrombectomy (TX) on valvular competence, thrombogenicity, venous wall morphology, and function after acute deep venous thrombosis (DVT) in canine veins. Methods: The femoral veins of male mongrel dogs were ligated proximally and distally for 48 hours to induce DVT. The thrombosed veins were treated with

Jae-Sung Cho; Eugenio Martelli; Geza Mozes; Virginia M. Miller; Peter Gloviczki



Catheter-associated bloodstream infections in the NICU: getting to zero.  


The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI. PMID:19451076

Curry, Sabra; Honeycutt, Michele; Goins, Gail; Gilliam, Craig


Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients.  


AIMS AND OBJECTIVES: To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. BACKGROUND: With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. DESIGN AND METHODS: Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. RESULTS: A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12·45 ± 6·17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. CONCLUSIONS: Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. RELEVANCE TO CLINICAL PRACTICE: Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upper extremity venous thrombosis. PMID:23710585

Yi, Xiao-Lei; Chen, Jie; Li, Jia; Feng, Liang; Wang, Yan; Zhu, Jia-An; Shen, E; Hu, Bing



Catheter-related thrombosis in cancer patients.  


Central venous catheters are commonly used in haematology departments for the administration of chemotherapy, blood products and parenteral nutrition in patients with haematological malignancy. Thrombosis is a recognized complication of such devices especially in oncology patients. Catheter-related thrombi (CRT) may lead to pulmonary embolism and infection, as well as catheter failure and potential delays in treatment. The vast majority of CRT are asymptomatic, thus a high index of suspicion is required in making the diagnosis. Doppler ultrasound or venography may be employed to identify CRT. Once confirmed, the initiation of treatment is a balance between the risks of anticoagulation against potential complications of CRT. A number of risk factors for CRT are discussed along with an overview of catheter types, their appropriate choice and intravascular positioning. PMID:23848991

Murray, Jim; Precious, Elizabeth; Alikhan, Raza



Value of superficial cultures for prediction of catheter-related bloodstream infection in long-term catheters: a prospective study.  


Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports. PMID:23850957

Guembe, M; Martín-Rabadán, P; Echenagusia, A; Camúñez, F; Rodríguez-Rosales, G; Simó, G; Echenagusia, M; Bouza, E



A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters  

Microsoft Academic Search

Background. Central venous catheters are frequently needed for the provision of haemodialysis, but their clinical usefulness is severely limited by infectious complications. The risk of such infections can be reduced by topical application of mupirocin to the exit sites of non-cuffed catheters or by the use of tunnelled, cuffed catheters. Whether mupirocin offers any addi- tional protection against infection in

David Wayne Johnson; Robert MacGinley; Troy David Kay; Carmel Mary Hawley; Scott Bryan Campbell; Nicole Maree Isbel; Peter Hollett


Implantable venous access devices in children with hemophilia: A report of low infection rates  

Microsoft Academic Search

Objective: The objective of this study was to define the efficacy and complications of implantable venous access devices (IVADs) in children with hemophilia. Study design: Records were reviewed on all patients with congenital blood coagulation disorders monitored at two children's hospitals in whom one or more central venous catheters had been placed. Results: Since 1989 external and implantable central venous

Kim Miller; George R. Buchanan; Susan Zappa; Cynthia Cochran; Joan Laufenberg; Desiree Medeiros; Joann Sanders



Cardiac arrhythmias associated with umbilical venous catheterisation in neonates  

PubMed Central

Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates.

Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico



Water-quality, well-construction, and ground-water level data for an investigation of radionuclides in ground water, Hickman and Maury counties, Tennessee  

USGS Publications Warehouse

Water quality, well construction, and groundwater level data were collected for an investigation of radionuclides in groundwater in Maury and Hickman Counties, Tennessee. Seventeen wells and 3 springs were sampled in Hickman County, and 20 wells were sampled in Maury County. Samples from each site were analyzed for radionuclides, common and trace inorganic ions, indicators of redox conditions, selected nutrients, total organic carbon, and selected physical characteristics. Well-construction data were obtained to help determine the source of the water. Where possible, groundwater level measurements were made for each well sampled. Samples were collected from May 1989 through mid-August 1989. Data are presented in tables. Maps of each county show the location of the sites sampled. (USGS)

Hileman, G. E.



Total parenteral alimentation via indwelling umbilical catheters in the newborn period.  

PubMed Central

Total parenteral alimentation (TPA) was delivered to 80 infants via indwelling umbilical artery and to 9 via indwelling umbilical venous catheters. The primary indication for catheter placement and maintenance was monitoring of arterial blood gases (umbilical venous catheter tip in left atrium) in a group of sick neonates requiring increased inspired oxygen or assisted ventilation. Results were compared with those from 23 infants who had tunnelled jugular catheters for a variety of chronic medical and surgical problems preventing gastric or intestinal feeding. A mean weight gain was achieved in both groups. Mortality and morbidity rates were similar in both groups. The most common complications were infection and thrombotic phenomena. Metabolic complications were few. It is concluded that infusing TPA solutions via indwelling umbilical catheters presents no greater risk than infusion via tunnelled jugular catheters, and provides a method for supplying adequate caloric intake for growth during the acute stage of illness.

Hall, R T; Rhodes, P G



Clinical Trial Evaluating a New Hub Device Designed to Prevent Catheter-Related Sepsis  

Microsoft Academic Search

A new commercial hub device designed to minimise catheter-related infections was evaluated in a prospective, randomised trial\\u000a in the intensive care and surgical units of the Hospital de Tortosa Verge de la Cinta in patients in whom the central venous\\u000a catheters were expected to remain indwelling for at least 7 days. The assessments conducted at catheter withdrawal included\\u000a cultures of

J. Luna; G. Masdeu; M. Pérez; R. Claramonte; I. Forcadell; F. Barrachina; M. Panisello



The prognostic significance of the ball-valve effect in Groshong catheters  

Microsoft Academic Search

The aim of the work was to determine the prognostic significance of the ball-valve effect (BVE) in a population of adult cancer patients with long-term indwelling Groshong catheters. A prospective longitudinal study of 356 Groshong catheters utilized for long-term central venous access was carried out in adult oncology patients. A subset analysis was undertaken of those catheters that developed BVE.

Blair Tolar; James R. Gould



Bacteremia Associated with Tunneled Hemodialysis Catheters: Outcome after Attempted Salvage  

PubMed Central

Background and objectives: Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success. Design, setting, participants, & measurements: In a prospective cohort study, all cases of catheter-associated bacteremia that occurred in a large dialysis center were identified during a 12-mo period. Catheter salvage was attempted according to a standard protocol in all cases in which a favorable early response to antibiotic therapy was seen, and patients were followed for at least 6 mo. Bacteremias, catheter changes, and all major clinical events were recorded. Results: During a period covering 252,986 catheter days, 208 episodes were identified involving 133 patients, 74% of which were selected for attempted salvage. Salvage was successful in 66.1% of incident bacteremias with a very low complication risk (0.9%). Some bacteremias, however, recurred as late as 6 mo after the initial infection; salvage was less likely to be successful in treating recurrences. Conclusions: Appropriately used catheter salvage can be successful in approximately two thirds of cases; however, recurrences continue to occur up to 6 mo later and are unlikely to be cured without catheter replacement.

Power, Albert; Singh, Seema; Choi, Peter; Taube, David H.; Duncan, Neill D.; Cairns, Tom D.



Disinfection of Needleless Catheter Connectors and Access Ports with Alcohol May Not Prevent Microbial Entry: The Promise of a Novel Antiseptic?Barrier Cap?  

Microsoft Academic Search

background. Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through

Steve Z. Menyhay; Dennis G. Maki



Umbilical vascular catheters: localization by two-dimensional echocardio/aortography.  


Umbilical vascular catheters are often necessary in the care of critically ill neonates. Position of the catheter tip is usually determined by roentgenography. Location of the umbilical arterial or venous catheter was determined by 2-dimensional echocardio/aortography in 55 consecutive infants and was compared to localization by thoraco-abdominal roentgenography. Most of the infants (76%) had respiratory distress syndrome or congenital heart disease. Echocaortographic localization of the umbilical arterial catheter correlated very closely (N = 50, sr = .90) with roentgenographic determination. For localization of the tip of the umbilical venous catheters, echocardiography was more accurate than roentgenography (employing contrast echocardiography for confirmation of cardiac chamber position). Two-dimensional echocardio/aortographic localization of the tip of indwelling umbilical vascular catheters is as accurate as roentgenography in the arterial system and more accurate than x-ray for umbilical venous catheters. Echocardio/aortography is superior to roentgenography (in localizing the catheter tip) because it 1) avoids ionizing radiation, 2) makes positioning of the patient unnecessary, 3) allows visualization of the catheter in relation to cardiovascular structures, and 4) may allow demonstration of intraarterial thrombo-emboli. PMID:7111058

George, L; Waldman, J D; Cohen, M L; Segall, M L; Kirkpatrick, S E; Turner, S W; Pappelbaum, S J



Paradoxical Catheter Embolism.  

National Technical Information Service (NTIS)

Paradoxical polythylene catheter embolism occurred in a 41-year-old woman. The fragment of intravenous catheter traversed a patent foramen ovale, lodged in a branch of a renal artery, and caused a renal infarct. When catheter embolism occurs and appropria...

G. Nash J. S. Moylan



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)



Radiofrequency Catheter Ablation Of Atrioventricular Nodal Reentry Tachycardia In A Patient With Inferior Vena Cava Anomaly  

PubMed Central

Curative radiofrequency catheter modification of the slow pathway is the recommended therapy for patients suffering from recurrent symptomatic atrioventricular nodal reentry tachycardia. This is usually performed via femoral vein and the inferior vena cava (IVC). Presence of venous occlusion or complex venous anomaly involving the IVC may preclude this approach. Here, we report a case with a complex venous anomaly involving the inferior vena cava, who underwent electrophysiological study and successful radiofrequency ablation by an alternative approach.

Karthigesan, Murugesan; Jayaprakash, Shenthar



Infection resistance of surface modified catheters with either short-lived or prolonged activity.  


It has been suggested that the invasion of microbes into the catheter tract occurs mainly at the time of catheter insertion. To investigate whether the presence of an antimicrobial environment during the initial period after insertion is sufficient to reduce the risk of subsequent catheter colonization and infection, we evaluated the use of benzalkonium chloride-heparin bonded (BZK-hep) central venous catheters, which exhibit short-lived surface antimicrobial activity, using a rat subcutaneous model. Bacterial adherence on these catheters was determined, seven days after challenging the insertion site with 10(6) cfu of Staphylococcus aureus. A chlorhexidine-silver sulphadiazine impregnated catheter (Arrowg+ard), with longer lasting surface antimicrobial activity, and a hydrophilic coated catheter ('Hydrocath'), were evaluated simultaneously for comparison. Unlike Arrowg+ard antiseptic catheters, BZK-hep 'Hydrocath' and control catheters had significant bacterial adherence on their surface. Arrowg+ard catheters were colonized in 19% of the animals compared with 100% in all the other groups (P < 0.05; mean cfu cm-2: control = 1.3 x 10(6), BZK-hep = 4.3 x 10(5), Hydrocath = 2 x 10(5), Arrowg+ard = 71). Our results indicate that catheters with short-lived surface antimicrobial activity are unlikely to provide long-term protection against catheter-related infection. The efficacy of Arrowg+ard catheters may be due to the initial high rate of kill and prolonged antimicrobial activity. PMID:8522776

Sampath, L A; Chowdhury, N; Caraos, L; Modak, S M



Clinical inquiries: what's the best way to manage upper extremity venous thrombosis?  


Standard management is best: start with unfractionated heparin or low-molecular-weight heparin and follow with long-term therapy with a vitamin K antagonist. Some evidence supports thrombolytic therapy, placement of a superior vena cava filter, or surgical thrombectomy in selected patients. Whether to remove venous catheters during initial treatment for catheter-induced venous thrombosis remains unclear, because limited studies address this issue specifically. PMID:20714458

Rabens, Clayton; Goodemote, Patricia; Jamieson, Barbara



Chronic venous insufficiency and venous leg ulceration  

Microsoft Academic Search

Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the

Isabel C. Valencia; Anna Falabella; Robert S. Kirsner; William H. Eaglstein



Anatomic considerations for central venous cannulation.  


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

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



Anatomic considerations for central venous cannulation  

PubMed Central

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

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



Venous Port Salvage Utilizing Low Dose tPA  

SciTech Connect

This study was performed to evaluate the efficacy of low dose tPA for catheter salvage in cases of fibrin sheath formation in patients with venous access ports. Prospective evaluation was accomplished in patients who had venous ports with catheter malfunction. There were a total of 50 patients and 56 occlusive events.Each patient had a catheter injection documenting a fibrin sheath.Patient population included 45 for chemotherapy and 5 for antibiotics.A low dose tPA regimen was instilled into the port and upon successful return of function, a completion venogram was accomplished. Fifty patients were enrolled in the study with the average time between placement and dysfunction of 99 days. Five patients had a second occlusive event (38.5 days) and one had a third event (27 days). All patients had a venogram confirming a fibrin sheath as the cause of catheter malfunction. The average dose of tPA was 2.29 mg (range 1 mg-4 mg). Success was achieved in 52 of the 56 occlusive events(92.9%). There were no bleeding complications. Catheter occlusion is a common complication of long-term venous access ports. Aggressive therapy with low-dose tPA can salvage function. It provides safe and effective therapy for venous port malfunction secondary to fibrin sheath.

Whigham, Cliff J.; Lindsey, Jason I.; Goodman, Chad J.; Fisher, Richard G. [Baylor College of Medicine, Department ofRadiology, One Baylor Plaza-MS 360, Houston, Texas77030-3487 (United States)



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:



Venous obstruction in permanent pacemaker patients: an isotopic study  

SciTech Connect

Isotope venography was used to study the venous circulation proximal to the superior vena cava in two groups of pacemaker patients, one with a single endocavitary electrode and the other with multiple pacing catheters. A control group of patients without pacemakers was also studied. Numerous abnormalities were found, especially in the group with multiple electrodes. These findings suggest that venous obstruction is a common complication of endocardial pacing.

Pauletti, M.; Di Ricco, G.; Solfanelli, S.; Marini, C.; Contini, C.; Giuntini, C.



Jugular Venous Bulb Oxyhemoglobin Saturation During Cardiac Surgery: Accuracy and Reliability Using a Continuous Monitor  

Microsoft Academic Search

Previous studies have demonstrated the feasibility of continuously monitoring jugular venous oxygen satu- ration (Sjo,) with a fiberoptic catheter during hypother- mic cardiopulmonary bypass (CPB). In the present study, with patients maintained at either moder- ate (28°C) or mild (32-34°C) hypothermia during CPB, Sjo, values obtained from a fiberoptic catheter were compared to intermittent samples analyzed by a co- oximeter.

Paolo Trubiano; Eric J. Heyer; David C. Adams; Donald J. McMahon; Ingrid Christiansen; Eric A. Rose



Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery  

Microsoft Academic Search

Continuous mixed venous oxygen saturation SvO2c was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h – 125 h) and there were no catheter-related

D. Schranz; S. Schmitt; H. Oelert; F. Schmid; R. Huth; B. Zimmer; A. Schuind; K. Vogel; H. Stopfkuchen; B. K. Jüngst



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


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



Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population.  


The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters. PMID:22210071

Weber, Joan M; Sheridan, Robert L; Fagan, Shawn; Ryan, Colleen M; Pasternack, Mark S; Tompkins, Ronald G


Continuous Monitoring of Mixed Venous Oxygen Saturation in a Pediatric Cardiac Surgical Patient  

Microsoft Academic Search

By inserting a 4-French Opticath catheter into the pulmonary artery through the right atrium and right ventricle during cardiac surgery in a 2-year-old boy, we could continuously monitor blood pressure and mixed venous oxygen saturation in the pulmonary artery. Because mixed venous oxygen saturation reflects instantly the balance between oxygen supply and demand, continuous monitoring can detect subtle changes in

Wen Je Ko; Ing Sh Chiu; Chung I Chang; Shu Hsun Chu



Catheter-Related Sepsis Due to Rhodotorula glutinis  

PubMed Central

We describe a central venous catheter-related (Port-A-Cath; Smiths Industries Medical Systems [SIMS] Deltec, Inc., St. Paul, Minn.) infection caused by Rhodotorula glutinis in a 51-year-old man with nasopharyngeal carcinoma. He was treated with fluconazole for 8 weeks and had the catheter removed. Two isolates of R. glutinis recovered from blood specimens (one obtained via peripheral veins and one via the catheter) before administration of fluconazole and one recovered from the removed catheter 17 days after initiation of fluconazole therapy exhibited high-level resistance to fluconazole (MICs, >256 ?g/ml). These three isolates were found to belong to a single clone on the basis of identical antibiotypes determined by the E test (PDM Epsilometer; AB Biodisk, Solna, Sweden) and biotypes determined by API ID32 C (bioMerieux, Marcy I'Etoile, France) and their identical random amplified polymorphic DNA patterns.

Hsueh, Po-Ren; Teng, Lee-Jene; Ho, Shen-Wu; Luh, Kwen-Tay



Superficial venous disease.  


Superficial venous disease is a common clinical problem. The concerning disease states of the superficial venous system are venous reflux, varicose veins, and superficial venous thrombosis. Superficial venous reflux can be a significant contributor to chronic venous stasis wounds of the lower extremity, the treatment of which can be costly both in terms of overall health care expenditure and lost working days for affected patients. Although commonly thought of as a benign process, superficial venous thrombosis is associated with several underlying pathologic processes, including malignancy and deep venous thrombosis. PMID:23885940

Brown, Kellie R; Rossi, Peter J



Upper Extremity Deep Vein Thrombosis: The Oft-forgotten Cousin of Venous Thromboembolic Disease  

Microsoft Academic Search

Opinion statement  Upper extremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due\\u000a to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central\\u000a venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only

Ronan Margey; Robert M. Schainfeld



Anatomical location of arterial and venous lines significantly affects motor performance in rats.  


Several motor-function scales have been developed to assess neurological function in animal models of stroke, subarachnoid hemorrhage and closed head injury. We hypothesize that the location of arterial and venous catheters, even in the absence of brain injury, may impact rats' motor performance. Our study examined the effect of catheter location, rate of infection and the time required for catheter placement. We further describe an original technique of tail artery cannulation without exposure of the artery. Sixty-one rats were anesthetized and randomly assigned to one of seven groups, including no catheter, tail artery or artery + vein catheters, or femoral artery or artery + vein catheters. A neurological severity score (NSS) was determined at 1 h, 24 h and 48 h after surgical preparation or catheter placement. NSS at 1 h after placement of unilateral and bilateral femoral catheters was higher than the NSS observed at 1 h after placement of tail arterial and venous catheters (P < 0.01). The NSS also was higher at 24 h in the bilateral femoral catheter groups as compared with the tail catheter groups (P < 0.05). There were no differences in the NSS observed between the groups that had tail catheters and the sham group at 1 h, 24 h or 48 h. Infection rate at the site of catheter placement and the time required for catheter placement was also higher in the femoral catheter groups (P < 0.001). Thus, we propose that the line location may bias a study's results and lead to deceptive interpretations of neurological assessment following rat head injury. Compared to femoral vessels, tail blood vessels are preferable locations for lines placement. PMID:22943533

Ohayon, Sharon; Gruenbaum, Shaun E; Artru, Alan A; Boyko, Matthew; Gruenbaum, Benjamin F; Dubilet, Michael; Leibowitz, Akiva; Shapira, Yoram; Teichberg, Vivian I; Zlotnik, Alexander



Successful percutaneous transcatheter patent foramen ovale closure through the right internal jugular vein using a steerable catheter.  


Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a deflectable catheter delivery system in a patient with a PFO, recurrent stroke, and an inferior vena cava filter. © 2013 Wiley Periodicals, Inc. PMID:23413211

Hascoet, Sebastien; Fraisse, Alain; Elbaz, Meyer



A simple inexpensive urodynamic catheter.  


Described herein is an easily constructed and inexpensive triple lumen urodynamic catheter. The catheter permits accurate and reproducible simultaneous measurements of urethral and bladder pressure. PMID:513224

Woodside, J R; McGuire, E J



The dos and do knots of central venous catheterization.  


Central venous catheterization plays an important role in patients with end-stage renal disease undergoing hemodialysis. Placement of a right subclavian hemodialysis catheter was complicated by looping and entrapment of the guidewire. Computed tomographic and three-dimensional scans were essential in locating and determining that the guidewire was outside the vessel. PMID:22414709

Vetrugno, Luigi; Piccoli, Gianluca; Costa, Maria Gabriella; Pompei, Livia; Chiarandini, Paolo; Morelli, Angelo; Della Rocca, Giorgio



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: [Mayo Clinic, Department of Radiology (United States)



Venous flaps.  


One of the earliest postulates concerning the physiological basis of flap survival is attributed to Sushruta, who, in his inimitable style, very succinctly noted in Sanskrit verse the following words: "through continuity survives." Sanskrit being a very telegraphic language, what derives from these words is as follows: Through (the flap's) continuity (with its original location) (it) survives. The principle of continuity has survived through the ages, though continuity has come to imply vascular continuity based on the Harvesian model of circulation. No matter how we classify flaps, i.e., random or axial, the Harvesian model of circulation is the key to the mechanism of survival. Lately, however, a new category of flaps, that is, "venous flaps," have been reported by a number of investigators where the classical Harvesian model is not in evidence, at least apparently. The following effort is directed toward presenting the existing data on this subject for future guidance in research and clinical applications. PMID:8446733

Thatte, M R; Thatte, R L



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:; 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)



Auditing urinary catheter care.  


Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided. PMID:22375340

Dailly, Sue


Keeping central venous lines open: a prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients  

Microsoft Academic Search

Objective. To prevent catheter occlusion, intermittently used central venous catheters are frequently sealed with vitamin C solution or heparin solution between use. The present study was designed to test the effectiveness of this approach and to compare the efficiency of sealing solutions. Design and setting. Prospective randomized study performed on a 9-bed medical ICU and on medical wards of an

Christian Rabe; Tobias Gramann; Ximena Sons; Marc Berna; María Ángeles González-Carmona; Hans-Ulrich Klehr; Tilman Sauerbruch; Wolfgang H. Caselmann



Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey  

Microsoft Academic Search

Background & Aims: Central venous catheter (CVC) infection is the most frequent complication during home parenteral nutrition (HPN). We prospectively assessed incidence and catheter-related sepsis (CRS)-associated factors in the 42 adult patients enrolled in our HPN centre since its opening. Methods: Age, frequency of infusions, CVC type, autonomy or nurse\\/family aid, underlying disease, involved infectious organism(s), hospital stay, efficacy of




A rare complication of endovenous laser ablation: intravascular laser catheter breakage.  


During endovenous laser ablation, which is performed as an alternative to surgery for the treatment of superficial venous insufficiency of lower extremity and associated varicose veins, it was realised that the distal end of the catheter protecting the fibre sheared off; the retained catheter fragment in the saphenous vein was removed by a mini incision. Herein, we aim to present a rare complication of endovenous laser ablation. PMID:23513025

Bozoglan, Orhan; Mese, Bulent; Inci, Mehmet Fatih; Eroglu, Erdinc



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

PubMed Central

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

Becker, Karsten; Merens, Audrey; Ferroni, Agnes; Dubern, Beatrice; Vu-Thien, Hoang



A prospective, randomized study in critically ill patients using the Oligon Vantex ® catheter  

Microsoft Academic Search

Microbial colonization and the incidence of catheter-related bloodstream infections (CR-BSI) associated with Oligon Vantex® silver central venous catheters (CVC) in critically ill patients were determined. A prospective, randomized, controlled 17-month trial was carried out in an intensive care unit (ICU). All patients requiring a triple-lumen CVC for four days or longer were enrolled. Patients were randomized to receive a standard

L Corral; M Nolla-Salas; J Ibañez-Nolla; M. A León; R. M D??az; M Cruz Mart??n; R Iglesia; R Catalan



Use of Tissue Plasminogen Activator for Reopening of Clotted Dialysis Catheters  

Microsoft Academic Search

The use of central venous catheters as permanent vascular access in chronic hemodialysis is complicated by clotting. We have tried a nonallergenic thrombolytic agent, tissue plasminogen activator (t-PA), to dissolve catheter luminal thrombosis. Eight patients, 7 in chronic hemodialysis and 1 treated by immune adsorption had 18 treatments with locally applied t-PA (2 mg\\/2 cm3). Fifteen out of 16 treatments

Dag Paulsen; Anna Reisœther; Marianne Aasen; Per Fauchald



Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter  

Microsoft Academic Search

The use of central venous catheters as access for hemodialysis has become common in children with end-stage renal disease.\\u000a Phrenic nerve palsy is an unusual complication of this procedure. We report a case of delayed right diaphragmatic palsy due\\u000a to phrenic nerve damage resulting from an indwelling right subclavian catheter in a 3-year-old child.

Sandeep Aggarwal; Pankaj Hari; Arvind Bagga; S. N. Mehta



Selection of the vascular catheter: can it minimise the risk of infection?  


Data regarding the prevention of catheter-related bloodstream infection (CRBSI) by making the correct decisions about when to place a central line, the appropriate selection of catheter composition and the size and number of lumens, a suitable choice of insertion site and the technique used are not well reported in recent medical literature. There is no clear evidence that the composition of the catheters presently on the market makes a significant difference to the risk of infection. Several prospective studies suggest that femoral vein location represents the highest risk of infection, followed by jugular vein and subclavian vein positioning, however, most articles do not correct for basic confounding variables. Several papers have reported that arterial catheters have a similar risk of infection as central venous catheters (CVCs). The slight increase in infection risk when using multi-lumen catheters is probably offset by their improved convenience. Current evidence does not support routine tunnelling of short-term catheters until its efficacy is evaluated at different placement sites, using specific catheters and situations and in relation to other preventive interventions. Cuffing is usually applied only to long-term tunnelled catheters. The available evidence suggests that chlorhexidine-silver sulfadiazine, minocycline-rifampicin CVCs and antifungal-coated catheters are useful in decreasing the incidence of CRBSI when other measures are not effective. PMID:21130605

Bouza, E; Guembe, M; Muñoz, P



Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients  

SciTech Connect

Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data.Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data.Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant (p = 0.6). Aspiration occlusion occurred in 13 patients (11.7%). Intracatheter urokinase was infused in eight of these patients and successfully restored catheter function in all but two instances. These complication rates are comparable to or better than those reported with chest ports.Conclusion: Peripheral ports for long-term central venous access placed by interventional radiologists in the interventional radiology suite are as safe and as effective as chest ports.

Bodner, Leonard J.; Nosher, John L.; Patel, Kaushik M.; Siegel, Randall L.; Biswal, Rajiv; Gribbin, Christopher E.; Tokarz, Robert [Department of Radiology, MEB 404, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903-0019 (United States)



Modeling of Fungal Biofilms Using a Rat Central-vein Catheter  

PubMed Central

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

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



Catheter sepsis during parenteral nutrition: the safety of long-term OpSite dressings.  


A prospective controlled study of the safety of various catheter dressing protocols was carried out in 168 patients receiving parenteral nutrition via an infraclavicular central venous catheter. Four protocols were compared: 36 patients received gauze dressings changed three times per week; 31 received OpSite dressings changed every 7th day (OpS-7), 32 received OpSite changed every 10th day (OpS-10), and 69 received OpSite changed twice weekly (OpS-ICU). Mean duration of parenteral nutrition was approximately 2 weeks and all groups were well matched except that OpS-ICU patients suffered more frequently from an acute illness. Catheter-related sepsis was identified by clinical signs of systemic sepsis, positive peripheral venous blood and catheter-tip cultures and/or defervescence of fever after catheter removal. Catheter-related sepsis rates were low in all groups: 1/36 for Gauze, 0/31 for OpS-7, 1/32 for OpS-10, and 2/69 for OpS-ICU. Septicemia attributable to causes apart from catheter sepsis occurred in two, two, three, and four patients, respectively. Bacterial colonization of skin beneath OpSite was no more common in the OpS-10 than in the other groups. Signs of inflammation at catheter insertion sites were common in all groups but did not relate closely to skin colonization. OpSite can be safely applied to central venous catheters inserted under strict aseptic conditions, even in patients with open septic drainage. Dressings can be left in place for 7 days with a margin of safety lasting to 10 days, thus saving on cost of materials and nursing time. PMID:3138446

Young, G P; Alexeyeff, M; Russell, D M; Thomas, R J


Coronary venous oximetry using MRI.  


Based on the Fick law, coronary venous blood oxygen measurements have value for assessing functional parameters such as the coronary flow reserve. At present, the application of this measure is restricted by its invasive nature. This report describes the design and testing of a noninvasive coronary venous blood oxygen measurement using MRI, with a preliminary focus on the coronary sinus. After design optimization including a four-coil phased array and an optimal set of data acquisition parameters, quality tests indicate measurement precision on the order of the gold standard optical measurement (3%O(2)). Comparative studies using catheter sampling suggest reasonable accuracy (3 subjects), with variability dominated by sampling location uncertainty ( approximately 7%O(2)). Intravenous dipyridamole (5 subjects) induces significant changes in sinus blood oxygenation (22 +/- 9% O(2)), corresponding to flow reserves of 1.8 +/- 0.4, suggesting the potential for clinical utility. Underestimation of flow reserve is dominated by right atrial mixing and the systemic effects of dipyridamole. Magn Reson Med 42:837-848, 1999. PMID:10542342

Foltz, W D; Merchant, N; Downar, E; Stainsby, J A; Wright, G A



Dedicated radial ventriculography pigtail catheter.  


A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The "short" dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The "long" dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs. PMID:23773499

Vidovich, Mladen I


[Evaluation of peripherally inserted central catheters in a pediatric population].  


A peripherally inserted central catheter (PICC) is a central venous access mostly used in France in the adult population, whereas it is only rarely used in the pediatric population. The main objective of this study was to analyze a cohort of children treated with PICCs inserted under radiological guidance. We conducted a single-center study in the Radiology department of Nice University Hospital and the Lenval Foundation Children's Hospital. During a 43-month period between November 2008 and June 2012, a total of 67 catheter placement attempts were performed in 57 pediatric patients aged from 7 months to 18 years. We achieved 95.5% technical success with a median procedure duration of 17min. Only 6% of the PICC placements required light intravenous sedation; all the others were performed using a combination of local anesthesia, EMLA cream, and equimolar mixture of oxygen and nitrous oxide (EMONO). Subjective scale analysis of pain during catheter insertion showed a median score of 2.1. Catheter life ranged from 1 to 210 days (median, 38.3 days) with the treatment fully completed in 75% of the cases. The overall complication rate was 18.7% (4.9 per 1000 catheter-days), largely dominated by mechanical complications (9.4%) such as accidental removal (6.2%) or catheter obstruction (3.1%). Infectious complications occurred in 7.8% of the patients. The duration of catheterization and the use of tape to secure the catheter significantly affected the occurrence of complications. Peripheral insertion of central catheters was highly feasible in infants and children. It is a simple, safe, and effective alternative to intravenous central devices in the pediatric population. The occurrence of complications, typically mechanical, must be reduced and prevented by strict management of this type of central line by the nursing team. PMID:23953872

Baudin, G; Occelli, A; Boyer, C; Geoffray, A; Chevallier, P



Air tract in the thrombus: paradoxical cerebral air embolism through a residual catheter track.  


We report a 49-year-old woman who sustained ischemic stroke after central venous catheter removal. Brain computed tomography (CT) scan revealed air bubbles in the subarachnoid vessels. Contrast-enhanced chest CT and ultrasonography revealed a residual catheter track in the center of a jugular vein thrombus. A right-to-left shunt was confirmed by transthoracic echocardiography and transcranial Doppler with bubble contrast. The patient was ultimately diagnosed with a paradoxical cerebral air embolism through the residual catheter track in the thrombus. Rapid recognition, response, and prompt diagnosis are the most important factors in the successful treatment of such an embolism. PMID:21820322

Oyama, Naoki; Sakaguchi, Manabu; Kitagawa, Kazuo



The Role of Intravascular Ultrasound in Venous Thromboembolism  

PubMed Central

Venous thromboembolism (VTE) remains a serious problem, and treatments surrounding this potentially life-threatening disease continue to evolve. Evidence-based guidelines purport the need for minimally invasive catheter-based procedures as part of the armamentarium to prevent and treat VTE. When the appropriate clinical scenarios arise, intravascular ultrasound (IVUS) becomes a necessary part of those procedures to provide alternative imaging that complements traditional venography. IVUS of the major axial veins provides a 360-degree two-dimensional gray scale ultrasound image of lumen and vessel wall structures. IVUS remains the criterion standard for venous imaging when contemplating catheter-based procedures from the common femoral vein to the inferior vena cava. Not only can precise location and size of these veins be determined by the IVUS probe from key landmarks and venous branches, but other important abnormalities can be visualized. These include external compression, acute and chronic thrombus, fibrosis, mural wall thickening, spurs, and trabeculations. Specific procedures that use IVUS include the treatment of venous obstruction and the placement of vena cava filters at the bedside. IVUS remains a vital part of accurately imaging the major axial veins when contemplating catheter-based procedures to prevent or treat VTE-related disorders.

McLafferty, Robert B.



[Experiences with the Port-A-Cath system, a fully implantable central venous access system, in children].  


The Port-A-Cath-system is a totally implantable catheter system for central venous access. It consists of a subcutaneous injection port, fixed on the pectoral fascia, and a silicone catheter, positioned via a jugular vein into the right atrium. This system was utilised in 14 children (between 10 weeks and 14 years of age) for administration of chemotherapy, total parenteral nutrition, delivery of drugs or blood products, and venous blood sampling over a 15 months period. The device presents only few problems in respect of biocompatibility. Three complications occurred: one case of sepsis, one of catheter dislocation and one of catheter occlusion. The advantage of the total implantability of the system and the low complication rate are attractive alternatives to other methods of prolonged central venous access. PMID:3551382

Hager, J; Margreiter, R; Ausserer, B



Arterial catheter-related infection of 2,949 catheters  

Microsoft Academic Search

INTRODUCTION: Which particular arterial catheter site is associated with a higher risk of infection remains controversial. The Centers for Disease Control and Prevention guidelines of 1996 and the latest guidelines of 2002 make no recommendation about which site or sites minimize the risk of catheter-related infection. The objective of the present study was to analyze the incidence of catheter-related local

Leonardo Lorente; Ruth Santacreu; María M Martín; Alejandro Jiménez; María L Mora



A mild restraint and chronic venous catherization system for cats.  


An inexpensive and minimally restrictive restraint system for cats is described which protects any temporary connections to chronic physiological implants during recording sessions and permits free movement of the head and extremities for behavioral studies. Procedures for constructing and implanting a chronic indwelling venous catheter device are also described which allows, directly with a syringe of via a connector system, for intravenous drug infusions in cats. These catheters have remained intact and relatively free of infection for a period of months before tissue rejection begins at the site of the subcutaneous implant. PMID:1187735

Smith, J M; Renault, P F; Schuster, C R


Venous leg ulcers.  


In 1837, Piorry, a French professor of medicine stated, "It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries." Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite the fact that millions of Americans are afflicted with chronic venous insufficiency and hundreds of thousands suffer from debilitating lower extremity venous ulcers. A better understanding of the pathophysiology of venous disease is necessary to provide appropriate and efficient medical care for patients suffering from lower extremity venous ulcerations. PMID:14614698

Gonsalves, Carin F



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:; Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael, E-mail: [Yale University School of Medicine, Department of Diagnostic Radiology, Vascular and Interventional Radiology (United States)



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.



Transcutaneously Tunneled Central Venous Lines in Cancer Patients: An Analysis of Device-Related Morbidity Factors Based on Prospective Data Collection  

Microsoft Academic Search

Abstaract  Background: Long-term transcutaneous tunneled central venous catheters are frequently placed in cancer patients, accounting for significant costs and morbidity. Factors influencing outcome, though, are poorly studied.Methods: Between June 1991 and June 1993, 923 central venous tunneled catheters were placed in 791 patients at Memorial Sloan-Kettering Cancer Center. Placement-, device-, and patient-related parameters were charted prospectively (median follow-up: 120 days) and

Roderich E. Schwarz; Daniel G. Coit; Jeffrey S. Groeger



Intravascular catheter-related bloodstream infection caused by Abiotrophia defectiva in a neutropenic child.  


Bacteraemia and endocarditis are the most frequently reported clinical infections due to Abiotrophia defectiva species. This species has been rarely implicated in infections in neutropenic patients. We report a rare case of long-term venous catheter-related infection caused by A. defectiva that occurred in a febrile child who had neutropenia and Langerhans' cell histiocytosis. PMID:23378563

Phulpin-Weibel, A; Gaspar, N; Emirian, A; Chachaty, E; Valteau-Couanet, D; Gachot, B



Mycobacterium septicum sp. nov., a new rapidly growing species associated with catheter-related bacteraemia  

Microsoft Academic Search

Rapidly growing mycobacteria are capable of causing several clinical diseases in both immunosuppressed and immunocompetent individuals. A previously unidentified, rapidly growing mycobacterium was determined to be the causative agent of central line sepsis in a child with underlying metastatic hepatoblastoma. Four isolates of this mycobacterium, three from blood and one from the central venous catheter tip, were studied. Phenotypic characterization,

Mark F. Schinsky; Michael M. McNeil; Anne M. Whitney; Arnold G. Steigerwalt; Brent A. Lasker; Margaret M. Floyd; Geoffrey G. Hogg; Don J. Brenner; June M. Brown


Atrial fibrillation: catheter ablation.  


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



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


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



Central venous injuries of the subclavian-jugular and innominate-caval confluences.  

PubMed Central

Injuries to the central venous system can result from penetrating trauma or iatrogenic causes. Injuries to major venous confluences can be particularly problematic, because the clavicle and sternum seriously limit exposure of the injury site. We report our institution's experience with central venous injuries of the subclavian-jugular and innominate-caval venous confluences. Significant injuries of the subclavian-jugular venous confluence frequently result from penetrating trauma, while injuries to the innominate-caval confluence are usually catheter-related. Median sternotomy provides adequate exposure of the innominate-caval confluence, while exposure of the subclavian-jugular venous confluence requires extension of the median sternotomy incision into the neck and resection of the clavicle. The literature is reviewed.

Baumgartner, F J; Rayhanabad, J; Bongard, F S; Milliken, J C; Donayre, C; Klein, S R



Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis  

SciTech Connect

Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

Nazir, Sarfraz Ahmed, E-mail:; Ganeshan, Arul [John Radcliffe Hospital, Department of Radiology (United Kingdom); Nazir, Sheraz [John Radcliffe Hospital, Department of Medicine (United Kingdom); Uberoi, Raman [John Radcliffe Hospital, Department of Radiology (United Kingdom)



Onyx Embolization of Dural Arteriovenous Fistula, using Scepter C Balloon Catheter: a Case Report.  


We report our experience using Onyx for embolization of dural arteriovenous fistula (DAVF) under dual lumen balloon catheter flow arrest. Transfemoral cerebral angiography revealed a superior sagittal sinus (SSS) DAVF that was supplied via multiple branches of the external carotid arteries, the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery. There was no anterograde venous drainage through the SSS, and venous drainage was almost retrograde through the medullary and cortical veins. Under general anesthesia, a transvenous approach was utilized to place the microcatheter close to the fistula site. After intravenous embolization with various coils, DAVF was partially occluded; Balloon catheter gained access to the DAVF via the right middle meningeal artery. We injected Onyx through the Scepter C catheter, after which DAVF was nearly completely occluded. Balloon-assisted Onyx embolization is a feasible and effective approach for the management of DAVF. PMID:24024076

Kim, Sung Tae; Jeong, Hae Woong; Seo, Jeonghwa



Onyx Embolization of Dural Arteriovenous Fistula, using Scepter C Balloon Catheter: a Case Report  

PubMed Central

We report our experience using Onyx for embolization of dural arteriovenous fistula (DAVF) under dual lumen balloon catheter flow arrest. Transfemoral cerebral angiography revealed a superior sagittal sinus (SSS) DAVF that was supplied via multiple branches of the external carotid arteries, the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery. There was no anterograde venous drainage through the SSS, and venous drainage was almost retrograde through the medullary and cortical veins. Under general anesthesia, a transvenous approach was utilized to place the microcatheter close to the fistula site. After intravenous embolization with various coils, DAVF was partially occluded; Balloon catheter gained access to the DAVF via the right middle meningeal artery. We injected Onyx through the Scepter C catheter, after which DAVF was nearly completely occluded. Balloon-assisted Onyx embolization is a feasible and effective approach for the management of DAVF.

Kim, Sung Tae; Seo, Jeonghwa



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.



Catheter-related thrombosis in hematologic patients.  


For many years central venous catheters (CVC) have been utilized to monitor hemodynamics and to deliver parenteral nutrition, blood products, pharmacological therapies or infusion fluids. Recently, CVC use has greatly increased with significant impact on the administration of chemotherapy, stem cell transplantation and other treatments to cancer patients. However, CVC use may be accompanied by a variety of side-effects, which increase with the duration of implantation. The most common catheter-related complications are thrombotic events and blood-stream infections. The true incidence of these complications is still uncertain and has changed over time due to CVC device improvement. More data are available in solid tumor than in oncohematologic patients. Recently, much attention has been paid to the issues of prevention and treatment of these complications. Some strategies have been proposed: fixed dose warfarin or low molecular weight heparins have been evaluated in some clinical trials of thromboprophylaxis in this condition. However, more studies are still needed to address this issue. This review will focus on CVC use and complications in oncohematologic patients. PMID:16029971

Moia, Marco; Cortelezzi, Agostino; Falanga, Anna



Successful prevention of tunneled, central catheter infection by antibiotic lock therapy using cefotaxime  

PubMed Central

BACKGROUND: Chronic hemodialysis patients frequently require vascular access through central venous catheters (CVCs). The most significant complication of these catheters is infection. This risk can be lowered by the use of an antibiotic-Heparin lock. This study focuses on hemodialysis patients using Tunneled-cuffed catheters (TCC), to assess the rate of catheter-related infections (CRI) in catheter-restricted filling with Cefotaxime and Heparin in end stage renal disease patients. METHODS: A double-blind randomized study was conducted to compare 5000 U/ml Heparin plus10 mg/ml cefotaxime (CE/HS) as catheter-lock solutions, with Heparin (5000 U/ml) alone. A total of 30 patients with end-stage renal disease and different etiologies, were enrolled for chronic hemodialysis with permanent catheters from December 2009 to March 2010. These patients were randomly assigned to two groups of 15 members. Blood samples were collected for culture, sensitivity, and colony count, from the catheter lumen and the peripheral vein. CRI was considered as the end point. RESULTS: The rate of CRI was significantly lower in the cefotaxime group versus control group (p < 0.001). No exit site infection was occurred in both groups. Infection-free survival rates at 180 days were 100% for the CE/HS group, and 56% for the HS group. CONCLUSIONS: Antibiotic lock therapy using cefotaxime reduces the risk of CRI in hemodialysis patients.

Mortazavi, Mojgan; Alsaeidi, Samira; Sobhani, Roohollah; Salimi, Fereshte; Atapour, Abdolamir; Sharif, Nima; Akbari, Mojtaba; Pakzad, Bahram; Jazi, Amir Hosein Davarpanah



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.

Coon, W W



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


Infectious complications of percutaneous central venous catheterization in pediatric patients  

Microsoft Academic Search

Objective  Analysis of infectious complications and risk factors in percutaneous central venous catheters.\\u000a \\u000a \\u000a \\u000a Design  One-year observational, prospective, multicenter study (1998–1999).\\u000a \\u000a \\u000a \\u000a Setting  Twenty Spanish pediatric intensive care units.\\u000a \\u000a \\u000a \\u000a Patients  Eight hundred thirty-two children aged 0–14 years.\\u000a \\u000a \\u000a \\u000a Intervention  None.\\u000a \\u000a \\u000a \\u000a Measurements and main results  One thousand ninety-two catheters were analyzed. Seventy-four (6.81%) catheter-related bloodstream infections (CRBSI) were\\u000a found. The CRBSI rate was 6.4 per 1,000 CVC days (95% CI 5.0–8.0).

M. Ángeles García-Teresa; Juan Casado-Flores; M. Ángel Delgado Domínguez; Jorge Roqueta-Mas; Francisco Cambra-Lasaosa; Andrés Concha-Torre; Cristina Fernández-Pérez



A survey of invasive catheter practices in U.S. burn centers.  


Burn-specific guidelines for optimal catheter rotation, catheter type, insertion methods, and catheter site care do not exist, and practices vary widely from one burn unit to another. The purpose of this study was to define current practices and identify areas of practice variation for future clinical investigation. An online survey was sent to the directors of 123 U.S. burn centers. The survey consisted of 23 questions related to specific practices in placement and maintenance of central venous catheters (CVCs), arterial catheters, and peripherally inserted central catheters (PICCs). The overall response rate was 36%; response rate from verified centers was 52%. Geographic representation was wide. CVC and arterial catheter replacement varied from every 3 days (24% of sites) to only for overt infection (24% of sites); 23% of sites did not use the femoral position for CVC placement. Nearly 60% of units used some kind of antiseptic catheter. Physicians inserted the majority of catheters, and 22% of sites used nonphysicians for at least some insertions. Ultrasound was routinely used by less than 50% of units. A wide variety of post-insertion dressing protocols were followed. PICCs were used in some critically injured patients in 37% of units; the majority of these users did not rotate PICCs. Thus, it can be surmised that wide practice variation exists among burn centers with regard to insertion and maintenance of invasive catheters. Areas with particular variability that would be appropriate targets of clinical investigation are line rotation protocols, catheter site care protocols, and use of PICCs in acute burns. PMID:23147213

Sheridan, Robert L; Neely, Alice N; Castillo, Mayra A; Shankowsky, Heather A; Fagan, Shawn P; Chung, Kevin K; Weber, Joan M


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)



Venous access ports: frequency and management of complications in oncology patients.  


Totally implantable venous access ports have been in use now for over 20 years. They are valuable instruments for long-term intravenous treatment of patients with cancer. Apart from perioperative difficulties, the typical complications associated with venous access ports are venous thrombosis, port infection, extravasation, pinch off syndrome, dislocation, occlusion and catheter leakages. The vast majority of these complications are avoidable, or at least the complication rate can be reduced with health care personnel training and education of patients. This review will give a broad overview on the frequency and possible complications related to port devices. Furthermore, this review suggests strategies for management including proposals to avoid such complications. PMID:18596390

Jordan, Karin; Behlendorf, Timo; Surov, Alexey; Kegel, Thomas; Maher, Gita; Wolf, Hans-Heinrich



Upper extremity venous aneurysm as a source of pulmonary emboli.  


Spontaneous venous aneurysms of the upper extremities and neck are rare and typically asymptomatic. We present the first reported case of a symptomatic, primary upper extremity venous aneurysm in a patient who initially presented with pulmonary emboli. A 22-year-old patient was admitted with chest pain, dyspnea, and a right axillary mass. Computed tomography revealed diffuse, bilateral pulmonary emboli in addition to a thrombosed axillary vein. Venography confirmed the diagnosis, and also revealed a subclavian vein stenosis at the crossing of the first rib. Pharmacomechanical thrombolysis, catheter-directed thrombolysis, and venoplasty were performed with adequate flow restoration, also revealing the presence of a previously thrombosed proximal brachial/distal axillary venous aneurysm. Hematologic testing showed a positive and persistent lupus anticoagulant. The patient declined surgical reconstruction and opted for long-term anticoagulation. At 24 months, the patient continued to remain symptom-free. PMID:23380560

Wallace, Justin R; Baril, Donald T; Chaer, Rabih A



Intravascular Catheter-Associated Infections  

Microsoft Academic Search

Serious infections associated with intravascular catheters are common. The available data suggests there are likely to be\\u000a more than 500 000 cases of catheter-associated bloodstream infections occurring annually in Western Europe and the USA. These\\u000a may be associated with as many as 100?000 deaths. The pathophysiology of this common condition is still not fully elucidated.\\u000a With catheters that are in

J. A. Crump; P. J. Collignon



Accessory hepatic vein to pulmonary venous atrium as a cause of cyanosis after the Fontan operation  

Microsoft Academic Search

The presence of an accessory hepatic vein to the pulmonary venous atrium should be considered in the setting of progressive cyanosis following the Fontan procedure. An inferior vena caval angiogram with “levophase” should demonstrate it. Surgical intervention or trans-catheter occlusion should lead to prompt resolution of cyanosis.

Patricio Fernandez-Martorell; Mark S. Sklansky; Victor W. Lucas; Iraj A. Kashani; Mark W. Cocalis; Stuart W. Jamieson; Abraham Rothman



64-slice CT imaging in a case of total anomalous pulmonary venous circulation  

PubMed Central

For long, catheter angiography has been the investigation of choice for the diagnosis of congenital anomalies of the heart such as total anomalous pulmonary venous circulation (TAPVC). In the last few years, MRI and multislice CT scan have also been introduced for this purpose. We report a case where 64-slice CT scan was found very useful in the evaluation of TAPVC.

Shaheen, Feroze; Gojwari, Tariq A.; Andrabi, Manzoor; Sofi, Sanjid; Singh, Manjit



Developmental venous anomalies (DVA): The so-called venous angioma  

Microsoft Academic Search

Summary Following a review of the literature it is possible to demonstrate the “normality” of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superfical and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with

Pierre Lasjaunias; Patricia Burrows; Chantal Planet



Catheter related blood stream infections in the paediatric intensive care unit: A descriptive study  

PubMed Central

Context: Catheter related blood stream infections (CRBSI) contributes significantly to morbidity, mortality and costs in intensive care unit (ICU). The patient profile, infrastructure and resources in ICU are different in the developing world as compared to western countries. Studies regarding CRBSI from pediatric intensive care unit (PICU) are scanty in the Indian literature. Aims: To determine the frequency and risk factors of CRBSI in children admitted to PICU. Settings and Design: Descriptive study done in the PICU of a tertiary care teaching hospital over a period of four months. Materials and Methods: Study children were followed up from the time of catheterization till discharge. Their clinical and treatment details were recorded and blood culture was done every 72 h, starting at 48 h after catheterization. The adherence of doctors to Centre for Disease Control (CDC) guidelines for catheter insertion was assessed using a checklist. Statistical Analysis: Clinical parameters were compared between colonized and non-colonized subjects and between patients with and without CRBSI. Unpaired t-test and Chi-square test were used to test the significance of observed differences. Results: Out of the 41 children, 21 developed colonization of their central venous catheter (66.24/1000 catheter days), and two developed CRBSI (6.3/1000 catheter days). Infants had a higher risk for developing colonization (P = 0.01). There was 85% adherence to CDC guidelines for catheter insertion. Conclusions: The incidence of CRBSI and catheter colonization is high in our in spite of good catheter insertion practices. Hence further studies to establish the role of adherence to catheter maintenance practices in reducing risk of CRBSI is required. The role of a composite package of interventions including insertion and maintenance bundles specifically targeting infants needs to be studied to bring down the catheter colonization as well as CRBSI rates.

Thomas, Diana; Parameswaran, Narayanan; Harish, B. N.



[Chronic venous insufficiency (CVI)].  


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



Indwelling catheters and medical implants with FXIIIa inhibitors: a novel approach to the treatment of catheter and medical device-related infections  

PubMed Central

Central venous catheters (CVCs) are being utilized with increasing frequency in intensive care and general medical wards. In spite of the extensive experience gained in their application, CVCs are related to the long-term risks of catheter sheath formation, infection and thrombosis (of the catheter or vessel itself) during catheterisation. Such CVC-related-complications are associated with increased morbidity, mortality, duration of hospitalisation and medical care cost [1]. The present study incorporates a novel group of Factor XIIIa (FXIIIa, plasma transglutaminase) inhibitors into a lubricious silicone elastomer in order to generate an optimized drug delivery system whereby a secondary sustained drug release profile occurs following an initial burst release for catheters and other medical devices. We propose that the incorporation of FXIIIa inhibitors into catheters, stents and other medical implant devices would reduce the incidence of catheter sheath formation, thrombotic occlusion and associated staphylococcal infection. This technique could be used as a local delivery system for extended release with an immediate onset of action for other poorly aqueous soluble compounds.

Daneshpour, Nooshin; Collighan, Russell; Perrie, Yvonne; Lambert, Peter; Rathbone, Dan; Lowry, Deborah; Griffin, Martin



Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.  


These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations. PMID:12233868

O'Grady, Naomi P; Alexander, Mary; Dellinger, E Patchen; Gerberding, Julie L; Heard, Stephen O; Maki, Dennis G; Masur, Henry; McCormick, Rita D; Mermel, Leonard A; Pearson, Michele L; Raad, Issam I; Randolph, Adrienne; Weinstein, Robert A



Treatment of chronic venous insufficiency  

Microsoft Academic Search

Opinion statement  Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux.\\u000a Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory\\u000a process. Compression therapy using pumps, bandaging, and\\/or graded compression stockings is the mainstay of treatment for\\u000a CVI. Compression therapy has been shown to be effective in reducing venous

Suman W. Rathbun; Angelia C. Kirkpatrick



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:; Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M. [Chang Gung Children's Hospital, Department of Pediatric Cardiology and Radiology (China)



Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients  

Microsoft Academic Search

Purpose  To evaluate the efficacy of multifaceted interventions in reducing complications of peripherally inserted central venous catheter\\u000a (PICC) in adult oncology patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Multifaceted interventions were implemented in our department in December 2006. These interventions include: (1) A mandatory\\u000a nurse reeducation was developed by a multidisciplinary task force; (2) Modification of peripherally inserted central catheter\\u000a insertion: take a chest X-ray before removal

Geng Tian; Yan Zhu; Li Qi; Fengqin Guo; Haidan Xu



Venous thrombosis: an overview  

SciTech Connect

Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

Peterson, C.W.



Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: A prospective study  

Microsoft Academic Search

Objective: To estimate the incidence and to characterize risk factors for central venous catheter (CVC)-related deep vein thrombosis (DVT) in a pediatric intensive care unit. Study design: Consecutive children admitted to a pediatric intensive care unit who required a CVC for more than 48 hours were examined by Doppler ultrasonography of the catheterized vein at days 2, 4, 6, or

Christel Beck; Josée Dubois; Andrée Grignon; Jacques Lacroix; Michèle David



Venous Thromboembolism in Pregnancy  

Microsoft Academic Search

Pregnancy is a hypercoagulable state accompanied by changes in maternal physiology that also contribute to an increased risk\\u000a of thrombosis. Diagnosis and treatment of venous thromboembolism (deep venous thrombosis and pulmonary embolism) during pregnancy\\u000a present unique challenges. In non-pregnant patients, there is ample clinical research upon which recommendations are based,\\u000a but there is a paucity of data in pregnancy resulting

Karen Rosene-Montella; Ghada Bourjeily


Optimizing dialysis delivery in tunneled dialysis catheters.  


Long-term dialysis is often delivered through tunneled central venous catheters (CVC) despite their associated morbidity and mortality rates. Because poor solute clearance might contribute to this risk, we examined the relation between blood pump speed (QB), access recirculation (AR), and dialysis delivery in patients with CVC. We conducted a prospective study on 102 patients receiving long-term hemodialysis with CVC. QB was systematically varied, and AR was measured by saline dilution with the blood supply lines in both the straight and the reversed positions during each of two dialysis sessions. During a third session, we measured ionic dialysance (EID) in patients with AR>0% and those in whom dialysis was usually delivered with catheters in the reversed position.Approximately one third (34.3%) of patients were usually run in the reversed position. Clinically significant AR (>10%) was infrequent (3%) in the straight position but common in the reversed position (86%). QB and EID were linearly correlated for both the straight and reversed positions. Approximately half (48.6%) of patients who were generally treated with their lines reversed were able to receive dialysis with the lines in the straight position within acceptable pressure limits when blood lines were switched part way through the run. In these patients, solute clearance was equivalent (EID straight 204 ml/min vs. reversed 196 ml/min, p=0.58) with lines in the straight configuration despite lower achieved QB (straight 354 ml/min vs. reversed 404 ml/min, p=0.04). Maximization of prescribed QB in CVC increased AR when blood line position was reversed but improved small solute clearance regardless of line position. This suggests that QB in CVC should be set as high as circuit pressure limits will allow, regardless of the potential for AR, and that reversal of line position confers no benefit with respect to solute clearance. PMID:16557101

Pannu, Neesh; Jhangri, Gian S; Tonelli, Marcello


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.



Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients  

SciTech Connect

The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

Goltz, Jan P., E-mail:; Scholl, Anne; Ritter, Christian O. [University of Wuerzburg, Institute of Radiology (Germany); Wittenberg, Guenther [Evangelisches Krankenhaus Bielefeld Gilead, Institute of Radiology (Germany); Hahn, Dietbert; Kickuth, Ralph [University of Wuerzburg, Institute of Radiology (Germany)



[Complications after implantation of subcutaneous central venous port].  


We retrospectively reviewed 500 cases who were implanted with subcutaneous central venous port(CV port)in our institution from Jan. 2007 to Nov. 2011, to investigate the complications arising after CV port implantation. The purpose of CV port implantation was chemotherapy access in 279 cases and home parenteral nutrition in 221 cases. The primary diseases were malignancy in 441 cases(colorectal cancer 252 cases, gastric cancer 54 cases, etc.)and benign diseases in 59 cases. Seven patients(1. 4%)had complications at implantation(pneumothorax 6 cases, catheter migration 1 case). Forty-three patients(8. 6%)had complications after port implantation. Among them, 18 suffered port infection, 10 had obstruction of the catheter system, 4 developed skin ulceration, 4 developed port rotation, 3 had venous thrombosis, and 3 developed catheter migration. The cumulative patency rates after 1, 2, and 3 years were 90. 7%, 81. 2%, and 74. 6%, respectively. Complications after port implantation were more frequently developed in home parenteral nutrition than in chemotherapy. PMID:23863584

Sakamoto, Eiji; Hasegawa, Hiroshi; Komatsu, Shunichiro; Norimizu, Shinji; Shingu, Yuji; Inaba, Kazuki; Taguchi, Yasuro; Ito, Yuko; Watanabe, Masahiro; Arimoto, Atsuki; Isaji, Takahiro; Makino, Arano; Miura, Yasutomo; Santo, Masaki



Evaluation of a new hydrocolloid occlusive dressing for central catheters used in total parenteral nutrition.  


Catheter-related sepsis still remains one of the most frequent and serious complication of total parenteral nutrition. Strategies for preventing contamination of central venous lines have focused on decreasing the number of micro-organisms around the exit site and inhibiting their entry into the catheter wound. This prospective study compares a new occlusive hydrocolloid dressing (Visiband; Convatec Squibb) with that of a polyurethane film dressing for nutritional catheters. Dressings were changed either on day 3 or day 5 after application. Swab smears of the catheter exit site at each dressing change were stained by Gram's method before inoculation onto a blood agar plate, a chocolate agar plate and a MacConkey agar plate. Significantly less colonisation occurred under the former dressing at day 3 and day 5 dressing changes. In addition, the polyurethane film dressing was associated with a significant increase in skin colonisation (P = 0.04) and the number of positive Gram-stain microbes if left unchanged for 5 days (P = 0.0018). Staphylococcus aureus catheter-related sepsis occurred in 1 patient on day 18 in the polyurethane film dressing group. In addition, Candida albicans colonisation was confined to patients with the polyurethane film dressing. While the type of dressing applied to the catheter exit site may influence the incidence of catheter colonisation and infection, it must be emphasised that strict adherence to aseptic technique during catheter insertion and manipulation of the dressing is vital in the prevention of catheter-related sepsis during total parenteral nutrition. PMID:1763392

Haffejee, A A; Moodley, J; Pillay, K; Singh, B; Thomson, S; Bhamjee, A



Button self-retaining drainage catheter  

Microsoft Academic Search

To help improve patient acceptance of long-term internal\\/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This

James G. Caridi; Irvin F. Hawkins; E. William Akins; Ronald S. Young



Characterization of Staphylococcus epidermidis Polysaccharide Intercellular Adhesin\\/Hemagglutinin in the Pathogenesis of Intravascular Catheter-Associated Infection in a Rat Model  

Microsoft Academic Search

Biofilm production is thought to be a crucial factor in the ability of Staphylococcus epidermidis to produce a bio- material-based infection. A rat central venous catheter (CVC)-associated infection model was used to assess the im- portance of biofilm production, mediated by polysaccharide intercellular adhesin\\/hemagglutinin (PIA\\/HA), in the pathogenesis of intravascular catheter-associated infection. PIA\\/HA-positive S. epidermidis 1457 was signifi- cantly more




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:, E-mail:



Catheter-related bacteremia due to Roseomonas species in pediatric hematology/oncology patients.  


Roseomonas is a newly described genus of pink-pigmented, gram-negative bacteria. Human infections caused by Roseomonas species are very rare. We report two cases of central venous catheter-related bacteremia associated with Roseomonas species (one case with R. gilardii and one with R. fauriae), and review the clinical spectrum of previously reported cases in the literature. Clinicals should be aware that Roseomonas species may cause serious infections in children. PMID:15782406

McLean, Thomas W; Rouster-Stevens, Kelly; Woods, Charles R; Shetty, Avinash K



Peripheral catheter techniques.  


With ultrasound, continuous peripheral nerve blocks (CPNBs) are one of the most recent developments in regional anesthesia in children. CPNBs are now used more widely in children because more suitable materials have been marketed, allowing complete, and prolonged postoperative pain control. Their use after orthopedic procedures in children and treatment for complex regional pain syndrome in adolescents has demonstrated the benefits. Perineural catheters have also shown their superiority over other techniques of continuous regional anesthesia in terms of side effects. The efficiency and the safety of these techniques may facilitate early ambulation with improved pain management, treatment at home with disposable pumps, and improved rehabilitation of children. Studies on large cohorts of patients published to date have failed to highlight any severe complications in their use compared with other adult studies. Accidents owing to systemic toxicity are very unlikely if the recommended maximum dose is not exceeded. The safety of continuous regional anesthesia techniques in children relies on the use of low-concentration l-enantiomer solutions (ropivacaine or levobupivacaine) accompanied by low plasma concentrations of local anesthetics, limiting the risk of systemic toxicity of these molecules. CPNB can ensure strong and lasting analgesia in hospital or at home. PMID:22050550

Dadure, Christophe; Capdevila, Xavier



Prevention of catheter-related bloodstream infections: an appraisal of developments in designing an infection-resistant 'dream dialysis-catheter'.  


With the increasing number of elderly, diabetics and debilitated patients being accepted for haemodialysis (HD), the use of central venous catheters (CVCs) as vascular access has become more widespread, with an inevitable inherent risk of catheter-related bloodstream infections (CRBSI) and ensuing mortality. No reliable plans for the effective management of CRBSI without actually sacrificing vascular access sites are presently available. Therefore, the onus really falls on renal physicians to make effective use of the established supportive guiding principles, practices, policies and programs to prevent CRBSI among HD patients. A huge body of research in polymer industry has aimed at alterations of physical, chemical, biological and immunological properties of CVCs to prevent the bacterial colonization of catheters. Developing an infection-resistant dialysis catheter has been an elusive dream. This article analyses the current state-of-the-art strategies aimed at preventing CRBSI and also reviews the progress made to date, in the direction of development of a 'bioactive' thrombosis and infection-resistant dialysis catheter. PMID:15958036

Saxena, Anil K; Panhotra, Bodh R



Impact of catheter antimicrobial coating on species-specific risk of catheter colonization: a meta-analysis  

PubMed Central

Background Antimicrobial catheters have been utilized to reduce risk of catheter colonization and infection. We aimed to determine if there is a greater than expected risk of microorganism-specific colonization associated with the use of antimicrobial central venous catheters (CVCs). Methods We performed a meta-analysis of 21 randomized, controlled trials comparing the incidence of specific bacterial and fungal species colonizing antimicrobial CVCs and standard CVCs in hospitalized patients. Results The proportion of all colonized minocycline-rifampin CVCs found to harbor Candida species was greater than the proportion of all colonized standard CVCs found to have Candida. In comparison, the proportion of colonized chlorhexidine-silver sulfadiazine CVCs specifically colonized with Acinetobacter species or diphtheroids was less than the proportion of similarly colonized standard CVCs. No such differences were found with CVCs colonized with staphylococci. Conclusion Commercially-available antimicrobial CVCs in clinical use may become colonized with distinct microbial flora probably related to their antimicrobial spectrum of activity. Some of these antimicrobial CVCs may therefore have limited additional benefit or more obvious advantages compared to standard CVCs for specific microbial pathogens. The choice of an antimicrobial CVC may be influenced by a number of clinical factors, including a previous history of colonization or infection with Acinetobacter, diphtheroids, or Candida species.



Venous leg ulcer pain.  


Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers. PMID:12856289

Ryan, Siobhan; Eager, Cathy; Sibbald, R Gary



Chronic venous insufficiency.  


Like the noninvasive assessment of arterial occlusive disease, the various methods for evaluation of chronic venous insufficiency (CVI) can be divided into those that provide hemodynamic information and those that provide anatomic detail. The majority of noninvasive methods for evaluation of CVI are directed toward assessing hemodynamic events in large vessels by detecting abnormally directed blood flow, elevated venous pressure, increased limb-volume changes, or valvular reflux. B-mode ultrasound, the principal non-invasive method for anatomic assessment of CVI, defines either valvular incompetence, obstruction, or recanalization changes. PMID:2406965

O'Donnell, T F; McEnroe, C S; Heggerick, P



Scanning single-mode fiber optic catheter-endoscope for optical coherence tomography  

NASA Astrophysics Data System (ADS)

We describe a new optical coherence tomography catheter-endoscope for micrometer-scale, cross-sectional imaging in internal organ systems. The catheter-endoscope uses single-mode fiber optics with a novel transverse scanning design. The distal end of the catheter-endoscope uses a gradient-index lens with a microprism to emit and collect a single spatial-mode optical beam with specific focusing characteristics. The beam is scanned in a circumferential pattern and can image transverse cross sections through the structure into which it is inserted. A device with a diameter as small as 1.1 mm has been achieved, and imaging of in vitro human venous morphology is demonstrated.

Tearney, G. J.; Boppart, S. A.; Bouma, B. E.; Brezinski, M. E.; Weissman, N. J.; Southern, J. F.; Fujimoto, J. G.



Prognostic indicators in venous ulcers  

Microsoft Academic Search

Background: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. Methods: This study examined data from a previously published prospective randomized placebo-controlled trial of an

Tania J. Phillips; Fidelis Machado; Richard Trout; John Porter; Jeffrey Olin; Vincent Falanga



Low flow veno-venous ECMO: an experimental study.  


Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered. PMID:10147372

Calderón, M; Verdín, R; Galván, J; Gonzalez, M; Cárdenas, H; Campos, R; Vidrio, H; Amezcua, J



Venous Hum Tinnitus  

Microsoft Academic Search

Venous hum tinnitus is an uncommon but treatable cause of objective tinnitus. Ligation of the internal jugular vein has been described with favorable results when the tinnitus is loud enough to disturb sleep or hearing. Careful history and physical examination is helpful in establishing the diagnosis, but other causes should be excluded prior to ligation. Angiography is indicated to rule

Saud Al Turki; Hussein Al-Kohlani; Sumayyah Shabra



Venous leg ulcers  

Microsoft Academic Search

In 1837, Piorry, a French professor of medicine stated, “It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries.” Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite

Carin F. Gonsalves



Portal venous occlusion  

Microsoft Academic Search

Summary Morbidly obese patients are significantly more susceptible to clotting phenomena, including recurrent deep venous thrombosis, pulmonary emboli, inferior vena caval thrombosis, and renal vein thrombosis. The patient described in this report developed the sudden onset of massive ascites two years following jejunoileal bypass for morbid obesity. Occlusion of the portal vein and its tributaries was demonstrated. Our experience and

Richard Metz; Robert Gray; Leonard Goldstein



Venous insufficiency (image)  


The valves in the veins usually channel the flow of blood toward the heart. When these valves are damaged, blood leaks and pools in the legs and feet. Venous insufficiency is a condition in which the veins fail to return blood ...


Management of Venous Thromboembolism  

Microsoft Academic Search

enous thromboembolism, including deep vein thrombosis and pulmonary embolism, represents a significant source of morbidity and mortality in the United States and worldwide. The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. Cumulative clinical experience gained from using these 2 classes of

Thomas M. Hyers



Venous thrombosis - series (image)  


... cardiac arrest and sometimes death. This is called pulmonary embolism. ... Post-operative patients are at risk for pulmonary embolism because of the time spent in bed after surgery. One method for reducing the risk of venous thrombosis is the use of sequential ...


Posttraumatic Portal Venous Gas  

Microsoft Academic Search

Portal venous gas (PVG) is a rare condition that can occur after blunt abdominal trauma. The case of a young boy with PVG after a car crash is reported. The boy died after surgery because of major posttraumatic bowel necrosis. The aim of this article is to show that PVG can be a serious condition after blunt abdominal trauma in

Christophe Laplace; Emil Nini; Denis Pezet; Alain Tanguy



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.

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



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.


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


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



Risk Factors for the Development of Catheter-Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition.  


BACKGROUND: Risk factors for development of catheter-related bloodstream infections (CRBSI) were studied in 125 adults and 18 children who received home parenteral nutrition (HPN). Methods: Medical records from a national home care pharmacy were reviewed for all patients that had HPN infused at least twice weekly for a minimum of two years from January 1, 2006-December 31, 2011. Infection and risk factor data were collected during this time period on all patients although those patients who received HPN for a longer period had data collected since initiation of HPN. RESULTS: In adults, 331 central venous catheters (CVCs) were placed. Total catheter years were 1157. Median CVC dwell time was 730 days. In children, there were 53 CVCs placed. Total catheter years were 113.1. Median CVC dwell time was 515 days. There were 147 CRBSIs (0.13/catheter year;0.35/1000 catheter days). In children there were 33 CRBSIs (0.29/catheter year;0.80/1000 days; P < .001 versus adults). In adults, univariate analysis showed use of subcutaneous infusion ports instead of tunneled catheters (P = .001), multiple lumen catheters (P = .001), increased frequency of lipid emulsion infusion (P = .001), obtaining blood from the CVC (P < 0.001), and infusion of non-PN medications via the CVC (P < .001) were significant risk factors for CRBSI. Increased PN frequency was associated with increased risk of CRBSI (P = .001) in children, but not in adults. Catheter disinfection with povidone-iodine was more effective than isopropyl alcohol alone. There were insufficient patients to evaluate chlorhexidine-containing regimens. Conclusion: Numerous risk factors for CRBSI were identified for which simple and current countermeasures already exist. PMID:23744839

Buchman, Alan L; Opilla, Marianne; Kwasny, Mary; Diamantidis, Thomas G; Okamoto, Rodney



Emergency department diagnosis of upper extremity deep venous thrombosis using bedside ultrasonography  

PubMed Central

A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy. Emergency department bedside ultrasound examination of both the right axillary vein and subclavian vein near the PICC line tip revealed deep venous thrombosis of both veins. Bedside upper extremity vascular ultrasonography can assist in the rapid diagnosis of upper extremity deep venous thrombosis in the emergency department.



Comparison of results of placement of cuffed -tunneled hemodialysis catheter in internal jugular vein with subclavian vein for long -term dialysis.  


Aim of the study was to comparison between internal jugular vs. subclavian vein cuffed tunnel catheter placement for dialysis. Material and methods. Cases who required central venous catheter for dialysis were included in this study. Forty cases were included in this study and divided to two groups. Catheters were placed randomly in internal jugular vein or subclavian. Patients were followed for 6 months. Early and late complications of catheter's placement were recorded. Analysis was done using Spss ver 13.0 (Chicago, IL, USA). Results. There were no significant differences between subclavian and internal jugular vein regarding occurrence of infection resulted in extraction or treatment. Also there were no significant differences regarding occurrence of thrombosis resulted in extraction or treatment. Failure rate was significantly higher in cases with internal jugular vein catheter compared to cases with subclavian vein catheter (p=0.04). Conclusion. Failure rate was significantly higher in cases with internal jugular vein catheter compared to subclavian cathether. Subclavian catheter is more appropriate route for catheter placement. PMID:23612620

Zafarghandi, Mohammad-Reza; Nazari, Iraj; Taghavi, Morteza; Salimi, Javad; Moini, Majid; Askarpour, Shahnam



Management of obstructed balloon catheters.  

PubMed Central

Failure of a balloon catheter to deflate is not uncommon and prevents its removal. Methods of overcoming the problem include traction, bursting the balloon by overinflation, dissolving it with solvents, puncturing it percutaneously with a needle, or puncturing it with a wire stylet passed through the catheter. All except the last technique have major disadvantages and are of questionable safety. Transcatheter puncture of the balloon was used in 16 patients to remove obstructed balloon catheters without any technical difficulty, distress to the patient, or complication. The procedure is safe, simple, and does not require an anaesthetic. If necessary it could be performed safely by nursing or paramedical staff without the patient having to be admitted to hospital. It is the method of choice for the management of this problem. Images FIG 1 FIG 2 FIG 3 FIG 4

Browning, G G; Barr, L; Horsburgh, A G



Catheter associated urinary tract infection and encrustation  

Microsoft Academic Search

This paper examines the relationship between urinary pH, infection and urinary catheter encrustation and discusses the current management and problems of catheter associated urinary infection and encrustation.

S. Choong; S. Wood; C. Fry; H. Whitfield



Multiple Parameter Intravascular Monitoring Catheter System.  

National Technical Information Service (NTIS)

A multiple parameter catheter for intravascular use has been designed, constructed and subjected to a number of successful in vivo animal tests. This catheter and associated readout equipment will monitor continuously and simultaneously blood pressure, te...

G. J. Fergusson C. P. Petroff W. H. Johnston A. Zapata



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:; 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)



Comparative utility of centrally versus peripherally transduced venous pressure monitoring in the perioperative period in spine surgery patients  

PubMed Central

Study Objective To compare central venous pressure (CVP) with peripheral venous pressure (PVP) monitoring during the intraoperative and postoperative periods in patients undergoing spine surgery. Design Prospective observational study. Setting University-affiliated teaching hospital. Patients 35 ASA physical status 1, 2, and 3 patients. Interventions A peripheral catheter in the forearm or hand and a central catheter into the internal jugular vein were placed for PVP and CVP monitoring, respectively. Measurements CVP and PVP values were collected simultaneously and recorded electronically at 5-minute intervals throughout surgery and in the recovey room. The number of attempts for catheter placement, ease of use, maintenance, and interpretation were recorded. Patient comfort, frequency of complications, and cost were analyzed. Main results The correlation coefficient between CVP and PVP was 0.650 in the operating room (P < 0.0001) and 0.388 in the recovery room (P < 0.0001). There was no difference between groups in number of attempts to place either catheter, maintenance, and interpretation with respect to PVP and CVP monitoring in the operating room. In the recovery room, the nurses reported a higher level of difficulty in interpretation of PVP than CVP, but no differences were noted in ease of maintenance. There were no complications related to either central or peripheral catheter placement. Patient comfort and cost efficiency were higher with a peripheral than a central catheter. Conclusion During clinically relevant conditions, there was limited correlation between PVP and CVP in the prone position during surgery and postoperatively in the recovery room.

Bombardieri, Anna Maria; Beckman, James; Shaw, Pamela; Girardi, Federico P.; Ma, Yan; Memtsoudis, Stavros G



Button self-retaining drainage catheter  

Microsoft Academic Search

To help improve patient acceptance of long-term internal\\/external catheter access to the biliary tract in those with benign\\u000a biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button\\u000a affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This

James G. Caridi; Irvin F. Hawkins; E. William Akins; Ronald S. Young



Venous thromboembolism in pregnancy.  


In Western nations, venous thromboembolism (VTE) is an important cause of morbidity and the most common cause of maternal death during pregnancy and the puerperium. Pregnancy is a hypercoagulable state in which coagulation is activated and thrombolysis inhibited. This prothrombotic risk is compounded when hereditary and acquired thrombophilias and other prothrombotic risk factors are present. The risk of venous thrombotic events is increased fivefold during pregnancy and 60-fold in the first 3 months after delivery (postpartum period) compared with nonpregnant women. Many of the signs and symptoms of VTE overlap those of a normal pregnancy, which complicates the diagnosis. Patients with history of previous VTE should use graduated compression stockings throughout pregnancy and the puerperium, and should receive postpartum anticoagulant prophylaxis. The indications for antepartum anticoagulant prophylaxis are somewhat controversial. This article reviews the management of VTE during pregnancy and in the postpartum period. PMID:21047579

Marik, Paul E



Catheter-Related Microbacterium Bacteremia Identified by 16S rRNA Gene Sequencing  

PubMed Central

We describe the application of 16S rRNA gene sequencing in defining two cases of catheter-related Microbacterium bacteremia. In the first case, a gram-positive bacillus was isolated from both the blood culture and central catheter tip of a 39-year-old woman with chronic myeloid leukemia. The API Coryne system identified the isolate as 98.9% Aureobacterium or Corynebacterium aquaticum. In the second case, a gram-positive bacillus was recovered from five sets of blood cultures from both central catheter and percutaneous venipuncture of a 5-year-old girl with acute myeloid leukemia. The isolate was identified by the API Coryne system as 99.7% Cellulomonas or Microbacterium species. Further phenotypic tests failed to identify the two isolates. 16S rRNA gene sequencing showed 99.4% similarity between the first isolate and Microbacterium oxydans and 98.7% similarity between the second isolate and Microbacterium trichotecenolyticum, indicating that both isolates were Microbacterium species. Microbacterium infections are rarely reported in the literature. Although the central venous catheter was previously proposed to be a source of bacteremia, the first case in this report represents the first culture-documented case of catheter-related Microbacterium bacteremia.

Lau, Susanna K. P.; Woo, Patrick C. Y.; Woo, Gibson K. S.; Yuen, Kwok-Yung



ArterioVenous Malformations  

Microsoft Academic Search

Intracranial arterio-venous malformations (AVM) are relatively uncommon, but increasingly recognized lesions that can cause\\u000a serious neurological symptoms or death. Although AVM can initially present with hemorrhages or seizures, an increasing number\\u000a is detected before symptomatic bleeding due to the recently developed imaging techniques. Over the last decades, the management\\u000a of AVM has been widely modified due to the availability of

Markus W. Gross; Rita Engenhart-Cabillic


Venous thromboembolism in pregnancy  

Microsoft Academic Search

Opinion statement  Low molecular weight heparins (LMWHs) appear to be as safe and effective as unfractionated heparin (UFH) for venous thromboembolic\\u000a disease (VTED) treatment or prophylaxis during pregnancy. Experience with other parenteral anticoagulant drugs is very limited,\\u000a and no alternative oral anticoagulants are available to date. In addition to cost, challenges of long-term LMWH use during\\u000a pregnancy that have not been

Marcelo P. Villa-Forte Gomes



Catheter-Associated Urinary Tract Infection  

Microsoft Academic Search

Objectives : To study the incidence, risk factors, clinical outcomes and antibiotic costs of catheter-associated urinary tract infections (CAUTI) in patients with indwelling urinary catheter for one week and longer. Material and Method : Patients in neurology and neurosurgery wards in a teaching hospital were studied. Patients with UTI before catheterization and in whom the catheter was removed before one

Somwang Danchaivijitr



Urethral response to latex and Silastic catheters.  

PubMed Central

The reaction of the urethral mucosa to latex and Silastic catheters was compared in two groups of patients undergoing prostatectomy. The bacteriologic response in the two groups differed little; however, Silastic catheters produced less cellular reaction than latex catheters. Images FIG. 1

Bruce, A. W.; Plumpton, K. J.; Willett, W. S.; Chadwick, P.



Catheter-related bloodstream infections in children receiving parenteral nutrition: considerations about the experience of the Pediatric Nutritional Team of the Tuscany Region, Italy  

Microsoft Academic Search

Infection is the most important clinical complication associated with the use of cen- tral venous catheters, both in terms of incidence and gravity. This study aims to assess the inci- dence of these infections in children receiving parenteral nutrition in a tertiary children's hospital and at home. A prospective cohort survey was carried out in a consecutive series of 671



Short-term femoral catheter insertion: a promising alternative to consistently allow long-term erythrocytapheresis therapy in children with sickle cell anemia.  


Erythrocytapheresis procedures, increasingly used in the management of patients with severe complications of sickle cell disease, are limited by adequate venous access. We have successfully used short-term femoral catheter insertion, during a 6.5-year period for a total of 443 procedures, to perform long-term erythrocytapheresis in 18 consecutive children with sickle cell disease. PMID:23092526

Billard, Marie; Combet, Sylvie; Hequet, Olivier; Kébaïli, Kamila; Lorthois, Sylvie; Pondarre, Corinne



An evaluation of transovarian uptake of metabolites using arterio-venous difference methods in dairy cattle  

Microsoft Academic Search

Arterio-venous (A-V) difference techniques were used in cattle to examine ovarian energy metabolism, cholesterol uptake and steroid hormone outputs. Catheters were inserted into the ovarian vein and facial artery, and Transonic flow transducers were placed around the ovarian A-V plexus. Further, in some cows, the effects of a challenge with GnRH were examined. Glucose uptake and lactate output were significant

A. R. Rabiee; I. J. Lean; J. M. Gooden; B. G. Miller; R. J. Scaramuzzi



Continuous mixed venous oxygen saturation measurement: A significant advance in hemodynamic monitoring?  

Microsoft Academic Search

Development of the flow-directed pulmonary artery catheter in combination with reflective fiberoptic oximetry techniques allows\\u000a the clinician to continuously measure mixed venous oxygen saturation (SvO2). A briet review of the determinants of oxygen balance, the Fick principle, and the technology of continuous SvO2 monitoring is preliminary to a debate between two clinicians on the usefulness ot SvO2 monitoring.\\u000a \\u000a One clinician

Edward A. Norfleet; Charles B. Watson



Reliability of continuous jugular venous bulb hemoglobin oxygen saturation during cardiac surgery  

Microsoft Academic Search

Objective: To evaluate the accuracy and reliability of continuous measurement of jugular venous bulb hemoglobin oxygen saturation (SjvO2) with a fiberoptic catheter (SjvO2OX) during cardiac surgery versus simultaneous paired measurements of hemoglobin oxygen saturation by the Hemoximeter (SjvO2HEM; Radiometer, Copenhagen, Denmark) and indirect estimations of hemoglobin oxygen saturation from measurements of partial pressure of oxygen in blood gases (SjvO2BG).Design: A

Eleni Anastasiou; Katerina Gerolioliou; Konstantinos Karakoulas; Maria Peftoulidou; Maria Giala



Radiofrequency guide wire recanalization of venous occlusions in patients with malignant superior vena cava syndrome.  


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. PMID:21976039

Davis, Robert M; David, Elizabeth; Pugash, Robyn A; Annamalai, Ganesan



Non-traumatic vascular emergencies: management of occluded hemodialysis shunts and venous access  

Microsoft Academic Search

.   Shunt thrombosis is a relatively frequent complication of implant grafts but less common in native fistulas; both may undergo\\u000a mechanical recanalization without thrombolysis. While in native fistulas, simple balloon angioplasty is a very useful tool\\u000a for short-segment thrombosis, extensive thrombosis in native veins or grafts requires use of different mechanical devices\\u000a or aspiration catheters. In venous access thrombosis, thrombolysis

Dierk Vorwerk



[Complications in the heart and vessels from the prolonged venous catheterization of burn patients].  


Under analysis were the results of 31 autopsies of patients with extensive (from 20 to 75% of the body surface) and deep burns who died of sepsis. In 15 patients peripheral and central veins were catheterized, the duration of staying the catheter in the veins varying from 7 till 80 days. A direct relationship between prolonged catheterization of the venous vessels in burned patients and the frequency of septic endocardites has been established. PMID:7385573

Bushuev, Iu I; Vazina, I R; Sosin, E Iu



Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux  

Microsoft Academic Search

Chronic venous insufficiency which produces lipodermatosclerosis, varicosities, or ulceration, is frequently caused by superficial venous reflux and deep venous incompetence. The anatomy of venous insufficiency has been clarified with duplex ultrasound, thus allowing appropriately directed therapy. However, postoperative venous physiology in patients undergoing superficial venous ablation has been infrequently reported. This study was undertaken to document the effect of superficial

Clifford M. Sales; Michael L. Bilof; Kathleen A. Petrillo; Norman L. Luka



Endoluminal treatment for venous vascular complications of malignant tumors  

PubMed Central

The aim of this study was to explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumors. Sixty-one patients with venous vascular complications of malignant tumors were treated from May 2002 to May 2009; 37 men and 24 women with mean age 57.8 years (33–82 years). Lesions included acute deep vein thrombosis (n=18); venous stenosis or occlusion (n=32); tumor embolus in vein (n=11). The interventional therapeutic operations included vena cava filter implantation, trans-catheter thrombolytic therapy, recanalization, percutaneous transluminal angioplasty (PTA) and stenting. The success rate of thrombolysis and stent implantation, the clinical success rate, complications, recurrence rate of the treated region and survival duration were recorded. Eighteen patients accepted filter and thrombolytic therapy with a success rate of 100%; total urokinase dosage was 7.42±1.49 (4.5–10) million units. Symptoms disappeared (n=15), were palliated (n=3) and thrombi were completely dissolved (n=2), almost completely dissolved (n=8, >90%), partially dissolved (n=6, 50–90%) and not dissolved (n=2, <50%). No pulmonary embolism emerged after the operation. Forty-three patients accepted recanalization, PTA and stent therapy with a success rate of 95.3% (41/43). Symptoms disappeared (n=25), were palliated (n=16) and did not change (n=2) 3 days following the operation. There were no severe complications during the procedure. During follow-up, 12 patients again suffered symptoms of venous occlusion and 47 patients died of tumor aggravation without symptom recurrence. As a result, interventional therapy has advantages including smaller injuries, well tolerance, high success rate, quick palliation of symptoms and superior clinical efficacy in the treatment of venous vascular complications for malignant tumors.




Non-invasive estimation of jugular venous oxygen saturation: a comparison between near infrared spectroscopy and transcutaneous venous oximetry.  


The ability of practitioners to assess the adequacy of global oxygen delivery is dependent on an accurate measurement of central venous saturation. Traditional techniques require the placement of invasive central venous access devices. This study aimed to compare two non-invasive technologies for the estimation of regional venous saturation (reflectance plethysmography and near infrared spectroscopy [NIRS]), using venous blood gas analysis as gold standard. Forty patients undergoing cardiac surgery were recruited in two groups. In the first group a reflectance pulse oximeter probe was placed on the skin overlying the internal jugular vein. In the second group, a Somanetics INVOS oximeter patch was placed on the skin overlying the internal jugular vein and overlying the ipsilateral cerebral hemisphere. Central venous catheters were placed in all patients. Oxygen saturation estimates from both groups were compared with measured saturation from venous blood. Twenty patients participated in each group.Data were analyzed by the limits of agreement technique suggested by Bland and Altman and by linear regression analysis. In the reflectance plethysmography group, the mean bias was 4.27% and the limits of agreement were 58.3 to -49.8% (r(2) = 0.00, p = 0.98). In the NIRS group the mean biases were 10.8% and 2.0% for the sensors attached over the cerebral hemisphere and over the internal jugular vein, respectively, and the limits of agreement were 33.1 to -11.4 and 19.5 to -15.5% (r(2) = 0.22, 0.28;p = 0.04, 0.03) for the cerebral hemisphere and internal jugular sites, respectively. While transcutaneous regional oximetry and NIRS have both been used to estimate venous and tissue oxygen saturation non-invasively, the correlation between estimates of ScvO(2) and SxvO(2) were statistically significant for near infrared spectroscopy, but not for transcutaneous regional oximetry. Placement of cerebral oximetry patches directly over the internal jugular vein (as opposed to on the forehead) appeared to approximate internal jugular venous saturation better (lower mean bias and tighter limits of agreement), which suggests this modality may with refinement offer the practitioner additional clinically useful information regarding global cerebral oxygen supply and demand matching. PMID:22290065

Colquhoun, Douglas A; Tucker-Schwartz, Jason M; Durieux, Marcel E; Thiele, Robert H



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 number NCT01629550



Central venous catheterization and thrombosis in newborns: update on diagnosis and management.  


Very low birth weight and other critically ill neonates require prolonged vascular access, which is achieved in current practice with central venous catheters. The initiation of adequate parenteral nutrition and prolonged intravenous medications represent the most important applications. Central vascular access in neonates is associated with a high risk for mechanical, infectious and thrombotic complications. The use of central lines is the most common cause for thrombosis in neonates and infants. The management of line-related thrombosis is based on expert opinion guidelines and is largely dependent on patient symptoms and the further requirement of the catheter. This review article focuses on pathophysiology, diagnosis, and acute and long-term management of catheter thrombosis in neonates. PMID:22958007

Sellitto, Maria; Messina, Francesco



Cerebral venous thrombosis  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Cerebral venous thrombosis is a rare disorder with highly variable and nonspecific clinical presentations. For these reasons,\\u000a specific treatment should be given only when the diagnosis has been firmly established. Etiologic diagnosis should begin in\\u000a the emergency department to identify underlying conditions that require specific treatment.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a The mainstay of treatment is anticoagulation with heparin, even in

Philippe Niclot; Marie Germaine Bousser



Management of venous thromboembolism  

Microsoft Academic Search

\\u000a Abstract\\u000a Purpose  To describe the drugs used to treat venous thromboembolism (VTE) and to review particular aspects of the management (elastic\\u000a stockings, thrombolysis, thrombectomy, vena cava filter).\\u000a \\u000a \\u000a \\u000a Source  Our review of the literature is focused on consensus documents and recent large randomized trials.\\u000a \\u000a \\u000a \\u000a Principal findings  Subcutaneous low molecular weight heparins (LMWH) have been shown to be both safe and effective for the initial

Philippe de Moerloose; Charles Marc Samama; Serge Motte



Postpartum hemorrhage balloon tamponade catheter  

US Patent & Trademark Office Database

A balloon tamponade catheter for controlling uterine postpartum hemorrhage has an elongated body with a balloon at a marginal distal end of the elongated body for insertion into the uterus. The balloon preferably has a pear-shaped appearance. The balloon may have a first hemisphere that is located on the catheter distal to second, smaller hemisphere. The first hemisphere has a plane of maximum diameter that is larger than the second hemisphere's plane of maximum diameter. Between the two planes of maximum diameter, the balloon comprises a transition section. In some cases, the transition section bows inward towards the elongated body when the balloon is uninflated and/or inflated. Additionally, the elongated body preferably does not extend distally past the distal end of the first hemisphere.



Genetic prothrombotic mutations are common in neonates but are not associated with umbilical catheter-associated thrombosis  

Microsoft Academic Search

Objective:To evaluate the prevalence of hereditary prothrombotic mutations, and their effect on the incidence and severity of umbilical arterial or venous catheter (UAC or UVC)-associated thrombosis.Study Design:All neonates with a UAC or UVC were studied prospectively for the presence, severity and timing of thrombosis with duplex Doppler ultrasound scan. Genetic testing for factor V Leiden (FVL), prothrombin mutation (PTm) and

R Turebylu; R Salis; R Erbe; D Martin; S Lakshminrusimha; R M Ryan



Inherited thrombophilia and venous thromboembolism  

Microsoft Academic Search

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

Ian A Greer



Venous air embolism: A review  

Microsoft Academic Search

Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under-pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to

Sally C. Palmon; Laurel E. Moore; Jeany Lundberg; Thomas Toung



Laparoscopic Management of Malfunctioning Peritoneal Dialysis Catheters  

PubMed Central

Objectives Continuous ambulatory peritoneal dialysis (CAPD) is an established alternative method to hemodialysis for treating end-stage renal disease patients. Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis (PD). Laparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. The purpose of this study is to present our experiences with laparoscopic repair of peritoneal catheter dysfunction Methods Between April 2006 and March 2010, 21 cases of laparoscopic interventions were performed for the salvage of malfunctioning CAPD catheter. Two trocars (5 mm) were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed and complications. Results The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in fifteen cases, malpositioning in four cases, and tunnel infection in the remaining two cases. Adhesiolysis was performed in cases with adhesions. In the cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn and exchanged because of infection. There were no mechanical or infection problems. The overall success rate of catheter function (>30 days after laparoscopy) was 100%, except for two cases in which the catheters had to be removed. Conclusion Laparoscopy is a safe, highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction.

Zakaria, Hazem M.



Catheter-associated infections in urology: Possible use of silver-impregnated catheters and the erlanger silver catheter  

Microsoft Academic Search

Summary  Indwelling urinary catheters play a very important part in urology. However, their use is accompanied by a considerable increase\\u000a in the risk of nosocomial urinary tract infections. The pathophysiological cause is ascribed to pathogens that adhere to the\\u000a catheter surface, proliferate and produce a biofilm. In addition to aseptic techniques, modification of the catheter material\\u000a to confer antimicrobial activity plays

W. Rösch; S. Lugauer



A comparison of clinical outcomes with regular- and low-profile totally implanted central venous port systems.  


The purpose of this study was to evaluate whether low-profile totally implanted central venous port systems can reduce the late complication of skin perforation. Forty patients (age, 57 +/- 13 years; 22 females, 18 males) were randomized for the implantation of a low-profile port system, and another 40 patients (age, 61 +/- 14 years; 24 females, 16 males) received a regular port system as control group. Indications for port catheter implantation were malignant disease requiring chemotherapy. All port implantations were performed in the angiography suite using sonographically guided central venous puncture and fluoroscopic guidance of the catheter placement. Procedure time, number of complications (procedure-related immediate, early, and late complications), and number of explantations were assessed. Follow-up was performed for 6 months. All port implantations were successfully completed in both study groups. There were two incidents of skin perforation observed in the control group. One skin perforation occurred 13 weeks and the other 16 weeks after port implantation (incidence, 5%) in patients with regular-profile port systems. Two infections were observed, one port infection in each study group. Both infections were characterized as catheter-related infections (infection rate: 0.15 catheter-related infections per 1000 catheter days). In conclusion, low-profile port systems can be placed as safely as traditional chest ports and reduce the risk of developing skin perforations, which occurs when the port system is too tight within the port pocket. PMID:19085032

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



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

SciTech Connect

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

Teichgraeber, Ulf Karl-Martin, E-mail:; Steitparth, Florian [Charite Campus Mitte, Department of Radiology (Germany); Cho, Chie Hee [Charite Campus Virchow-Klinikum, Department of Radiology (Germany); Benter, Thomas [Elblandkliniken Riesa (Germany); Gebauer, Bernhard [Charite Campus Virchow-Klinikum, Department of Radiology (Germany)



Tunneled-cuffed catheter implanted into the accessory hemiazygos vein because of occlusion of the left innominate vein.  


Hemodialyzed patients are at risk of multiple catheterizations. Nephrologists performing such procedures need to be familiar with congenital and acquired vascular abnormalities. We describe a successful insertion and use of a cuffed-tunneled catheter in a patient with unusual anatomy of the central venous system. Computed tomography angiography revealed thrombosis of the right subclavian vein and bilateral occlusion of innominate veins. The left internal jugular and subclavian veins joined to form a large vessel that drained through the accessory hemiazygos and azygos veins into the superior vena cava. The catheter was implanted through the left internal jugular vein into the accessory hemiazygos vein. The presented case demonstrates that the catheter can be implanted into distended collateral, especially when no other location is possible. PMID:22099255

Letachowicz, Krzysztof; Ko?odziej, Marian; Mi?dzybrodzki, Krzysztof; Letachowicz, Waldemar; Weyde, Wac?aw; S?siadek, Marek; Klinger, Marian



Tensile set behavior of Foley catheter balloons.  


The removal of indwelling urinary balloon catheters from patients is usually associated with many problems. The problems such as balloon deflation failure; encrustations on balloons, eyes, and lumen; and catheter associated infections are widely discussed in the literature. The tensile set exhibited by the catheter balloon material could also play a role and further complicate the removal process. This article addresses this issue by comparing the tensile set behavior of the balloon material from three commercially available Foley catheters. The balloon materials were subjected to aging in synthetic urine at 37 degrees C for 28 days to simulate clinical conditions. The deflation time of catheter balloons aged in similar conditions were also measured. It was found that different brands of catheters exhibited statistically significant differences in their properties. The tensile set data of the aged samples could be correlated with the deflation time of the balloons. The clinical significance of the tensile set is also highlighted. PMID:10029146

Joseph, R; Ramesh, P; Sivakumar, R



Proteus mirabilis biofilms and the encrustation of urethral catheters  

Microsoft Academic Search

Bacterial biofilms were observed on 69 of 75 catheters taken from patients undergoing long-term bladder management. Ten catheters were colonized by pure cultures of Proteus mirabilis. In each of these cases the bacteria formed layers on the catheter surface, underlying encrustations of struvite and hydroxyapatite which partially or completely occluded the catheter lumen. Encrustation was also apparent on catheters colonized

D. Stickler; L. Ganderton; J. King; J. Nettleton; C. Winters



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)



Identification of Mycobacterium neoaurum isolated from a neutropenic patient with catheter-related bacteremia by 16S rRNA sequencing.  


A rapidly growing pigmented mycobacterial strain with an ambiguous biochemical profile was isolated from the blood culture taken through the Hickman catheter of a 9-year-old girl with acute lymphoblastic leukemia. Whole-cell fatty acid analysis showed that the best match profile was that of Mycobacterium aurum, but the similarity index was only 0.217, meaning that there were no good matches between the isolate and the organisms in the database of the Microbial Identification System. The 16S rRNA gene of the mycobacterial strain was amplified, agarose gel purified, and sequenced. There were 44 base differences between the gene sequence of the isolate and that of M. aurum but only one base difference between the sequence of the isolate and that of Mycobacterium neoaurum, showing that the isolate was indeed a strain of M. neoaurum by using this "gold standard." This represents the first case of M. neoaurum infection documented by 16S rRNA sequencing. PMID:10970421

Woo, P C; Tsoi, H W; Leung, K W; Lum, P N; Leung, A S; Ma, C H; Kam, K M; Yuen, K Y



Antibiotic bonded nephrostomy catheters for percutaneous nephrostomies  

Microsoft Academic Search

A prospective controlled trial of the effectiveness of a cefoxitin-bonded nephrostomy catheter was undertaken to determine\\u000a the effectiveness of an antibiotic bonded catheter in decreasing the infectious complications of percutaneous nephrostomy.\\u000a The study concludes that bonding of the antibiotic cefoxitin to percutanoeus nephrostomy catheters did not influence the incidence\\u000a of bacteriuria or urinary tract infection. In addition, observations on the

John L. Nosher; Alan S. Ericksen; Gary S. Needell; Richard A. Harvey; Ralph S. Greco



Management of venous malformations.  


Venous malformations (VMs) frequently occur in the head and neck with a predilection for the parotid gland, submandibular triangle, buccal space, muscles of mastication, lips, and upper aerodigestive tract. They are composed of congenitally disrupted ectatic veins with inappropriate connections and tubular channels. Because VMs have poorly defined boundaries and a tendency to infiltrate normal tissue, they require calculated treatment decisions in the effort to preserve surrounding architecture. Sclerotherapy, surgical excision, neodymium:yttrium aluminum garnet laser therapy, or a combination of these modalities is employed in the management of VMs. Although many small VMs can be cured, the objective is often to control the disease with periodic therapy. Location, size, and proximity to vital structures dictate the type of therapy chosen. Vigilance with long-term follow up is important. This review outlines current diagnostic and therapeutic approaches to simple and extensive cervicofacial VMs. PMID:23188688

Richter, Gresham T; Braswell, Leah



Minimizing risks associated with peripherally inserted central catheters in the NICU.  


Peripherally inserted central catheters (PICC lines) provide prolonged venous access, a means of administration of needed medications that would otherwise be irritating to peripheral vessels, and a means of assuring better parenteral nutrition to infants who are unable to tolerate enteral feedings. Not only do these central lines provide life-saving therapy, they are easily inserted, cost effective, and convenient. Although there are many benefits to the use of these catheters, physicians and nurses within the NICU must remain acutely aware of the risks involved with placement of PICC lines so that complications can be minimized. Prevention of sepsis in neonates is always a priority, and several measures can be implemented to reduce this risk, including scrupulous aseptic technique, knowledgeable selection of the insertion site, and consistent daily care. Other complications such as thrombosis, extravascular collection of fluid due to catheter migration or blockage, vessel perforation, and line leakage are all concerns when using this valuable tool in the care of infants. Careful catheter tip placement and conscientious ongoing monitoring can assist in reducing morbidity as well as mortality related to PICC lines. PMID:11198450

Camara, D


Migration of distal ventriculoperitoneal shunt catheter into the heart. Case report and review of the literature.  


Migration of distal ventriculoperitoneal shunt tubing is known to occur in a wide of variety of locations. The authors report an unusual complication involving a previously confirmed intraperitoneal shunt catheter that migrated into the heart and pulmonary vasculature. Radiographic evidence suggested that this occurred secondary to cannulation of a segment of the external jugular vein with a shunt trochar during tunneling of the distal catheter. This is the sixth reported case of a peritoneal shunt tube migrating proximally into the heart. The authors review the literature regarding migration of distal tubing into the heart and pulmonary artery. Based on imaging studies obtained in the present case, the authors posit that the mechanism for this unusual type of shunt migration is inadvertent penetration of either the internal or external jugular vein during the initial tunneling procedure. Negative intrathoracic pressure and slow venous flow then draws the catheter out of the peritoneum and into the vasculature. The distal catheter then migrates into the right side of the heart and pulmonary artery. Diagnosis and management of this type of complication is discussed. PMID:14758952

Fewel, Matthew E; Garton, Hugh J L



Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit  

Microsoft Academic Search

Objective  Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related\\u000a to identified risk factors would reduce CR-BSI rates.\\u000a \\u000a \\u000a \\u000a \\u000a Design  Prospective, observational, interventional and interrupted time-series study.\\u000a \\u000a \\u000a \\u000a Setting  Pediatric Intensive Care Unit (PICU) in a university hospital.\\u000a \\u000a \\u000a \\u000a Methods  During a 7-year period, 609 central venous catheters (CVC) were placed in 389 patients. CR-BSI risk factors were determined\\u000a by multivariate analysis

Corsino Rey; Francisco Álvarez; Victoria De-La-Rua; Andrés Concha; Alberto Medina; Juan-José Díaz; Sergio Menéndez; Marta Los-Arcos; Juan Mayordomo-Colunga



Catheter-associated urinary tract infections: impact of catheter materials on their management  

Microsoft Academic Search

Infection associated with an indwelling catheter is a representative type of biofilm infection occurring in the urinary tract. Since the most effective way to control this intractable infection is the prevention of bacterial attachment and subsequent biofilm formation on the catheter, the importance of catheter materials and anti-bacterial coating cannot be underestimated. The difference in the degree of bacterial attachment

H. Kumon; H. Hashimoto; M. Nishimura; K. Monden; N. Ono



Large bore catheters with surface treatments versus untreated catheters for vascular access in hemodialysis.  


Infection, thrombosis, and stenosis are among the most frequent complications associated with blood-contacting catheters. Complications resulting from infection remain a major problem for hemodialysis catheters, with significant numbers of catheters being removed due to catheter-related sepsis. Numerous strategies have been employed to reduce the occurrence of infection and im-prove long-term outcomes, with varying degrees of success. The most important is the careful and sterile handling by the attending staff of the catheters during hemodialysis treatments to minimize or stop a microbial colonization of the skin and the catheter. Another approach is coating the external surface of the catheters with substances which are antibacterial like silver and/or substances with low thrombogenicity like silicone. This investigation reviews results of animal and clinical experiments conducted to assess the efficacy and biocompatibility of silver and silicone coated dialysis catheters. It is concluded that silver coatings can reduce bacterial colonization and occurrence of infection associated with these devices. The catheters employing ion implantation of silicone rubber showed low thrombogenicity. Results of the studies indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters. A new development is the microdomain structured surface (PUR-SMA coated catheters). Preliminary results with these catheters are very encouraging. PMID:15209851

Bambauer, Rolf; Latza, Reinhard; Bambauer, Silke; Tobin, Eric



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.



Venous air embolism: a review.  


Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to recognize and treat venous air entrainment. An in-depth review of the pathophysiology, clinical presentation, detection, prevention, and treatment of VAE is presented. PMID:9172037

Palmon, S C; Moore, L E; Lundberg, J; Toung, T



Pressure induced cellular senescence-a possible mechanism linking venous hypertension to venous ulcers  

Microsoft Academic Search

Introduction: Slowed healing and venous ulcers are the soft tissue effects of chronic venous insufficiency (CVI). Chronic venous hypertension has long been thought to be the root cause of these soft tissue effects, but mechanisms linking venous hypertension to delayed wound healing have been elusive. Dermal fibroblasts isolated from venous ulcers have morphologies and protein production suggestive of premature aging.

N. Fernandez; K. M. Lounsbury; T. Osler; K. A. Corrow; C. Healey; P. Forgione; A. C. Stanley



Correlation of clinical findings with venous hemodynamics in 386 patients with chronic venous insufficiency.  


Deep venous insufficiency secondary to deep valvular incompetence predominated over superficial venous insufficiency in an unselected patient population with advanced chronic venous insufficiency. Venous obstruction was uncommon (5 percent), suggesting that venous bypass surgery may have limited applicability in the management of chronic venous insufficiency. Although the majority of patients (72 percent) with stage III venous disease (ulcer) had deep venous insufficiency alone and would be potential candidates for deep valvular reconstruction, 13 percent were found to have superficial venous insufficiency alone, and the remaining 15 percent, deep venous insufficiency with a hemodynamically significant component of superficial venous insufficiency. These findings suggest that not all patients with stage III disease have altered hemodynamics on the basis of deep venous valvular incompetency. Although most stage III chronic venous insufficiency is secondary to altered deep venous hemodynamics, as demonstrated by shortened venous refill time, there is a significant group of patients with severe chronic venous insufficiency having superficial venous insufficiency alone or in combination with deep venous insufficiency (28 percent). Thus, it is imperative that those patients with superficial venous insufficiency be identified by a widely available and reproducible method, such as light reflection rheography, since they may respond to surgery of the superficial venous system alone. PMID:3400816

McEnroe, C S; O'Donnell, T F; Mackey, W C



Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure  

Microsoft Academic Search

Objective  To assess whether subtracting the expiratory change in intra-abdominal (bladder) pressure (?IAP) from central venous pressure\\u000a (CVP) provides a reliable estimate of transmural CVP in spontaneously breathing patients with expiratory muscle activity.\\u000a \\u000a \\u000a \\u000a Design and setting  Prospective observational study in a medical ICU.\\u000a \\u000a \\u000a \\u000a Patients  Twenty-four spontaneously breathing patients with central venous and bladder catheters: 18 with no clinical evidence of active\\u000a expiration (group 1) and

Ahmad S. Qureshi; Robert S. Shapiro; James W. Leatherman



21 CFR 870.1200 - Diagnostic intravascular catheter.  

Code of Federal Regulations, 2013 CFR

...intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters, among others. (b)...



21 CFR 876.5030 - Continent ileostomy catheter.  

Code of Federal Regulations, 2010 CFR

...2009-04-01 2009-04-01 false Continent ileostomy catheter. 876.5030 ...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible...



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...



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...



Arterial emboli of venous origin.  


In a small but significant group of patients with documented systemic emboli, a source is never determined. It is in this group of patients that an arterial embolus of venous origin should be considered. During the past 20 years, we identified four patients who fulfilled the diagnostic criteria for an arterial embolus of venous origin. In each, the diagnosis was made during life. In addition, we reviewed the 40 additional patient reports in the literature that appeared to meet the criteria for the diagnosis of venous origin arterial emboli. Noninvasive methods were useful in determining the presence of thrombus in the venous system, and right to left shunting across an intracardiac defect. We conclude that treatment with heparin is the mainstay of therapy, and that caval interruption should be used only on a selective basis. PMID:1729744

Katz, S; Andros, G; Kohl, R; Harris, R; Dulawa, L; Oblath, R



Total anomalous systemic venous return.  


We have described an 18-year-old boy who is asymptomatic nine years after surgical correction of total anomalous systemic venous return. His clinical course and anatomy are compared to the eight previously reported patients. PMID:7355335

Pearl, W R; Spicer, M J



Eliminating catheter-associated urinary tract infections: part II. Limit duration of catheter use.  


This article is the second in a two-part series focusing on catheter-associated urinary tract infections. Part I of the series focused on the most significant modifiable risk factor, avoiding use of urethral catheters. Part II focuses on the second major modifiable risk factor, reducing catheter-days. A quality improvement case is provided to illustrate the strategies for limiting the duration of catheter use. Together, these two articles provide important information on the two most significant risk facts for eliminating the incidence of catheter-associated urinary tract infections. PMID:19957459

Rhodes, Nancy; McVay, Tonya; Harrington, Linda; Luquire, Rosemary; Winter, Melissa; Helms, Brenda


Idiopathic venous thromboembolism and thrombophilia  

PubMed Central

During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromboembolism, and a classification of major thrombophilic factors according to their intrinsic risk of thrombosis and of thrombotic recurrences. Great interest is given to the predictors of recurrence and the importance of prolonged anticoagulation is underlined. The antiphospholipid antibody syndrome, the most common acquired thrombophilia, is presented separately. The revised diagnosis criteria are discussed. Some characteristics of the antiphospholipid syndrome are worth presenting: the risk of both venous and arterial thrombosis, the high risk of thrombotic recurrence and the diversity of antiphospholipid antibodies. Patients experiencing idiopathic venous thromboembolic event have a great risk of recurrence, and highly benefit from long time anticoagulation. Natural coagulation inhibitors deficiencies, homozygous factor V Leiden and prothrombin G20210A and the antiphospholipid syndrome, increase the risk of first venous thrombosis and their recurrences and require adequate prevention. Abbreviations: VTE–venous thromboembolism, HRT–hormone replacement therapy, AVK–antivitamin K, FVL–factor V Leiden, PT G20210A–prothrombin G20210A, TAFI–thrombin activatable fibrinolysis inhibitor, PAI–1–plasminogen activator inhibitor 1, T–PA–tissue plasminogen activator, APS–antiphospholipid syndrome, LA–lupus anticoagulant, Abeta2GP1–anti beta2 glycoprotein 1.

Hostiuc, M; Bartos, D



Tubes, lines, catheters, and other interesting devices  

Microsoft Academic Search

Medical devices (tubes, catheters, lines, prostheses, etc.) are a common finding on radiologic studies. Sometimes they may be misdiagnosed as a pathologic process, or an important observation concerning a medical device may be overlooked because of lack of familiarity with a particular device. This review discusses a variety of tubes, lines, catheters, and other interesting and important medical devices found

Tim B. Hunter



Spontaneous Intravesical Knotting of Urethral Catheter  

PubMed Central

Infant feeding tubes (IFT) have been universally used as urethral catheters in neonates and children for several decades. Though generally a safe procedure, it may cause significant morbidity if the catheter spontaneously knots inside the bladder. We report this complication in three children including a neonate.



Infection of Hemodialysis Catheters: Incidence and Mechanisms  

Microsoft Academic Search

Fifty-three consecutive subclavian or jugular hemodialysis catheters inserted into 41 patients were prospectively studied over a period of 8 months in order to determine the incidence of infection and its mechanisms. The intravascular, intradermal and the Y catheter segments as well as both connections were cultured using a quantitative technique for the intraluminal surface. In addition, the intravascular and intradermal

Jaume Almirall; Juliàn Gonzalez; Jordi Rello; Josep Maria Campistol; Jesús Montoliu; Jorge Puig de la Bellacasa; Lluís Revert; Josep Maria Gatell



Clinical evaluation of new urodynamic catheter.  


A commercially available triple lumen urodynamic catheter has been utilized for urodynamic recordings in more than 650 patients. The recordings have been highly accurate and reproducible, and we recommend this catheter for those who perform liquid perfusion urodynamic studies. PMID:4012991

Woodside, J R; McGuire, E J



Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S.  


These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations. PMID:12415057

O'Grady, Naomi P; Alexander, Mary; Dellinger, E Patchen; Gerberding, Julie L; Heard, Stephen O; Maki, Dennis G; Masur, Henry; McCormick, Rita D; Mermel, Leonard A; Pearson, Michele L; Raad, Issam I; Randolph, Adrienne; Weinstein, Robert A



Understanding Guyton's venous return curves  

PubMed Central

Based on observations that as cardiac output (as determined by an artificial pump) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return (equal to cardiac output in steady state). The idea that right atrial pressure is a back pressure limiting cardiac output and the associated idea that “venous recoil” does work to produce flow have confused physiologists and clinicians for decades because Guyton's interpretation interchanges independent and dependent variables. Here Guyton's model and data are reanalyzed to clarify the role of arterial and right atrial pressures and cardiac output and to clearly delineate that cardiac output is the independent (causal) variable in the experiments. Guyton's original mathematical model is used with his data to show that a simultaneous increase in arterial pressure and decrease in right atrial pressure with increasing cardiac output is due to a blood volume shift into the systemic arterial circulation from the systemic venous circulation. This is because Guyton's model assumes a constant blood volume in the systemic circulation. The increase in right atrial pressure observed when cardiac output decreases in a closed circulation with constant resistance and capacitance is due to the redistribution of blood volume and not because right atrial pressure limits venous return. Because Guyton's venous return curves have generated much confusion and little clarity, we suggest that the concept and previous interpretations of venous return be removed from educational materials.

Feigl, Eric O.



In vivo quantitative assessment of catheter patency in rats.  


Formation of fibrin sleeves around catheter tips is a central factor in catheter failure during chronic implantation, and such tissue growth can occur despite administration of anticoagulants. We developed a novel method for monitoring catheter patency. This method recognizes the progressive nature of catheter occlusion, and tracks this process over time through measurement of changes in catheter resistance to a standardized 1 mL bolus infusion from a pressurized reservoir. Two indirect measures of catheter patency were used: (a) reservoir residual pressure and (b) reservoir discharge time. This method was applied to the study of catheter patency in rats comparing the effect of catheter material (silastic, polyurethane, Microrenathanetrade mark), lock solution (heparin, heparin/dexamethasone) and two different cannulation sites (superior vena cava via the external jugular vein, inferior vena cava via the femoral vein). Our findings reveal that application of flexible smaller-size silastic catheters and a dexamethasone lock solution resulted in prolonged catheter patency. Patency could be maintained over nine weeks with the femoral vein catheters, compared with five weeks with the external jugular vein catheters. The current method for measuring catheter patency provides a useful index for the assessment of tissue growth around the catheter tip. The method also provides an objective and quantitative way of comparing changes in catheter patency for different surgical methods and catheter types. Our method improves on the conventional method of assessing catheter occlusion by judging the ability to aspirate from the catheter. PMID:16004684

Yang, Jun; Maarek, Jean-Michel I; Holschneider, Daniel P



Comparison of surgical bypass and percutaneous balloon dilatation with primary stent placement in the treatment of central venous obstruction in the dialysis patient: One-year follow-up  

Microsoft Academic Search

Central venous stenosis and occlusion are complications that are being observed with increasing frequency as a result of the use of long-term central venous catheters. These complications are especially problematic in patients with end-stage renal disease and functioning ipsilateral arteriovenous (AV) grafts or fistulas (AV grafts). We have previously demonstrated that the 1-year patency rate for simple balloon angioplasty in

Devinder S. Bhatia; Samuel R. Money; John L. Ochsner; Donald E. Crockett; David Chatman; Shabbir A. Dharamsey; Reynaldo F. Mulingtapang; Dinesh Shaw; Stephen R. Ramee



Venous thromboembolism in pregnancy.  


The purpose of this review is to summarize the epidemiology of venous thromboembolism (VTE) in pregnancy and describe strategies used to prevent and treat it. The main reason for the increased risk of VTE in pregnancy is hypercoagulability. The hypercoagulability of pregnancy, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth, is present as early as the first trimester and so is the increased risk of VTE. Other risk factors include a history of thrombosis, inherited and acquired thrombophilia, certain medical conditions, and complications of pregnancy and childbirth. Candidates for anticoagulation are women with a current thrombosis, a history of thrombosis, thrombophilia, and a history of poor pregnancy outcome, or postpartum risk factors for VTE. For fetal reasons, the preferred agents for anticoagulation in pregnancy are heparins. There are no large trials of anticoagulants in pregnancy and recommendations are based on case series and the opinion of experts. Nonetheless, anticoagulants are believed to improve the outcome of pregnancy for women who have or have had VTE. PMID:19228606

James, Andra H



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: [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)



Characteristics of catheter-related bloodstream infections in children with intestinal failure: implications for clinical management.  


Catheter-related bloodstream infection is a major cause of mortality and morbidity in the intestinal-failure population. This study reports characteristics of CRBSI with implications for clinical management in parenteral nutrition-dependent children with intestinal failure. The researchers report the rate of central catheter infections, and the causative organisms, as well as identify risk factors in our intestinal-failure patients that would be amenable to preventive measures.The study is a retrospective review of the medical records of 101 patients with intestinal failure (IF), seen in the Intestinal Rehabilitation Clinic at Children's Medical Center of Dallas from May 2005 to March 2007. Catheter-related bloodstream infections (CRBSIs) were categorized as nosocomial or community-acquired. Data collected for each episode include microorganisms isolated from blood and potential risk factors. Z test was done to compare the infection rates.There were 92 episodes of CRBSIs in 45 parenteral nutrition (PN)-dependent patients with central venous catheters (CVC) in place for a total of 13,978 days. Eighty-three percent (n = 76) of CRBSIs developed in the community at a rate of 7.0 per 1,000 days. Seventeen percent (n = 16) nosocomial CRBSIs were observed at a rate of 5.5 per 1,000 catheter days. CRBSI rate was not statistically different between the two groups (7.0 vs. 5.5, p = .378).CRBSI in the intestinal-failure population is due to a wide variety of organisms with numerous risk factors. Education of CVC management with the practice of consistent guidelines may reduce CRBSI incidence, thus reducing the morbidity and mortality in the intestinal-failure patients. PMID:20010229

Drews, Barbara B; Sanghavi, Rinarani; Siegel, Jane D; Metcalf, Pat; Mittal, Naveen K


Comparison of subcutaneous central venous port via jugular and subclavian access in 347 patients at a single center  

PubMed Central

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method.




[Hysterosalpingography with the Foley catheter].  


Five-hundred hysterosalpingographies with Foley-catheter were investigated and compared to that made with Schultze-instrument. The investigations were performed in both phases in cases of cyclic menstrual bleeding. The advantages of the method used are the followings: simple, atraumatic, painless. There was no flow-back of the contrast material, the shape of the internal genitals was visible in the proper position, moreover, the present method allowed an observation in the original state of the shape of the internal os and the cervical canal by a x-ray-amplifier. The method simplified the hydrotubations during and after plastic surgery on the fallopian tubes. The method can not be employed in the case of Asherman's syndrome, where the uterine cavity is significantly narrowed. PMID:4096161

Siklósi, G; Vígváry, Z; Makó, E



Electromagnetic tracking for catheter localization  

NASA Astrophysics Data System (ADS)

A low frequency AC electromagnetic tracking system is presented that is capable of determining the position and orientation of a catheter tip. Advantages of using magnetic tracking for this application is that magnetic fields are non-ionizing and pass through the human body with minimal attenuation. Low frequency fields are used to mitigate the effects of eddy currents induced in conductive materials found in the environment. There are two significant differences between this and other magnetic tracking technologies, these being (1) the use of a single magnetic sensing coil for position and orientation determination and (2) the eliminating of range restrictions between the sensing antenna and the magnetic field generators. This paper will discuss the general theory of electromagnetic tracking, why it is that researchers have an intense interest for internal tracking and a comparison of the new and old tracking technologies. Some applications of this tracking technology will also be presented.

Schneider, Mark R.



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:; 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)



Characterization of the developed antimicrobial urological catheters.  


Antimicrobial urological catheters were developed by the mixed, covalent and non-covalent binding of sparfloxacin (SPA) to heparin (HP) film which was first deposited on the latex surface of biomaterial. The SPA-HP modified surface was characterized by SEM analysis and ATR-Fourier transform infrared spectroscopy. For the antimicrobial prevention, SPA as an antibiotic with a broad antimicrobial spectrum was chosen. Antimicrobial activity of antibiotic-modified catheter against Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli strains was assessed using various procedures. On the basis of the inhibition zone and diffusion assays the efficacy around the modified catheters was demonstrated. The test samples clearly showed an antibacterial activity against all tested bacterial stains for a least one month. Inhibition of the bacterial colonization on the modified catheter surface was proved by the biofilm test. Antimicrobial activity of SPA-treated catheter surface was also quantitatively evaluated according to standard method of ISO based on JIS. The R-values were found to be higher than 3.8. The performed research indicated that the immobilization of SPA on the catheter surface by means of the mixed-type bonds resulted in stable antibacterial protection of the urological catheters for a long time. PMID:20951780

Kowalczuk, Dorota; Ginalska, Gra?yna; Golus, Joanna



A new device for continuous ambulatory central venous pressure measurement.  


We have developed a device for continuous direct measurement of human central venous pressure (CVP) during space flight. Normal resting CVP is typically in the range of 5-10 mmHg; in zero gravity, the expected changes are +/- 5 mmHg or less. A 1-mm Hg change in CVP can represent a substantial intravascular fluid shift. The device is small, battery powered, and designed to run for at least 24 hr. Pressure is measured in a saline solution-filled catheter inserted into a central vein. The transducer is placed in the axilla at the level of the catheter tip to offset hydrostatic gradients. A pump and an electronic system mount on the leg. This assembly provides a slow, continuous infusion of heparinized saline solution to maintain the patency of the catheter. The electronic system generates a digital display in mm Hg, an analog output, and a visible and audible alarm for excessive pressure. An air-filled syringe allows for a two-point calibration (zero and a positive pressure generated by measured compression of a known gas volume). A two-failure tolerant system minimizes electric shock hazards. Two latex diaphragms separate the saline solution from the transducer surface, and the electronic system and pump chamber are in separate enclosures. A clear polycarbonate case allows bubbles to be seen. The unit has been tested for pump function, temperature stability, drift, and accuracy. We conclude that this approach provides a unit with sufficient stability, accuracy, and temperature insensitivity for measuring ambulatory CVP for up to 28 hr. The design may be suitable for ambulatory measurement of other intravascular and intracardiac pressures. PMID:3452746

Buckey, J C; Goble, R L; Blomqvist, C G



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


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



Peritoneal catheter for massive cardiac ascites.  


Cardiac ascites represents 5% of all causes of ascites. Diuretics and salt restriction remain the cornerstone of management. Large volume paracentesis is needed among patients who do not respond to conservative management. The use of peritoneal catheters to continuously drain steady amounts of ascitic fluid has been generally used in malignant ascites. When the ascites of any other origin is massive and requires many consecutive days of large-volume paracentesis, the use of a catheter may represent a more convenient strategy. We present a patient with cardiac ascites that was successfully managed with a peritoneal catheter. PMID:23595184

Aisenberg, Gabriel M



Cryoballoon Catheter Ablation in Atrial Fibrillation  

PubMed Central

Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

Ozcan, Cevher; Ruskin, Jeremy; Mansour, Moussa



Systemic venous drainage: can we help Newton?  


In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton. PMID:17336540

Corno, Antonio F



Locking of tunneled hemodialysis catheters with gentamicin and heparin  

Microsoft Academic Search

Locking of tunneled hemodialysis catheters with gentamicin and heparin.IntroductionCatheter-related infection (CRI) is a major cause of morbidity and mortality in patients receiving hemodialysis. Antibiotic locking of these catheters has been shown to increase both the success of systemic antibiotic treatment in line sepsis, and to reduce the incidence of sepsis. We have studied the use of gentamicin locking of catheters




Atraumatic complex transradial intervention using large bore sheathless guide catheter  

Microsoft Academic Search

The Asahi sheathless guide catheter system is a hydrophilic catheter with a central dila- tor that does not require an introducer sheath during transradial percutaneous coronary intervention. Conventional sheath introducers are often 1- to 2F larger than the catheter itself; therefore, this system enables the use of a larger French catheter during proce- dures than would otherwise be possible using

M. A. Mamas; F. Fath-Ordoubadi; D. G. Fraser



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:; Wingen, Markus; Guenther, Rolf W.; Haage, Patrick [University Hospital, Department of Diagnostic Radiology (Germany)



Iliofemoral venous obstruction without thrombosis.  


Nonthrombotic iliofemoral venous obstruction, masquerading as deep vein thrombosis, was diagnosed in four patients. In each instance the patient was hospitalized and intravenous heparin therapy was started. Phlebography demonstrated venous outflow obstruction without thrombosis; subsequent CT scanning revealed an obstructing lesion in each case. At surgical exploration, (1) endoaneurysmorrhaphy of a hypogastric artery aneurysm decompressed an obstructed right iliac vein; (2) a primary iliac vein leiomyosarcoma was extirpated; (3) a synovial cyst arising from the right hip joint, which obstructed the femoral vein, was excised; and, (4) a postherniorrhaphy inflammatory mass obstructing the left iliofemoral vein junction was confirmed with biopsy results. Improved diagnostic accuracy with its attendant specific therapy is achieved in suspected cases of iliofemoral vein thrombosis if, in addition to noninvasive venous studies or phlebography, CT scanning of the abdomen and pelvis is performed. PMID:3694758

Harris, R W; Andros, G; Dulawa, L B; Oblath, R W; Horowitz, R



Surgical treatment of acute deep venous thrombosis  

Microsoft Academic Search

In patients with venous thrombotic disease and in whom anticoagulation or thrombolytic therapy is inappropriate, ineffective, or even contraindicated, insertion of vena caval filters or venous thrombectomy must be considered.

Reginald S. A. Lord; Frank C. Chen; Terence J. Devine; Ian V. Benn



Pathophysiology of Spontaneous Venous Gas Embolism.  

National Technical Information Service (NTIS)

The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon...

C. J. Lambertsen K. H. Albertine J. B. Pisarello N. D. Flores



Fracture of J-tipped guidewire during central venous catheterization and its successful removal under fluoroscopic guidance -A case report-  

PubMed Central

Central venous catheterization by Seldinger's technique uses a guidewire which may cause complications such as kinking, knotting and fracture. Fractured guidewire may lead to severe outcomes such as embolization, and removal of it may also cause problems such as vessel damage. We experienced a case of right internal jugular venous catheterization complicated by guidewire fracture entrapped in the central venous catheter, and its successful removal under fluoroscopic guidance using snare-loop. The patient recovered without any complications. When resistance is felt during insertion or withdrawal of the guidewire, force should not be applied to the guidewire and care should also be exercised when passing the tissue dilator over the guidewire. Clinicians should be aware of this rare complication and snare-loop technique could be considered as one of the methods for removal of the fractured guidewire.

Park, Sun Kyung; Yi, In-Kyong; Lee, Jae-Ho; Kim, Dae-Hee



Cerebral venous thrombosis: diagnosis dilemma  

PubMed Central

Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.

Chiewvit, Pipat; Piyapittayanan, Siriwan; Poungvarin, Niphon



A comparison of two transparent film-type dressings in central venous therapy.  


A prospective randomized clinical trial has been conducted to compare the clinical performance, with prolonged use, of two film-type transparent dressings used over subclavian and jugular single-lumen venous catheters. 'OpSite', a traditional dressing with a moderate moisture vapour permeability was compared with a new dressing of high moisture vapour permeability, 'OpSite IV3000'. Information was collected daily to assess the nature and incidence of complications, dressing durability and the ease of application and removal. One hundred and one patients provided two well-matched populations receiving a total of 153 dressings for a total of 780 catheter-days. No differences between the two dressings were noted with respect to the incidence of complications, such as moisture accumulation or lifting, and dressing durability. The low incidence of catheter-related sepsis ('OpSite' group three episodes and 'OpSite IV3000' group one episode) suggests that transparent dressings do not increase this risk. This clinical study demonstrated the new 'OpSite IV3000' to be easier to handle, leading to better application, improved catheter fixation and easy removal. PMID:8097215

Wille, J C; Blussé van Oud Albas, A; Thewessen, E A



Epidemiology and Costs of Venous Diseases in Central ItalyThe San Valentino Venous Disease Project  

Microsoft Academic Search

The Prevalence of Early Atherosclerosis study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The prevalence of superficial and deep venous disease, the prevalence of venous thrombosis and pulmonary embolism, and the prevalence of the most common venous malformations were studied through use of

M. R. Cesarone; G. Belcaro; A. N. Nicolaides; G. Laurora; M. T. De Sanctis; L. Incandela; A. Barsotti



The Chait Trapdoor cecostomy catheter: an alternative access device to pigtail catheters for chronic cholecystostomy drains.  


Acute cholecystitis is a well known complication in the critically ill patient population. These patients are often at high risk for morbidity and mortality associated with cholecystectomy. Percutaneous cholecystostomy has been shown to be an effective procedure in the treatment of acute cholecystitis in this patient population. Some patients require prolonged catheter drainage before definitive therapy. In four patients with patent cystic ducts, standard drainage catheters were exchanged for 10.2-F Chait pediatric cecostomy catheters. The low profile of the catheter and the "Trapdoor" feature allow maintenance and increased patient satisfaction while maintaining drainage and access. PMID:18192480

Allen, Anthony W; Varma, Manish K; Meyermann, Mark W



21 CFR 874.4175 - Nasopharyngeal catheter.  

Code of Federal Regulations, 2013 CFR

...4175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4175 Nasopharyngeal catheter. (a) Identification....



[The microbiologist and the catheter related infection].  


Different multicentre epidemiological studies such as ENVIN-HELICS or EPINE, have remarked that catheter related bloodstream infection (CRBI) is an increasingly condition in hospital environment. The microbiologist plays a major role in the diagnosis, either by recommending what type of catheter must be considered for confirmatory diagnosis, when these samples must be sent for culture, when is indicated to perform surveillance studies of the catheter and what results are clinically significant to be informed. In this paper, different aspects of the CRBI, such as the pathogenesis, etiology, epidemiology and diagnosis are reviewed. The different microbiological diagnostic methods, both conservatives and those involving the removal of the catheter are up-to-dated. PMID:20559602

García-Rodríguez, J; de Pablos, M; Gutiérrez, A



Intravascular Catheter-Related Bloodstream Infection  

PubMed Central

Intravascular catheters required for the care of many hospitalized patients can give rise to bloodstream infection, a complication of care that has occurred most frequently in intensive care unit (ICU) settings. Elucidation of the pathogenesis of catheter-related bloodstream infections (CRBSIs) has guided development of effective diagnostic, management, and prevention strategies. When CRBSIs occur in the ICU, physicians must be prepared to recognize and treat them. Prevention of these infections requires careful attention to optimal catheter selection, insertion and maintenance, and to removal of catheters when they are no longer needed. This review provides a succinct summary of the epidemiology, pathogenesis, and microbiology of CRBSIs and a review of current guidance for the diagnosis, management, and prevention of these infections.

Shah, Harshal; Bosch, Wendelyn; Thompson, Kristine M.; Hellinger, Walter C.



Complications of chronic indwelling urinary catheters.  


Chronic indwelling catheters are used to manage urinary retention, especially in the presence of urethral obstruction, and to facilitate healing of incontinence-related skin breakdown. These indwelling foreign bodies become coated and sometimes obstructed by biofilm laden with bacteria and struvite crystals. Bacteria invariably colonize the system and may invade the blood stream following trauma or obstruction. Staff should maintain a closed, dependent system to avoid introducing new organisms and be vigilant for the development of obstruction, avoid trauma, and consider chronic catheters and drainage bags to be potential sources of antibiotic-resistant bacteria for secretion containment and when antibiotics are selected for empiric therapy. Suprapubic catheters should be considered when urethral catheters are associated with discomfort or periurethral suppurative complications, especially in males. PMID:16843240

Drinka, Paul J



Robotic catheter navigation within the left ventricle.  


Robotic navigation systems aim to improve ablation catheter maneuverability, tissue contact, and stability. These attributes suggest that such systems could enhance outcomes in the ablation of ventricular tachycardia (VT). To date, however, ablation has been confined to the atria. We present a case in which robotic catheter navigation alongside three-dimensional anatomical mapping enabled successful ablation of VT within the left ventricle. PMID:20663076

Duncan, Edward; Johns, Neville; Schilling, Richard J; Sporton, Simon



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:; 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)



Capillary versus venous bedside blood glucose estimations  

Microsoft Academic Search

Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients.Methods: Blood glucose levels were synchronously analysed using a bedside blood glucometer on capillary and venous derived samples from consenting ED patients aged >12 years. The venous sample was sent for comparative testing using

R Boyd; B Leigh; P Stuart



Imaging of head and neck venous malformations  

Microsoft Academic Search

Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated

Christine M. Flis; Stephen E. Connor



Acute lipodermatosclerosis is associated with venous insufficiency  

Microsoft Academic Search

Background: Acute lipodermatosclerosis is characterized by pain and tenderness in the medial aspect of the leg. It is thought to be the result of venous insufficiency and to be the acute counterpart of chronic lipodermatosclerosis, a hallmark of venous disease. However, there is no direct evidence linking acute lipodermatosclerosis to venous disease.Objective: Our purpose was to determine whether acute lipodermatosclerosis

Adam S Greenberg; Anthony Hasan; Berta M Montalvo; Anne Falabella; Vincent Falanga



Internal and external urinary catheters: a primer for clinical practice.  


Internal and external urinary catheters are used to manage urinary incontinence and incomplete bladder emptying. Bladder dysfunction cause determines whether short- or long-term catheter use is required which, in turn, determines whether an indwelling, intermittent, or external catheter should be used. The method of catheterization is based on the underlying bladder condition, the goals of treatment, and gender appropriateness. Complications such as infection (eg, catheter-associated urinary tract infection, sepsis) and its related sequelae have been found to be directly related to length of time of catheter use (eg, women are at greater risk for catheter-associated urinary tract infection when an indwelling catheter is in place >2 weeks); thus, catheter use must be medically justified and in the case of an indwelling catheter, involve the shortest period possible to ensure patient safety and regulatory compliance. Some newer catheter systems include coatings to prevent complications; complications specific to indwelling catheter use include obstruction from encrustations, urethral trauma and erosion, bladder stones and bladder cancer, and, in men, epididymitis. Complications from external catheters may occur when skin condition is compromised. Overuse of catheters has reimbursement ramifications. Numerous guidelines reflect the need for the judicious use of urinary catheters, particularly in long-term care patients. Because evidence-based research on long-term use of these devices is lacking, clinicians should use clinical experience when caring for patients with catheters. PMID:19104121

Newman, Diane K



Tamm-Horsfall protein facilitates catheter associated urinary tract infection  

PubMed Central

Background Urinary catheters are associated, commonly with bacteriuria and frequently with urinary tract infection. Tamm-Horsfall Protein (THP) is urine's most abundant protein and is known to bind to uropathogenic bacteria. The role of THP in the pathogenesis of catheter associated urinary tract infection (CAUTI) is not clear. We examined the role of THP in facilitating bacterial binding to urinary catheters in vivo and in vitro. Findings Twenty one urinary catheters were obtained from 20 hospitalized patients. THP was eluted from the catheter surface and catheter segments were cultured. Additional studies were performed in vitro on unused silicone and latex catheters to determine the binding of THP, and the effect of THP on the binding of Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa), to the catheter surface. On catheters obtained from patients, the THP deposition was significantly more on culture positive catheters than on culture negative catheters. In the in vitro studies, THP bound to both silicone and latex catheters, and THP enhanced the adherence of E. coli and P. aeruginosa to both types of catheters. Conclusion THP binds to urinary catheters and facilitates the binding of uropathogenic bacteria to catheters.



Proposed catheter standards for pharyngeal manofluorography (videomanometry)  


With the recent introduction of commercially available pharyngeal manofluorography systems, catheter design should be standardized. Catheters of different designs can produce different data because of their design characteristics. A standard catheter design should make results between investigators comparable and facilitate acceptable normal values. The authors' combined laboratory experience with many catheter designs was reviewed and the literature consulted. For pharyngeal manofluorography, the proposed standard catheter should be 2 x 4 mm in diameter, ovoid, and 100 cm long. The catheter should be marked in centimeters with an anterior and posterior orientation. There should be a slightly malleable, 3- to 4-cm length without sensors beyond the most distal sensor. Solid state transducer sensors should be three or four in number and placed in the pharyngoesophageal segment, midhypopharynx, and tongue base (esophagus for fourth sensor). Sensor spacing should be 3 cm, except 2 cm between the midhypopharynx and tongue base. Unidirectional, in-line, posteriorly oriented sensors with the option of a single circumferential sensor in the cricopharyngeus are currently preferred over circumferential sensors because of their small diameter (patient comfort). PMID:9513306

Salassa, J R; DeVault, K R; McConnel, F M



Interventional catheter procedures used in congenital heart disease.  


Many of the transcatheter devices described in this article remain investigational in the United States. Currently, we consider the applications of these techniques as either (1) procedures of choice (for closures of patent ductus arteriosus, balloon dilation or stent implantation for peripheral pulmonary stenoses, balloon dilation of recurrent or persistent aortic coarctation, balloon pulmonary valvotomy, closure of congenital muscular or postoperative residual ventricular septal defects, closure of patent foramen ovale in the setting of cyanosis, balloon aortic valvotomy, fenestration closures, coil embolization of thoracic collateral vessels); (2) effective alternatives to surgical therapy (closures of atrial septal defects of the secundum type, balloon dilation of native aortic coarctation, stent implantation for conduit or baffle obstruction, device emobolization of paravalvular leaks or coronary artery fistulas); or (3) treatments with unproven effect (closure of acute postmyocardial infarction ventricular septal defects, closure of patent foramen ovale for idiopathic stroke, stent implantation for pulmonary venous stenosis) (Table 1). Patients with congenital heart disease often undergo multiple catheterizations and surgical therapies, each with its own complications and sequelae. Clinical trials of catheter-based technologies for patients with congenital heart disease have consisted of uncontrolled case series with a lack of standardized follow-up. Additional prospective large-scale clinical trials of these therapies seem necessary before their widespread acceptance. PMID:8252560

Landzberg, M J; Lock, J E



Bilateral pulmonary emboli secondary to indwelling hemodialysis reliable outflow catheter.  


We present a 33-year-old dialysis-dependent female who presented with new onset split second heart sound. Following a failed left upper extremity dialysis fistula, a right upper extremity hemodialysis reliable outflow (HeRO) graft was performed in 2011. Her subsequent cadaveric renal transplant had delayed function necessitating concurrent use of hemodialysis. However, as renal function improved, hemodialysis was discontinued. Two weeks following transplantation, the HeRO graft occluded. Subsequent clinical and radiological assessment confirmed widespread pulmonary emboli. Following cessation of hemodialysis and subsequent HeRO graft occlusion, removal was deemed appropriate to reduce further thromboembolic phenomenon. Right atrial thrombi are complications associated with central venous catheters. However, their actual incidence varies significantly. Right heart thromboemboli are associated with a 4% to 6% pulmonary embolism rate. Katzman et al assessed 38 patients who underwent HeRO graft and reported 1 (2.6%) patient with right atrial emboli and likely pulmonary embolism. Although thrombotic complications remain rare, consideration of graft removal should always be evaluated particularly in the absence of an alternative thrombotic source. PMID:23567802

Coan, Kathryn E; O'Donnell, Mark E; Fankhauser, Grant T; Bodnar, Zachary; Chandrasekaran, Krishnaswamy; Stone, William M



Preventing catheter-associated urinary tract infections in acute care: the bundle approach.  


Catheter-associated urinary tract infections account for 40% of all nosocomial infections. A multidisciplinary team implemented evidence-based guidelines and a urinary catheter bundle, focusing on optimizing the use of urinary catheters through continual assessment and prompt catheter removal. Data were obtained on catheter device days, compliance with urinary catheter orders, and computer documentation of continued catheter indications. Results included an overall reduction of 71% in catheter device days and a 56% reduction in catheter use. PMID:22327333

Andreessen, Linda; Wilde, Mary H; Herendeen, Pam


Risk factors for venous thromboembolism  

Microsoft Academic Search

Until the 1990s, venous thromboembolism (VTE) was viewed primarily as a complication of hospitalization for major surgery (or associated with the late stage of terminal illness). However, recent trials in patients hospitalized with a wide variety of acute medical illnesses have demonstrated a risk of VTE in medical patients comparable with that seen after major general surgery. In addition, epidemiologic

Frederick Anderson; Frederick A. Spencer



Antiphospholipid Antibodies and Venous Thromboembolism  

Microsoft Academic Search

NTIPHOSPHOLIPID antibodies (APLA) are a hetero- geneous group of antibodies that can be detected as lupus anticoagulants (LA) and anticardiolipin antibodies (ACLA).' It is generally assumed that an association exists between APLA and venous thromboembolism (VTE). This assumption is based primarily upon the results of cross- sectional studies of patients with systemic lupus erythemato- sus The results of studies in

J. S. Ginsberg; P. S. Wells; P. Brill-Edwards; D. Donovan; K. Moffatt; M. Johnston; P. Stevens; J. Hirsh



Unanswered questions in venous thromboembolism  

Microsoft Academic Search

We have made great strides in the diagnosis, treatment and prevention of venous thromboembolism (VTE). Despite these advances, however, questions remain. Perhaps the most important unmet need is the development and implementation of strategies to increase the uptake of guidelines for thromboprophylaxis. VTE is largely preventable with appropriate prophylaxis. New oral anticoagulants have the potential to further streamline VTE prevention

Jeffrey I. Weitz



Venous thromoboembolic disease and pregnancy  

Microsoft Academic Search

Although venous thromboembolism is a preventable and treatable condition, it remains the most common cause of direct maternal death in the UK, with a four-fold increased incidence compared to that of the non-pregnant population. The risk of VTE is apparent from early pregnancy and maximal immediately postpartum. Increasing rates of obesity and maternal age over 35 years are in part

M Martineau; C Nelson-Piercy



Multiple venous aneurysms of neck  

PubMed Central

Venous aneurysm of neck is a rare anomaly, usually presenting as a painless mass which increases in size on valsalva maneuver. A child with multiple aneurysms of the right common facial and external jugular veins diagnosed on Doppler ultrasonography and magnetic resonance venography is reported.

Swaika, Sweta; Basu, Sudipta; Bhadra, Ram C.; Maitra, Sujay



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)



Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery.  


Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient. PMID:22862957

Kjeld, Thomas; Hansen, Egon G; Holler, Nana G; Rottensten, Henrik; Hyldegaard, Ole; Jansen, Eric C



Managing venous stasis disease and ulcers.  


Venous leg ulcers are arguably the most common type of venous ulcers seen in clinical practice. Compression therapy is the essential intervention in venous leg ulcer treatment, but coexisting arterial vascular insufficiency must be excluded before compression is initiated. No single topical dressing has been shown to be superior for all wounds. Venous leg ulcers are chronic and often difficult to heal, with only 40% to 70% healing after 6 months of treatment. Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery. PMID:23571036

Thomas, David R



Molecular mechanisms in chronic venous insufficiency.  


Chronic venous disease (CVD) is common. Its manifestations include varicose veins; skin changes such as dermatitis, hyperpigmentation, and lipodermatosclerosis; and chronic leg ulcers. Recent advances in the understanding of its pathophysiology have shown how molecular mechanisms in the inflammatory cascade are involved in these diverse findings. Venous hypertension and associated fluid shear stress alterations on the endothelial surface may initiate this cascade and may lead to adverse changes in the venous wall, venous valves, and skin that can eventually result in varicose veins and in venous ulcers. PMID:17484957

Bergan, John



[Intensifying iron chelating therapy with desferrioxamine using implantable venous access catheters (Port-A-Cath)].  


Deferoxamine is still today the only preventive and curative treatment of transfusional hemochromatosis. It must be perfused daily, intravenously or subcutaneously, during several hours. Implantable infusion devices (Port-A-Cath) offer intravenous access, allowing to use higher doses, while avoiding local swelling due to subcutaneous injections. This device was inserted in 7 major thalassemic patients who presented with severe complications of iron overload, including 4 of them with signs of cardiac failure. Ferritinemias of all patients were lowered after intensifying iron chelation: cardiac function improved drastically in 2 patients. Devices were responsible for some complications: occlusion in one patient, local infections in two. This way of administration of desferal seems useful in patients with high ferritinemia and/or organic complications related to hemochromatosis. PMID:1610270

de Montalembert, M; Jan, D; Clairicia, M; Hannedouche, T; Sidi, D; Girot, R



Prevention of central venous catheter-related infection in the intensive care unit  

Microsoft Academic Search

: This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http:\\/\\/\\/series\\/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http:\\/\\/\\/series\\/2855.

Denis Frasca; Claire Dahyot-Fizelier; Olivier Mimoz



Development and Characterization of an In Vivo Central Venous Catheter Candida albicans Biofilm Model  

Microsoft Academic Search

Biofilms represent a niche for microorganisms where they are protected from both the host immune system and antimicrobial therapies. Biofilm growth serves as an increasing source of clinical infections. Candida infections are difficult to manage due to their persistent nature and associated drug resistance. Observations made in biofilm research have generally been limited to in vitro models. Using a rat

D. Andes; J. Nett; P. Oschel; R. Albrecht; K. Marchillo; A. Pitula



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



Catheter-associated urinary tract infections: new aspects of novel urinary catheters  

Microsoft Academic Search

Nosocomial urinary tract infection is the most common infection acquired both in hospitals and nursing homes and is usually associated with catheterisation. These catheter-associated urinary tract infections (CAUTIs) have been reported to increase mortality and have a considerable economic impact. To date, the sole effective preventative strategy is the use of a closed drainage system and removal of the catheter

U-Syn Ha; Yong-Hyun Cho



Analysis of Risk Factors for Catheter-Related Bacteremia in 2000 Permanent Dual Catheters for Hemodialysis  

Microsoft Academic Search

Background: Infection constitutes a leading cause of morbidity and mortality in hemodialysis (HD) patients. The type of vascular access is an important determinant of the risk of infection. Therefore, identification of risk factors leading to catheter-related bacteremia (CRB) is strongly required. The aim of this prospective large cohort study of HD patients using only catheters as vascular access was to

Xavier Lemaire; Marion Morena; Hélène Leray-Moragués; Delphine Henriet-Viprey; Leila Chenine; Christine Defez-Fougeron; Bernard Canaud



Undersampled Projection Reconstruction for Active Catheter Imaging With Adaptable Temporal Resolution and Catheter-Only Views  

PubMed Central

In this study undersampled projection reconstruction (PR) was used for rapid catheter imaging in the heart, employing steady-state free precession (SSFP) contrast. Active catheters and phased-array coils were used for combined imaging of anatomy and catheter position in swine. Real-time imaging of catheter position was performed with relatively high spatial and temporal resolution, providing 2 × 2 × 8 mm spatial resolution and four to eight frames per second. Two interactive features were introduced. The number of projections (Np) was adjusted interactively to trade off imaging speed and artifact reduction, allowing acquisition of high-quality or high-frame-rate images. Thin-slice imaging was performed, with interactive requests for thick-slab projection images of the signal received solely from the active catheter. Briefly toggling on catheter-only projection images was valuable for verifying that the catheter tip was contained within the selected slice, or for locating the catheter when part of it was outside the selected slice.

Peters, Dana C.; Lederman, Robert J.; Dick, Alexander J.; Raman, Venkatesh K.; Guttman, Michael A.; Derbyshire, J. Andrew; McVeigh, Elliot R.



Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery.  


We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter (PICC) in a chemotherapy patient. A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area. The patient completed chemotherapy without complications 1 mo ago; however, he experienced pain in the right subclavian area during his last chemotherapy session. Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery, for which the patient was admitted to our hospital. We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare, but were unsuccessful because the catheter was lodged in the pulmonary artery wall. Therefore, a second attempt was made through the right femoral vein using a snare with triple loops, but we could not grasp the migrated PICC. Finally, a string was tied to the top of the snare, allowing us to curve the snare toward the pulmonary artery by pulling the string. Finally, the catheter body was grasped and retrieved. The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters. PMID:24109502

Teragawa, Hiroki; Sueda, Takashi; Fujii, Yuichi; Takemoto, Hiroaki; Toyota, Yasushi; Nomura, Shuichi; Nakagawa, Keigo



Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery  

PubMed Central

We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter (PICC) in a chemotherapy patient. A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area. The patient completed chemotherapy without complications 1 mo ago; however, he experienced pain in the right subclavian area during his last chemotherapy session. Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery, for which the patient was admitted to our hospital. We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare, but were unsuccessful because the catheter was lodged in the pulmonary artery wall. Therefore, a second attempt was made through the right femoral vein using a snare with triple loops, but we could not grasp the migrated PICC. Finally, a string was tied to the top of the snare, allowing us to curve the snare toward the pulmonary artery by pulling the string. Finally, the catheter body was grasped and retrieved. The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.

Teragawa, Hiroki; Sueda, Takashi; Fujii, Yuichi; Takemoto, Hiroaki; Toyota, Yasushi; Nomura, Shuichi; Nakagawa, Keigo



Percutaneous Selective Embolectomy using a Fogarty Thru-Lumen Catheter for Pancreas Graft Thrombosis: A Case Report  

SciTech Connect

A 57-year-old woman with a history of diabetes mellitus underwent simultaneous pancreas-kidney transplantation. The pancreaticoduodenal graft was implanted in the right iliac fossa. The donor's portal vein was anastomosed to the recipient's inferior vena cava (IVC). Seven days after the surgery, a thrombus was detected in the graft veins. Percutaneous thrombolysis was immediately performed; however, venous congestion was still present. We therefore attempted selective embolectomy using a Fogarty Thru-Lumen Catheter. Thrombi were directed from the graft veins toward the IVC and captured in the IVC filter with complete elimination of the thrombus without any major complications. We present our technique for the successful treatment of pancreas graft thrombosis within a short time period by percutaneous selective embolectomy using a Fogarty Thru-Lumen Catheter.

Izaki, Kenta, E-mail:; Yamaguchi, Masato [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Matsumoto, Ippei; Shinzeki, Makoto; Ku, Yonson [Kobe University Graduate School of Medicine, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery (Japan); Sugimura, Kazuro; Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan)



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:; 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)



Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath  

PubMed Central

Background A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation. Objective To report our initial experience using this system for remotely performing catheter ablation in humans. Methods Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n?=?1), atrial flutter (n?=?2) and atrial fibrillation (n?=?7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success. Results Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm2 for all ten ablation procedures. Conclusions Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator. Electronic supplementary material The online version of this article (doi:10.1007/s10840-007-9184-z) contains supplementary material, which is available to authorized users.

Wallace, Daniel T.; Goldenberg, Alex S.; Peters, Nicholas S.; Davies, D. Wyn



Cerebral venous outflow and arterial microsphere flow with elevated venous pressure.  


The cerebral blood flow response to cerebral venous pressure elevation was studied in pentobarbital-anesthetized dogs using the cerebral venous outflow and radiolabeled microsphere techniques. Cerebral venous pressure elevation resulted in a significant reduction in cerebral venous outflow at a pressure of approximately 2.0 mmHg (referenced at the level of the external auditory meatus). At higher pressures, cerebral venous outflow decreased at a rate of 0.5 ml x min-1 x mmHg-1. Mean arterial pressure was 102.0 mmHg, and thus cerebral perfusion pressure (mean arterial pressure minus cerebral venous pressure) was well within the range for cerebral autoregulation. These results were obtained regardless of whether cerebrospinal fluid pressure was allowed to rise concomitantly with cerebral venous pressure (11 dogs) or was maintained at atmospheric pressure (7 dogs). However, simultaneous measurement of cerebral venous outflow and total and regional cerebral blood flow with the radiolabeled microsphere technique with venous pressure elevation (6 dogs) produced discrepant results. As cerebral venous pressure was elevated to approximately 16.0 mmHg, cerebral venous outflow decreased to 40% of control while total and regional cerebral blood flow values remained unchanged, so that regional and cerebral vascular resistances decreased. These results suggest that cerebral venous pressure elevation opens intracranial venous anastomotic channels and diverts blood flow from the measured venous drainage through other drainage sites. In addition, our results suggest that the dominant mechanism of cerebral autoregulation is metabolic, not myogenic. PMID:6404180

Wagner, E M; Traystman, R J



[Indications for catheter ablation of ventricular tachycardia].  


Ventricular tachyarrhythmias (VT) can cause sudden cardiac death. This can be prevented by an implantable cardioverter-defibrillator (ICD) but approximately 25 % of patients with an ICD develop electrical storm (? 3 VTs within 24 hours) during the course of 4-5 years. This is a life-threatening event even in the presence of an ICD, particularly if incessant VT is present, and may significantly deteriorate the patient's psychological state if multiple shocks are discharged. Catheter ablation of VT has developed into a standard procedure in many specialized electrophysiology centers. Patients with hemodynamically stable and unstable VT are amendable to substrate-based ablation strategies. Catheter ablation can be performed as emergency procedure in patients with electrical storm as well as electively in patients with monomorphic VT stored in ICD memory. In patients with ischemic or non-ischemic cardiomyopathy, VT ablation is complementary to ICD implantation and can reduce the number of ventricular arrhythmia episodes and shocks and should be performed early. In patients with electrical storm, catheter ablation can acutely achieve rhythm stabilization and may improve prognosis in the long term. Further indications for catheter ablation exist in patients with idiopathic VT where catheter ablation represents a curative therapy, and in patients with symptomatic or asymptomatic frequent premature ventricular beats which may improve prognosis in patients with heart failure and cardiac resynchronization therapy. PMID:24046136

Deneke, T; Israel, C W; Krug, J; Nentwich, K; Müller, P; Mügge, A; Schade, A



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)



Cerebral venous development in relation to developmental venous anomalies and Vein of Galen aneurysmal malformations.  


Cerebrovascular venous development and intracranial vascular malformations are extensive topics for which volumes of text may be devoted. However, a basic knowledge of the embryology of cerebral venous system and venous architecture is essential for understanding of cerebral vascular malformations. The aim of this work is to provide the reader with a brief overview of the development of the cranial venous anatomy. We will highlight the superficial and deep venous systems with special attention to developmental venous anomalies and vein of Galen aneurysmal malformations. PMID:21596280

Pearl, Monica; Gregg, Lydia; Gandhi, Dheeraj



Vascular access in neonates and infants--indications, routes, techniques and devices, complications.  


Venous cannulation has been in regular use in neonates since the 1940s. This was at first through the umbilical vein, but the frequency of complications lead to other central and peripheral routes being used for infusion of fluid, nutrients and drugs. Today, peripheral venous access is preferred except for high volume fluid resuscitation, reliable infusion of irritant drugs and long-term parenteral nutrition. Intraosseous infusion provides a reliable alternative to peripheral veins for rapid infusion of fluid. Long, thin silastic catheters can be inserted through a peripheral venous cannulae for parenteral nutrition or other central venous infusions as an alternative to direct central venous cannulation using the Seldinger or other techniques. Broviac or Hickman catheters, inserted through a subcutaneous tunnel are only considered when central venous cannulation is likely to be needed for more than six weeks. The most common serious complication of vascular access is infection. Infection associated with central venous catheters is reduced by prophylactic vancomycin or teicoplanin. Other complications of central venous infusion are associated with cannulae malpositioning, bleeding and thrombosis. Distal hypoperfusion may follow arterial cannulation. Modern emergency and intensive care paediatrics is impossible without adequate venous and arterial vascular access. However no other skill for neonatal intensive care causes more anxiety in primary care providers or is more difficult to teach. PMID:10150755

Möller, J C; Reiss, I; Schaible, T



Mixed Capillary Venous Retroperitoneal Hemangioma  

PubMed Central

We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

Godar, Mohit; Yuan, Qinghai; Shakya, Rukeshman; Xia, Yang



The importance of effective catheter securement.  


This article examines the importance of securing/fixing indwelling urinary catheters. The Oxford English dictionary interlinks the two words-'secure' and 'fix'-as having the same meaning. To secure the catheter should not be confused with 'support', whereby the weight of the urine drainage bag is supported with the use of velcro straps or a sleeve. The author introduces the need for the concept of this practice to be at the forefront of nurses' minds in all settings, and this is demonstrated through the use of case studies. Current guidance in this area is reviewed, as well as the problems that can arise when catheters are not secured properly and the available products for health professionals to use. PMID:20948482

Fisher, Jayne


Catheter embolectomy for acute pulmonary embolism.  


Massive pulmonary embolism (PE) is a life-threatening condition with a high early mortality rate due to acute right ventricular failure and cardiogenic shock. As soon as the diagnosis is suspected, an IV bolus of unfractionated heparin