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Sample records for venous hickman catheter

  1. Ethanol versus heparin locks for the prevention of central venous catheter-associated bloodstream infections: a randomized trial in adult haematology patients with Hickman devices.

    PubMed

    Worth, L J; Slavin, M A; Heath, S; Szer, J; Grigg, A P

    2014-09-01

    The effectiveness of ethanol locks for prevention of central venous catheter (CVC)-associated bloodstream infection (CLABSI) in adult haematology patients has not been thoroughly evaluated. This study aimed to compare prospectively heparinized saline with 70% ethanol locks using 2 h dwell time in patients with tunnelled CVCs. In saline (N = 43) and ethanol (N = 42) groups, CLABSI rates were 6.0 [95% confidence interval (CI): 3.4-9.8] and 4.1 (95% CI: 1.9-7.7) per 1000 CVC days, respectively (P = 0.42). In the ethanol group, two exit-site infections and one tunnel/pocket infection were observed. Reduction in device-associated infection was not achieved with prophylactic 70% ethanol locks in patients with haematological malignancy and tunnelled CVCs. PMID:25063013

  2. Complications associated with central venous catheters in a haematology unit.

    PubMed Central

    Sharpe, P. C.; Morris, T. C.

    1994-01-01

    The use of central venous catheters in patients suffering from haematological disorders has brought enormous benefits, but has been associated with an increase in septicaemia. We have reviewed septic and other complications in 43 patients who received one of three different forms of central venous catheters (type A-Hickman, type B-Portacath, type C-Pasport) during 1991. All complications were reviewed up to 18 months following insertion. The total complication rate was 31% (0.97 per 100 catheter days), and the total sepsis complication rate was 18.8% (0.49 per 100 catheter days). Type A catheters had the greatest sepsis complication rate of 29.5% (0.84 per 100 catheter days), with type B 15% (0.39 per 100 catheter days) and type C 9.9% (0.32 per 100 catheter days). Prophylactic antibiotics on the day of catheter insertion did not reduce the sepsis rate or prolong catheter survival. PMID:8650826

  3. Complications associated with central venous catheters in a haematology unit.

    PubMed

    Sharpe, P C; Morris, T C

    1994-10-01

    The use of central venous catheters in patients suffering from haematological disorders has brought enormous benefits, but has been associated with an increase in septicaemia. We have reviewed septic and other complications in 43 patients who received one of three different forms of central venous catheters (type A-Hickman, type B-Portacath, type C-Pasport) during 1991. All complications were reviewed up to 18 months following insertion. The total complication rate was 31% (0.97 per 100 catheter days), and the total sepsis complication rate was 18.8% (0.49 per 100 catheter days). Type A catheters had the greatest sepsis complication rate of 29.5% (0.84 per 100 catheter days), with type B 15% (0.39 per 100 catheter days) and type C 9.9% (0.32 per 100 catheter days). Prophylactic antibiotics on the day of catheter insertion did not reduce the sepsis rate or prolong catheter survival. PMID:8650826

  4. Central venous catheter - flushing

    MedlinePLUS

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

  5. Pneumothorax as a complication of central venous catheter insertion

    PubMed Central

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

    2015-01-01

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

  6. Complex central venous catheter insertion for hemodialysis.

    PubMed

    Powell, Steven; Belfield, Jane

    2014-01-01

    Despite the introduction of payment by results in the UK, there has been no decrease in central venous catheter (CVC) use. In part, this may relate to a requirement to dialyse through a CVC while autogenous access matures. Mortality data have improved in parallel and patients on hemodialysis live longer, which may lead to an increased exposure to CVCs.Exposure to CVCs carries a significant risk of infection and occlusion requiring their repositioning or exchange. The mid to long-term sequelae of CVC use is central venous occlusion leaving clinical teams with an ever increasing challenge to find adequate venous access.In this article, we will discuss the challenges faced by operators inserting CVCs into the hemodialysis-dependent patient who has exhausted more tradition insertion sites. These include translumbar caval catheters, transocclusion and transcollateral catheters, transjugular Inferior Vena Cava catheter positioning, and transhepatic catheters. We will demonstrate the techniques employed, complications, and anticipated longevity of function. PMID:24817471

  7. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

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

  8. Ultrasound assessment of thrombotic complications in pediatric patients with tunneled central venous catheters

    PubMed Central

    Kosiak, Wojciech; Irga, Ninela; Po?czy?ska, Katarzyna

    2013-01-01

    Central venous access consists in inserting a vascular catheter to the vena cava and placing its tip in the vicinity of the opening to the right atrium. In the patients of the Clinic of Pediatrics, Hematology and Oncology at the Academic Clinical Centre of the Medical University in Gda?sk, such implantation procedures are conducted 40–50 times in a year using Broviac/Hickman catheters that are placed in the subclavian vein. In the Ultrasound and Biopsy Laboratory at the clinic mentioned above, approximately 200–250 examinations have been conducted since 2005 to assess the central venous access. Implantation of a catheter considerably increases the comfort of patients who require a long-term venous access. Nevertheless, it is an invasive procedure, burdened with a risk of numerous, early and late complications. The late complications are associated with implanted catheters and include catheter-related thrombosis. The aim of this paper was to present three patients of the Clinic of Pediatrics, Hematology and Oncology at the Academic Clinical Centre of the Medical University in Gda?sk, in whom thrombotic complications occurred as a result of long-term central venous catheters. The paper also discusses the possibilities of using sonography in the assessment of such complications. In the presented patients, it was possible to determine the size and localization of a thrombus which enabled effective treatment in two cases. The pathomechanism of catheter-related thrombosis was explained and the risk factors of such complications were discussed. The attention was paid to the necessity of conducting ultrasound examinations in pediatric patients with inserted catheters as soon as the first symptoms of thrombosis appear. Based on own observations and despite the lack of validation of ultrasound imaging in the assessment of central catheters, we believe that this method is highly promising and can be recommended for the assessment of thrombotic complications in pediatric patients with central venous catheters. PMID:26673005

  9. Central venous catheter - dressing change

    MedlinePLUS

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

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

    SciTech Connect

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

    2007-07-15

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

  11. Dynamics of central venous catheter-related sepsis in rats.

    PubMed Central

    Paston, M J; Meguid, R A; Muscaritoli, M; Forbes, B; Yang, Z J; Meguid, M M

    1993-01-01

    To determine when catheter-related sepsis clears after removal of an infected central venous catheter (CVC) and when a new sterile CVC can be inserted without risk of recolonization, a catheter infected with 10(5) CFU of Staphylococcus epidermidis per ml was inserted into 40 Fischer 344 rats. Five control rats had sterile catheters. Insertion of an infected CVC was followed by a significant rise in leukocytes after 4 days and the presence of S. epidermidis in lungs, livers, spleens, kidneys, and the catheter tip, as examined by bacteriological assay. After the infected catheter was removed, the rat recovered from the induced catheter-related sepsis within 12 h. When a new sterile CVC was inserted into the femoral vein, the leukocyte count remained normal, and all catheter tips and tissue cultures were sterile 4 days later. PMID:8315012

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

    PubMed

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

    2014-10-01

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

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

    PubMed Central

    Roldan, Carlos J.; Paniagua, Linda

    2015-01-01

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

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

    PubMed

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

    2014-03-01

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

  15. Daptomycin antibiotic lock therapy in a rat model of staphylococcal central venous catheter biofilm infections.

    PubMed

    Van Praagh, Andrew D G; Li, Tongchuan; Zhang, Shuxin; Arya, Anu; Chen, Liping; Zhang, Xi-Xian; Bertolami, Shellie; Mortin, Lawrence I

    2011-09-01

    Antibiotic lock therapy (ALT) is an adjunctive procedure to prevent or treat central venous catheter infections, ensuing catheter-related bacteremia, and catheter-related metastatic infections. Daptomycin is a cyclic lipopeptide that is rapidly bactericidal against methicillin-susceptible and -resistant Staphylococcus aureus. The efficacies of daptomycin against central venous catheter biofilms, catheter-related bacteremia, and catheter-related metastatic infections were evaluated by adapting a previously reported central venous catheter biofilm model in rats. Combined daptomycin ALT and systemic dosing resulted in the clearance of an established in vivo S. aureus central venous catheter biofilm after just two daily ALT treatments (30 min with daptomycin at 5 mg/ml) with concurrent systemic daptomycin dosing (40 mg/kg of body weight/day subcutaneously [s.c.]; equivalent exposure of 6 mg/kg/day in people). Daptomycin ALT solutions formulated in either saline or lactated Ringer's solution were equally fast in eradicating established in vivo methicillin-resistant Staphylococcus epidermidis (MRSE) central venous catheter biofilms. However, the lactated Ringer's formulation was superior to that of saline in sustaining the bacterial clearance of treated central venous catheters (83% versus 50%). In MRSE-infected central venous catheter studies, 3 days of daptomycin or vancomycin ALT (18 h at 5 mg/ml) with systemic s.c. dosing (40 mg/kg/day daptomycin or 100 mg/kg/day vancomycin) was equally effective 1 week posttherapy in maintaining cleared central venous catheters (90% [n = 10] versus 100% [n = 8]). These results suggest that daptomycin ALT, along with systemic dosing, could be an effective treatment option for the prevention or eradication of staphylococcal central venous catheter biofilm infections, thereby reducing the occurrence of catheter-related bacteremia or catheter-related metastatic infections. PMID:21709082

  16. Persistent Left Superior Vena Cava in Hematological Malignancy Requiring Central Venous Catheter Insertion for Intensive Chemotherapy

    PubMed Central

    Imataki, Osamu; Kubo, Hiroyuki; Hamasaki, Yukiko; Oku, Maki; Kida, Jun-ichiro; Uemura, Makiko; Matsuka, Harumi

    2015-01-01

    Persistent left superior vena cava is a congenital vascular anomaly, which is possibly arrhythmogenic and thrombogenic, rarely complicated with coronary sinus atresia. We treated a 42-year-old male with Hodgkin's lymphoma requiring central venous catheter placement for intensive chemotherapy. Persistent left superior vena cava was revealed after the insertion of the central venous catheter by the radiological finding of the catheter tip cannulated into the vena cava cavity. The relationship between coronary sinus atresia and persistent left superior vena cava induced by central venous catheterization remains unclear; however, the hematologist should pay attention to the malpositioning of the central venous catheter.

  17. Hemodynamics of Central Venous Catheters: experiments and simulations

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

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

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

    PubMed

    Malenka, D J; Ross, J M

    1989-01-01

    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

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

    SciTech Connect

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

    2000-03-15

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

  20. Antiseptic-Impregnated Central Venous Catheters: Their Evaluation in Burn Patients

    PubMed Central

    Ramos, G.; Bolgiani, A.; Patiño, O.; Prezzavento, G.; Guastavino, P.; Durlach, R.; Fernandez Caniggia, L.; Benaim, F.

    2006-01-01

    Summary Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidiscolonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are. PMID:21991025

  1. Antiseptic-impregnated central venous catheters: their evaluation in burn patients.

    PubMed

    Ramos, G; Bolgiani, A; Patiño, O; Prezzavento, G; Guastavino, P; Durlach, R; Fernandez Caniggia, L; Benaim, F

    2006-06-30

    Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidiscolonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are. PMID:21991025

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

    SciTech Connect

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

    1999-01-15

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

  3. Calcified central venous catheter fibrin sheath: case report and review of the literature.

    PubMed

    Keehn, Aryeh; Rabinowitz, Dan; Williams, Steve K; Taragin, Benjamin H

    2015-01-01

    We present a 6-year-old girl with acute lymphoblastic leukemia who demonstrated on chest X-ray a radiopacity in the superior vena cava after removal of an implanted venous access device. This radiopacity was initially thought to be a retained catheter fragment. On review of previous imaging, we were able to document the temporal development of a calcified catheter cast as distinct from the catheter. This case represents a rare consequence of central venous catheterization in children. Knowledge of this finding as a possible complication may help avoid performance of unnecessary follow-up imaging or invasive procedures. PMID:26259863

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

    PubMed Central

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

    2015-01-01

    Background Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. Methods We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.” Results Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. Conclusions In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy. Trial Registration Clinicaltrials.gov NCT01737554 PMID:26322512

  5. Membranoproliferative glomerulonephritis in patients with chronic venous catheters: a case report and literature review.

    PubMed

    Sy, John; Nast, Cynthia C; Pham, Phuong-Thu T; Pham, Phuong-Chi T

    2014-01-01

    Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters. PMID:24592339

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

    PubMed Central

    2013-01-01

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

  7. A case report of abdominal compartment syndrome caused by malposition of a femoral venous catheter

    PubMed Central

    Pafitanis, Georgios; Spyridon, Koulas; Theodorakopoulou, Evgenia; Mason, Katrina; Ygropoulou, Olga; Mousafiri, Ourania

    2015-01-01

    Introduction Venous catheter malposition is a rare event with potential catastrophic consequences. To our knowledge we describe one of the first case reports of an adult presenting with a rare late complication of femoral venous catheter malposition: abdominal compartment syndrome. Presentation of case A 39 year-old female sustained severe cerebral injury in a road traffic accident. During initial resuscitation a femoral venous catheter was inserted without ultrasound guidance with no immediate concerns. After 48 h whilst in intensive care unit the patient developed progressive abdominal distension. Bedside investigations revealed raised intra-abdominal pressures associated with new organ failure. Subsequent an emergency laparotomy and on-table intravenous contrast radiographs revealed extravasation of contrast into the peritoneal space from the malposition of the catheter into the abdominal cavity. Discussion Complications of central venous catheterization are associated with adverse events with significant morbidity to the patient as well as having cost implications. Mechanical complications are underreported but are potentially preventable through ultrasound-guided insertion, in accordance with international guidelines. Conclusion This case report highlights the importance of safe methods of catheter insertion, the need for increased awareness of late femoral catheter malposition and its potential catastrophic consequences. PMID:26036458

  8. Deep venous thrombosis screening in patients with inherited bleeding disorders and central venous catheters.

    PubMed

    Cost, C R; Journeycake, J M

    2011-11-01

    Children with inherited bleeding disorders often require central venous catheters (CVCs). Although CVCs are known to be complicated by deep venous thrombosis (DVT), little is known about the timeline of DVT development or risk of post-thrombotic syndrome (PTS). The aim of this study was to determine the timeline and confirm the incidence of thrombosis in patients with bleeding disorders who have CVCs. In 2002, we instituted a screening programme to monitor for CVC-related complications in children with haemophilia and von Willebrand disease. This is a retrospective review of this cohort. All children with CVC followed up between 1 January 2000 and 1 June 2009 were evaluated for DVT every 24 months with contrast venography and Doppler sonography. An institutional PTS severity scale was utilized at each visit. Thirty-six patients had 37 CVCs placed. Thirty patients had imaging studies, with DVT observed in 14 (47%). Most cases of DVT were diagnosed at the first venogram (median CVC duration 26 months). There were no abnormal ultrasound results. Sixteen patients (44%) had clinical findings consistent with PTS, including 10 (71%) with an abnormal venogram. Dilated chest wall veins appeared to be more strongly associated with underlying DVT (positive predictive value of 0.8) than arm circumference discrepancy. Successful transition to use of peripheral veins occurred at a median of 11 months after abnormal venograms. CVC-related DVT is common in children with inherited bleeding disorders and likely occurs earlier than previously thought. Clinical signs of PTS are also common, but long-term sequelae and severity of PTS are not known. PMID:21435117

  9. Deep Venous Thrombosis Screening in Patients with Inherited Bleeding Disorders and Central Venous Catheters

    PubMed Central

    Cost, Carrye R.; Journeycake, Janna M.

    2011-01-01

    Introduction Children with inherited bleeding disorders often require central venous catheters (CVC). Although CVCs are known to be complicated by deep venous thrombosis (DVT), little is known about the timeline of DVT development or risk of post-thrombotic syndrome (PTS). Aim To determine the timeline and confirm the incidence of thrombosis in patients with bleeding disorders who have CVCs. Methods In 2002 we instituted a screening program to monitor for CVC-related complications in children with hemophilia and von Willebrand disease. This is a retrospective review of this cohort. All children with CVC followed between January 1, 2000 and June 1, 2009 were evaluated for DVT every 24 months with contrast venography and Doppler sonography. An institutional PTS severity scale was utilized at each visit. Results Thirty-six patients had 37 CVCs placed. Thirty patients had imaging studies, with DVT observed in 14 (47%). Most DVT were diagnosed at the first venogram (median CVC duration 26 months). There were no abnormal ultrasound results. Sixteen patients (44%) had clinical findings consistent with PTS, including 10 (71%) with an abnormal venogram. Dilated chest wall veins appeared to be more strongly associated with underlying DVT (positive predictive value of 0.8) than arm circumference discrepancy. Successful transition to use of peripheral veins occurred at a median of 11 months after abnormal venograms. Conclusions CVC-related DVT is common in children with inherited bleeding disorders, and likely occurs earlier than previously thought. Clinical signs of PTS are also common, but long-term sequelae and severity of PTS are not known. PMID:21435117

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

    PubMed Central

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    MedlinePLUS

    ... catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter (SIRspecialists) YouTube RSS Feeds Radiation Safety ... Talking People Are Talking: Know Your Treatment Options! Social Media Connect With SIR Vision to Heal: SIR Blog ...

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

    SciTech Connect

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

    2010-04-15

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

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

    PubMed

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

    2001-02-01

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

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

    PubMed Central

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

    2001-01-01

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

  16. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    Randolph, Adrienne G; Cook, Deborah J; Gonzales, Calle A; Andrew, Maureen

    1998-01-01

    Objective: To evaluate the effect of heparin on duration of catheter patency and on prevention of complications associated with use of peripheral venous and arterial catheters. Design: Critical appraisal and meta-analysis of 26 randomised controlled trials that evaluated infusion of heparin intermittently or continuously. Thirteen trials of peripheral venous catheters and two of peripheral arterial catheters met criteria for inclusion. Main outcome measures: Data on the populations, interventions, outcomes, and methodological quality. Results: For peripheral venous catheters locked between use flushing with 10?U/ml of heparin instead of normal saline did not reduce the incidence of catheter clotting and phlebitis or improve catheter patency. When heparin was given as a continuous infusion at 1?U/ml the risk of phlebitis decreased (relative risk 0.55; 95% confidence interval 0.39 to 0.77), the duration of patency increased, and infusion failure was reduced (0.88; 0.72 to 1.07). Heparin significantly prolonged duration of patency of radial artery catheters and decreased the risk of clot formation (0.51; 0.42 to 0.61). Conclusions: Use of intermittent heparin flushes at doses of 10?U/ml in peripheral venous catheters locked between use had no benefit over normal saline flush. Infusion of low dose heparin through a peripheral arterial catheter prolonged the duration of patency but further study is needed to establish its benefit for peripheral venous catheters. Key messages Despite almost universal use, agreement has not been reached on the need to administer heparin through peripheral intravascular catheters The results of 13 trials on peripheral venous catheters and two trials on peripheral arterial catheters were critically appraised to clarify what evidence supports the use of heparin Flushing peripheral venous catheters locked between use with heparinised saline at 10?U/ml is no more beneficial than flushing with normal saline Heparin significantly prolongs the duration of peripheral arterial catheter patency and decreases the risk of clot formation In peripheral venous catheters heparin added to the infusion at 1?U/ml decreases phlebitis and may prolong duration of catheter patency and decrease infusion failure PMID:9550955

  17. Abnormal location of umbilical venous catheter due to Scimitar syndrome.

    PubMed

    Mart, Christopher R; Van Dorn, Charlotte S

    2014-09-01

    Scimitar syndrome is a rare congenital anomaly where the right pulmonary veins return to the inferior vena cava (IVC) just below the diaphragm. On chest X-ray (CXR), an IVC catheter will be in a bizarre location outside the heart if it inadvertently passes into the scimitar vein rather than into the right atrium. PMID:25298705

  18. [Life threatening embolism caused by central venous catheter fragments in psychiatric patients].

    PubMed

    Nau, R; Thiel, A; Prange, H W

    1994-05-01

    Central venous catheters are sometimes the cause of life-threatening complications. In two patients with underlying psychiatric disorders we observed an embolism as a result of catheter fragments. The first patient was a 30-year-old woman with a borderline personality disorder and several previous episodes of self-mutilation, psychogenic seizures and disturbances of consciousness. She cut her central venous line positioned in the external jugular vein when she was unattended. The intravasal fragment dislocated into the right ventricle and had to be removed by a forceps used for myocardial biopsies. The second patients was a 34-year-old mentally retarded male with a history of psychomotoric and grand mal seizures who suffered from a prolonged disturbance of consciousness with uncontrolled motor activity after four grand mal seizures. Despite physical restraint, the tip of his central venous catheter inserted through the subclavian vein broke and embolized in the right atrium. The embolus was removed by thoracotomy. To avoid these complications central venous lines should be used only when critically needed in uncooperative patients or those who display disturbance of consciousness and uncontrolled motor activity. PMID:8052339

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

    PubMed Central

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

    2015-01-01

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

  20. Endovascular Technique for Revision of Excess Catheter Length in Subcutaneous Implanted Venous Access Devices

    SciTech Connect

    Murthy, Ravi; Arbabzadeh, Massoud; Richard III, Howard; Levitin, Abraham; Lund, Gunnar; Stainken, Brian

    2004-06-15

    To describe the implementation of a technique to trim the excess length of a central venous catheter via a process of endovascular snaring without exposing or changing the device. We report on the outcome of this technique in 3 patients. The technique was successful in two cases and successful with a modification in the remaining case. The technique is useful to salvage an implanted venous access device. It appears to be less invasive with reduced procedure time and less patient discomfort than other techniques.

  1. Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy.

    PubMed

    Guillet, Stéphanie; Zeller, Valérie; Dubée, Vincent; Ducroquet, Françoise; Desplaces, Nicole; Horellou, Marie Hélène; Marmor, Simon; Ziza, Jean Marc

    2015-01-01

    The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ?2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified. PMID:26459894

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

    PubMed Central

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

    2013-01-01

    Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps. Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention. Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test). Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after). Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68.6% when three of five steps were done; p<0.001). The intervention was described as helpful by 46.8% of the participants, as neutral by 46.8%, and as disruptive by 6.4%. Conclusions: A multimodal strategy to improve both compliance with safety steps for peripheral venous catheter insertion and performance of an optimum procedure was effective and was regarded helpful by healthcare workers. PMID:24327944

  3. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

    PubMed Central

    Chiu, Diana Yuan Yng; Green, Darren; Kalra, Philip A.; Abidin, Nik

    2015-01-01

    Three-dimensional (3D) echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice. PMID:26688761

  4. Prevention of central venous catheter-related infection in the neonatal unit: a literature review.

    PubMed

    Taylor, Jacqueline E; McDonald, Susan J; Tan, Kenneth

    2015-07-01

    Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams. PMID:25076387

  5. Intraperitoneal extravasation of total parental nutrition infusate from an umbilical venous catheter.

    PubMed

    Shareena, I; Khu, Y S; Cheah, F C

    2008-02-01

    A preterm male infant who had an umbilical venous catheter (UVC) in situ for infusion of total parenteral nutrition (TPN) subsequently developed abdominal distension. He was initially diagnosed to have necrotising enterocolitis. However, a diagnostic abdominal paracentesis yielded fluid which biochemical analysis found to be consistent with TPN. TPN is often infused through a UVC, in the first few days of life, for the nutritional support of a premature infant. Various complications have been reported to be associated with this path of delivery, one of which will be illustrated in this case report. PMID:18301823

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

    PubMed Central

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

    2015-01-01

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

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

    ClinicalTrials.gov

    2014-10-09

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

  8. Internal mammary artery injury during central venous catheter insertion for TPN: rare but fatal.

    PubMed

    Mazeh, Haggi; Alaiyan, Bilal; Vald, Ori; Mizrahi, Ido; Klimov, Alexander; Eid, Ahmed; Freund, Herbert R

    2010-01-01

    Vascular injuries caused by subclavian central venous catheter (CVC) insertion can be associated with major complications. Such injuries differ in clinical presentation as well as optimal management, which ranges from observation only to surgical or endovascular repair. We report an injury to a branch of the internal mammary artery following an attempt to introduce a subclavian CVC, resulting in a massive hemothorax. This very rare injury was diagnosed and treated by angiography and embolization; however, the patient later succumbed to multi-organ failure. Suspicion of such an injury in a similar clinical setting should result in immediate angiography that can be lifesaving. To the best of our knowledge, this is the only report of such an adverse event in an adult. PMID:20392598

  9. The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters

    PubMed Central

    Salimi, Fereshte; Imani, Mohammad Reza; Ghasemi, Navab; Keshavarzian, Amir; Jazi, Amir Hosein Davarpanah

    2013-01-01

    Background: Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark. Materials and Methods: A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction. Results: The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients. Conclusion: Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients. PMID:24174941

  10. Safety of Central Venous Catheter Placement at Diagnosis of Acute Lymphoblastic Leukemia in Children

    PubMed Central

    Gonzalez, G.; Davidoff, A.M.; Howard, S.C.; Pui, C-H.; Rao, B.N.; Shenep, J. L.; Wozniak, A.; Shochat, S.J.

    2015-01-01

    Background Central venous catheters (CVC) facilitate the management of patients with cancer. Optimal timing for placement of a CVC is controversial. We sought to determine whether early placement in children with acute lymphoblastic leukemia (ALL), a group at high risk for infection and thrombosis, was associated with an increased rate of surgical complications. Procedure We evaluated the incidence and risk factors for early surgical complications in children with ALL diagnosed between 2004 and 2009 at a single pediatric cancer center. Results One hundred seventy-two patients were studied. There were 17 episodes of bloodstream infection, for a 30-day incidence of 9.8% (95% CI, 5.9–15%). There were no surgical site infections and no CVC was removed due to infection. Early thrombosis occurred in only one patient, 3 days after CVC placement. Infection was not influenced by catheter type, patient age, body mass index, or fever at the time of placement. The infection rate was not statistically higher when the ANC was <500/mm3 at the time of CVC placement (14.2% vs. 6.8%; P = 0.12). Conclusion Early CVC placement at the time of diagnosis of ALL was associated with a low surgical complication rate with no catheters requiring removal due to infection. Utilizing our current methods of preoperative preparation, surgical management and postoperative CVC care, early placement of a CVC is safe in children with ALL even when their ANC is <500/mm3, but larger cohort studies would be helpful to further clarify this issue. Pediatr Blood Cancer 2012;58:498–502. PMID:22162460

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

    SciTech Connect

    Guntur Ramkumar, Prasad Chakraverty, Sam Zealley, Ian

    2010-02-15

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

  12. Antibiotics Before Removal of Percutaneously Inserted Central Venous Catheters Reduces Clinical Sepsis in Premature Infants

    PubMed Central

    Reynolds, Gail E.; Tierney, Sarah B.

    2015-01-01

    OBJECTIVES: Evaluate the incidence of postcatheter removal clinical sepsis when antibiotics were infused prior to the removal of percutaneously inserted central venous catheters (PICCs). METHODS: A retrospective chart review of premature neonates (n = 196) weighing ?1250 g at birth with 218 PICC line removals in the presence or absence of antibiotics at a tertiary level neonatal intensive care unit (NICU) between January 1, 2010, and May 31, 2012. Charts were reviewed looking for the presence of clinical sepsis defined as a sepsis workup including white blood cell count, differential, C-reactive protein, blood and/or cerebral spinal fluid (CSF), and urine cultures along with at least 48 hours of antibiotic therapy given within 72 hours after removal of a PICC line. Antibiotics were considered present at line removal if given within 12 hours before catheter removal either electively or at completion of a planned course. RESULTS: When antibiotics were given within 12 hours before PICC line removal, only 2% of the line removal episodes (1/48) resulted in a neonate developing clinical sepsis versus 13% (21/165) when no antibiotics were given prior to removal (p = 0.03, Fisher's exact test). Despite the increased use of elective antibiotics with line removal, there was no increase in total antibiotic usage due to the overall decrease in episodes of clinical sepsis or changes in antibiogram susceptibility patterns. CONCLUSIONS: There was an 11% absolute decrease and a 6-fold relative decrease in postcatheter removal clinical sepsis events in premature neonates who received antibiotics prior to PICC line removal. PMID:26170772

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

    SciTech Connect

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

    2009-09-15

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

  14. Long-Term Central Venous Catheter Use and Risk of Infection in Older Adults With Cancer

    PubMed Central

    Lipitz-Snyderman, Allison; Sepkowitz, Kent A.; Elkin, Elena B.; Pinheiro, Laura C.; Sima, Camelia S.; Son, Crystal H.; Atoria, Coral L.; Bach, Peter B.

    2014-01-01

    Purpose Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. Patients and Methods We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Conclusion Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality. PMID:24982458

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

    PubMed Central

    2013-01-01

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

  16. Convective Leakage Makes Heparin Locking of Central Venous Catheters Ineffective Within Seconds: Experimental Measurements in a Model Superior Vena Cava.

    PubMed

    Barbour, Michael C; McGah, Patrick M; Ng, Chin H; Clark, Alicia M; Gow, Kenneth W; Aliseda, Alberto

    2015-01-01

    Central venous catheters (CVCs), placed in the superior vena cava (SVC) for hemodialysis or chemotherapy, are routinely filled while not in use with heparin, an anticoagulant, to maintain patency and prevent thrombus formation at the catheter tip. The heparin-locking procedure, however, places the patient at risk for systemic bleeding, as heparin is known to leak from the catheter into the blood stream. We provide evidence from detailed in vitro experiments that shows the driving mechanism behind heparin leakage to be convective-diffusive transport due to the pulsatile flow surrounding the catheter. This novel mechanism is supported by experimental planar laser-induced fluorescence (PLIF) and particle image velocimetry (PIV) measurements of flow velocity and heparin transport from a CVC placed inside a model SVC inside a pulsatile flow loop. The results predict an initial, fast (<10 s), convection-dominated phase that rapidly depletes the concentration of heparin in the near-tip region, the region of the catheter with side holes. This is followed by a slow, diffusion-limited phase inside the catheter lumen, where the concentration is still high, that is insufficient at replenishing the lost heparin concentration in the near-tip region. The results presented here, which are consistent with previous in vivo estimates of 24 hour leakage rates, predict that the concentration of heparin in the near-tip region is essentially zero for the majority of the interdialytic phase, rendering the heparin locking procedure ineffective. PMID:26418203

  17. Complete heart block during central venous catheter placement in a patient with pre-existing left bundle branch block.

    PubMed

    Unnikrishnan, D; Idris, N; Varshneya, N

    2003-11-01

    Heart block and arrhythmia are complications of pulmonary artery and cardiac catheterization. Injury to the conducting system of the heart often involves the right bundle causing right bundle branch block (RBBB). If patients already have left bundle branch block (LBBB), complete heart block (CHB) may result. After trauma, impairment of the right bundle is usually transient with recovery in hours, but complete heart block can lead to symptoms requiring invasive treatment. Similar complications are rare with insertion of central venous catheters, as they should not enter the heart. Injury to the right bundle during central venous catheter insertion can be by trauma from the guide wire or from the catheter itself. The function of the AV node and bundle of His in these patients has not been studied before. We report a patient with LBBB who developed CHB during insertion of a central venous cannula. Conduction through the AV node and His-Purkinje system was intact, showing that the transient RBBB was caused by traumatic injury rather than by other disease of the conduction system. PMID:14570803

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

    PubMed Central

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

    2008-01-01

    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. PMID:18954471

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

    PubMed Central

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

    2012-01-01

    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. PMID:23251176

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

    SciTech Connect

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

    2004-11-15

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

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

    PubMed

    Ash, Stephen R

    2007-01-01

    Over 60% of patients initiating chronic hemodialysis in the United States have a chronic central venous catheter (CVC) as their first blood access device. Although it would be better if these patients started dialysis with fistulas, the CVC is used because it is a reliable and relatively safe method for obtaining blood access over a period of months. Drawing blood from a vein at 300-400 ml/minute is a relatively delicate and somewhat unpredictable process, and there is always a tendency for the vein wall to draw over the arterial tip and obstruct flow. Several methods have been employed to minimize this problem and maximize blood flow, and differing catheter designs have resulted. With all of the different catheter designs now on the market, it is natural to ask what is the logic of different designs. Moreover, in the absence of many direct comparative studies it is natural to ask whether one design is really better than another. There is some misinformation regarding catheter design and function. The following is a list of 10 frequently asked questions In this review, the hydraulic features of CVC are discussed and explained, and logical answers are provided for the following questions: 1. Why do ''D'' catheters flow better than concentric or side by side catheters? 2. Why are all catheters about the same diameter? Does making them bigger really decrease the resistance to flow? 3. Why might a split tip catheter flow better than a solid body catheter? 4. What happens to injections of lock solution at catheter volume? 5. What's better-numerous side holes or none? 6. Why does blood rise into some internal jugular catheters over time, displacing the lock solution? 7. How can a little kink (or stenosis) decrease flow so much? 8. Where should the tips be placed-superior vena cava or right atrium? 9. Which is really better, splitsheath or over-the-wire placement? 10. Which dialysis access has a lower complication rate--CVC or arteriovenous (AV) graft? There remain important problems with CVC for dialysis. With a few more improvements, chronic CVC for dialysis could become a painless, effective and safe long-term access for the majority of dialysis patients and acceptable as an alternative to AV grafts. PMID:17555490

  2. On-demand antimicrobial release from a temperature-sensitive polymer - comparison with ad libitum release from central venous catheters.

    PubMed

    Sjollema, Jelmer; Dijkstra, Rene J B; Abeln, Caroline; van der Mei, Henny C; van Asseldonk, Dirk; Busscher, Henk J

    2014-08-28

    Antimicrobial releasing biomaterial coatings have found application for instance in the fixation of orthopedic joint prostheses and central venous catheters. Most frequently, the release kinetics is such that antimicrobially-effective concentrations are only reached within the first days to weeks after implantation, leaving no local antimicrobial release available when a biomaterial-associated infection occurs later. Here we compare the ad libitum release of chlorhexidine and silver-sulfadiazine from a central venous catheter with their release from a new, on-demand release coating consisting of a temperature-sensitive copolymer of styrene and n-butyl (meth)acrylate. The copolymer can be loaded with an antimicrobial, which is released when the temperature is raised above its glass transition temperature. Ad libitum release of chlorhexidine and silver-sulfadiazine from a commercially-purchased catheter and associated antimicrobial efficacy against Staphylococcus aureus was limited to 16days. Consecutive temperature-triggers of our on-demand coating yielded little or no antimicrobial efficacy of silver-acetate release, but antimicrobially-effective chlorhexidine concentrations were observed over a time period of 60-80days. This attests to the clear advantage of on-demand coatings above ad libitum releasing coatings, that may have released their antimicrobial content before it is actually needed. Importantly, glass transition temperature of chlorhexidine loaded copolymers was lower (48°C) than of silver loaded ones (61°C), facilitating their clinical use. PMID:24950430

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

    SciTech Connect

    Wissgott, Christian Kamusella, Peter; Andresen, Reimer

    2013-08-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. [Incidents and hazards in the use of blank metal clamps with venous catheters].

    PubMed

    Pedal, I; König, H G

    1984-03-01

    The use of blank metal clamps resulted in severe damaging of infusion systems in two cases. In one case the silicone tube of a Shaldon catheter was damaged by the clamps and thus became detached from the Luer-Lock syringe connecting piece, whereupon the patient bled to death. In another case the too forcible screwing while fastening a Luer-Lock coupling by means of a metal clamp produced a tear in the connecting piece. The female patient, who sat upright, collapsed and died under the clinical suspicion of air embolism, which, however, could not be confirmed at autopsy. Such incidents are avoidable only if doctors and nurses are carefully trained in the handling of vascular catheters and infusion systems and if they are expressly informed not to use blank metal clamps. PMID:6697896

  6. Minimally Invasive Monitoring of Chronic Central Venous Catheter Patency in Mice Using Digital Subtraction Angiography (DSA)

    PubMed Central

    Figueiredo, Giovanna; Fiebig, Teresa; Kirschner, Stefanie; Nikoubashman, Omid; Kabelitz, Lisa; Othman, Ahmed; Nonn, Andrea; Kramer, Martin; Brockmann, Marc A.

    2015-01-01

    Background Repetitive administration of medication or contrast agents is frequently performed in mice. The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture. With catheter occlusion being the most commonly reported complication of chronic jugular vein catheterization, we tested whether digital subtraction angiography (DSA) can be utilized to evaluate VAMP patency in mice. Methods Twenty-three mice underwent catheterization of the jugular vein and subcutaneous implantation of a VAMP. The VAMP was flushed every second day with 50 ?L of heparinized saline solution (25 IU/ml). DSA was performed during injection of 100 ?L of an iodine based contrast agent using an industrial X-ray inspection system intraoperatively, as well as 7±2 and 14±2 days post implantation. Results DSA allowed localization of catheter tip position, to rule out dislocation, kinking or occlusion of a microcatheter, and to evaluate parent vessel patency. In addition, we observed different ante- and retrograde collateral flow patterns in case of jugular vein occlusion. More exactly, 30% of animals showed parent vessel occlusion after 7±2 days in our setting. At this time point, nevertheless, all VAMPs verified intravascular contrast administration. After 14±2 days, intravascular contrast injection was verified in 70% of the implanted VAMPs, whereas at this point of time 5 animals had died or were sacrificed and in 2 mice parent vessel occlusion hampered intravascular contrast injection. Notably, no occlusion of the catheter itself was observed. Conclusion From our observations we conclude DSA to be a fast and valuable minimally invasive tool for investigation of catheter and parent vessel patency and for anatomical studies of collateral blood flow in animals as small as mice. PMID:26098622

  7. Central venous catheter thrombosis as a cause of SVC obstruction and cardiac tamponade in a patient with Diamond-Blackfan anemia and iron overload.

    PubMed

    Norris, Mark L; Klaassen, Robert

    2006-01-01

    Cardiac tamponade is an infrequent but potentially lethal complication related to use of central venous catheters (CVC). We present the case of a 16-year-old female with Diamond-Blackfan anemia (DBA) who developed pericardial tamponade secondary to superior venous caval obstruction caused by CVC thrombosis. The patient presented 3 months after line placement with vomiting, abdominal pain, and cardiomegaly on chest X-ray (CXR). Her condition quickly decompensated with cardiac arrest and subsequent death despite immediate pericardiocentesis. As a result of this case, our center has developed a protocol for the management of CVC problems as a means of facilitating rapid recognition of central line clots. PMID:15768384

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  10. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital.

    PubMed

    Pinon, M; Bezzio, S; Tovo, P A; Fagioli, F; Farinasso, L; Calabrese, R; Marengo, M; Giacchino, M

    2009-12-01

    The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age

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

    PubMed Central

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

    2013-01-01

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

  12. Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy.

    PubMed

    Kriegel, Irène; Cottu, Paul H; Fourchotte, Virginie; Sanchez, Sebastian; Fromantin, Isabelle; Kirov, Krassen; Guillaume, Alain; Pelloquin, Anne; Esteve, Marc; Salmon, Remy J

    2011-11-01

    The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention. PMID:21970853

  13. Cerebral air embolism following the removal of a central venous catheter in the absence of intracardiac right-to-left shunting: a case report.

    PubMed

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

    2015-04-01

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

  14. Heparin Saline Versus Normal Saline for Flushing and Locking Peripheral Venous Catheters in Decompensated Liver Cirrhosis Patients

    PubMed Central

    Wang, Rui; Zhang, Ming-Guang; Luo, Ou; He, Liu; Li, Jia-Xin; Tang, Yun-Jing; Luo, Yan-Li; Zhou, Min; Tang, Li; Zhang, Zong-Xia; Wu, Hao; Chen, Xin-Zu

    2015-01-01

    Abstract A prospective randomized, controlled, single-blinded trial to compare the effectiveness and safety of heparin saline (HS) to those of normal saline (NS) as flushing and locking solutions for peripheral venous catheter (PVC) in decompensated liver cirrhosis (DLC) patients. Patients with DLC at our institution between April 2012 and March 2013 were enrolled after obtaining informed consent. The patients were randomly allocated into 2 groups: the NS group received preservative-free 0.9% sodium chloride as the flushing and locking solution, while the HS group received HS (50?U/mL). PVC-related events and the duration of PVC maintenance were compared between the 2 groups. Moreover, the preinfusion and postinfusion levels of prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet (PLT) were also compared. A total of 32 and 36 DLC patients in the NS (125 PVCs) and HS (65 PVCs) groups, respectively, were analyzed. Baseline characteristics, including gender, age, Child–Pugh grade, PVC type and administration of anticoagulant, and irritant agents, were comparable between the 2 groups (P?>?0.05). The maintenance times of the HS and NS groups were 80.27?±?26.47 and 84.19?±?29.32?hours, respectively (P?=?0.397). Removal of PVC for abnormal reasons occurred in 30.7% and 22.4% of patients in the HS and NS groups (P?=?0.208). The PVC occlusion rates were 6.2% and 5.6% in the HS and NS groups, respectively (OR?=?1.11, 95% CI 0.31–3.92). The PT, APTT, and PLT levels were comparable between the 2 groups both before and after infusion (P?>?0.05). Incremental analyses showed that Child–Pugh grade C might be a risk factor for the suppression of PLT in the HS group. We consider NS to be as effective as and safer than conventional HS for flushing and locking PVC in decompensated liver cirrhosis patients. PMID:26252305

  15. How Should Long-Term Tunneled Central Venous Catheters Be Managed in Microbiology Laboratories in Order To Provide an Accurate Diagnosis of Colonization?

    PubMed Central

    Martín-Rabadán, P.; Echenagusia, A.; Camúñez, F.; Rodríguez-Rosales, G.; Simó, G.; Echenagusia, M.

    2012-01-01

    Guidelines recommend the roll-plate technique for short-term central venous catheter (CVC) tip cultures. However, the issue of whether the roll-plate technique is better than the sonication method for long-term CVCs remains unresolved. In addition, no data are available for predicting the value of direct Gram staining in anticipating catheter colonization or catheter-related bloodstream infection (CRBSI) in these long-term CVCs. Our objectives were to compare the roll-plate technique and the sonication method and to define the validity values of Gram staining for the prediction of colonization and CRBSI in patients with long-term tunneled CVCs. During the study period, all tunneled CVCs removed at our institution were prospectively and routinely sent to the microbiology laboratory for Gram staining (first) and tip culture (the Maki technique and sonication, in a random order). We received 149 tunneled CVCs, 39 (26.2%) of which were colonized and 11 (7.4%) of which were associated with CRBSI. Overall, the roll-plate method detected 94.9% of the colonized catheters, whereas sonication detected only 43.6% (P < 0.001). The validity values of Gram staining for the detection of colonization and CRBSI were as follows: a sensitivity of 35.9% to 60.0%, a specificity of 100% to 94.2%, a positive predictive value of 100% to 42.9%, and a negative predictive value of 81.5% to 97.0%. The roll-plate technique proved to be better than sonication for the detection of bacteria in long-term tunneled CVCs. Gram staining of the tips of tunneled CVCs can anticipate a positive culture and rule out CRBSI. In our opinion, direct Gram staining should be incorporated into routine microbiological assessments of long-term catheter tips. PMID:22170928

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

    PubMed

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

    2013-11-01

    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

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

    PubMed Central

    2011-01-01

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

  18. Prediction of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS).

    PubMed

    Schalk, Enrico; Hanus, Lynn; Färber, Jacqueline; Fischer, Thomas; Heidel, Florian H

    2015-09-01

    The aim of this study was to predict the probability of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1-60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p?

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

    PubMed Central

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

    2015-01-01

    Objective To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. Design This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. Patients 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. Intervention Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. Results The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. Conclusions According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing. Trial Registration This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682). PMID:26086783

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

    PubMed Central

    Samantaray, Aloka; Rao, Mangu Hanumantha

    2014-01-01

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

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

    PubMed Central

    2012-01-01

    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

  2. Heparin Saline Versus Normal Saline for Flushing and Locking Peripheral Venous Catheters in Decompensated Liver Cirrhosis Patients: A Randomized Controlled Trial.

    PubMed

    Wang, Rui; Zhang, Ming-Guang; Luo, Ou; He, Liu; Li, Jia-Xin; Tang, Yun-Jing; Luo, Yan-Li; Zhou, Min; Tang, Li; Zhang, Zong-Xia; Wu, Hao; Chen, Xin-Zu

    2015-08-01

    A prospective randomized, controlled, single-blinded trial to compare the effectiveness and safety of heparin saline (HS) to those of normal saline (NS) as flushing and locking solutions for peripheral venous catheter (PVC) in decompensated liver cirrhosis (DLC) patients.Patients with DLC at our institution between April 2012 and March 2013 were enrolled after obtaining informed consent. The patients were randomly allocated into 2 groups: the NS group received preservative-free 0.9% sodium chloride as the flushing and locking solution, while the HS group received HS (50?U/mL). PVC-related events and the duration of PVC maintenance were compared between the 2 groups. Moreover, the preinfusion and postinfusion levels of prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet (PLT) were also compared.A total of 32 and 36 DLC patients in the NS (125 PVCs) and HS (65 PVCs) groups, respectively, were analyzed. Baseline characteristics, including gender, age, Child-Pugh grade, PVC type and administration of anticoagulant, and irritant agents, were comparable between the 2 groups (P?>?0.05). The maintenance times of the HS and NS groups were 80.27?±?26.47 and 84.19?±?29.32?hours, respectively (P?=?0.397). Removal of PVC for abnormal reasons occurred in 30.7% and 22.4% of patients in the HS and NS groups (P?=?0.208). The PVC occlusion rates were 6.2% and 5.6% in the HS and NS groups, respectively (OR?=?1.11, 95% CI 0.31-3.92). The PT, APTT, and PLT levels were comparable between the 2 groups both before and after infusion (P?>?0.05). Incremental analyses showed that Child-Pugh grade C might be a risk factor for the suppression of PLT in the HS group.We consider NS to be as effective as and safer than conventional HS for flushing and locking PVC in decompensated liver cirrhosis patients. PMID:26252305

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

    PubMed Central

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

    2013-01-01

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

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

    SciTech Connect

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

    2011-12-15

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

  5. Jugular Venous Catheterization: A Case of Knotting

    PubMed Central

    Erk?l?ç, E.; Aksoy, M.; Gümü?, T.; Sar?, S.; Kesimci, E.

    2015-01-01

    A 79-year-old woman, diagnosed for cancer of the ovary, had a central catheter that was placed with difficulty through the right internal jugular vein intraoperatively. After oophorectomy, it was realized that the catheter was knotted. Thus, the central venous catheter was removed successfully using a traction technique in the operating room. Central venous catheter use may result in various complications, although it has been used as an invasive method for hemodynamic monitoring and fluid and drug infusion. Here, we present catheter knotting in a case with solutions for this complication, under literature review.

  6. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class II... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140...

  7. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  8. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  9. Urinary catheters

    MedlinePLUS

    ... or dementia Catheters come in many sizes, materials (latex, silicone, Teflon™), and types (Foley, straight, coude tip). ... of catheter use include: Allergy or sensitivity to latex Bladder stones Blood infections ( septicemia ) Blood in the ...

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

    PubMed Central

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

    2012-01-01

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

  11. Sponsored by: Philip Mattson, Tod Companion, Matt Hickman Office of Standards, Science and Technology Directorate,

    E-print Network

    Sponsored by: Philip Mattson, Tod Companion, Matt Hickman Office of Standards, Science the development and dissemination of advanced technologies, guidelines, and services through measurement science ......................................................................Definition of a Response Robot (Ground, Aerial, Aquatic) 9

  12. Hydrophilic Catheters

    PubMed Central

    2006-01-01

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

  13. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  14. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  15. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  16. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  17. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  18. Central vascular catheters and infections.

    PubMed

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

    2014-03-01

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

  19. Evaluation of a new catheter for total parenteral nutrition.

    PubMed

    Superina, R A; Wesson, D E; Bahoric, A; Filler, R M

    1988-01-01

    Central venous catheters play an important role in the management of children with a variety of disorders. Desirable characteristics of such catheters include ease and reliability of placement, secure fixation, low rates of complication, and ease of removal. We describe our experience with a new form of catheter that displays all of these characteristics. One hundred twenty-nine catheters were inserted in 111 patients over a 2-year period for a total of 5,729 treatment days. This catheter is made of silicone rubber and is positioned by using P-wave changes seen during intraoperative electrocardiography. x-Ray confirmation is not routinely necessary. The catheter is fixed in position by use of a grommet, which is sutured in the neck at the site of the venotomy. This form of fixation allows the catheter to be easily removed by nonsurgical means while keeping it securely in position for the duration of use. Our experience with this catheter has been associated with a low incidence of septic (1.1-4.2 septic episodes per 1,000 patient days) and mechanical (2.3 episodes per 1,000 patient days) complications in a setting that includes both in-hospital and home total parenteral nutrition patients. It is felt that this new form of catheter and catheter fixation offers several advantages over other types of central venous catheters currently in use. PMID:3141602

  20. Delayed massive hydrothorax following subclavian catheter insertion: an unusual complication.

    PubMed

    Aggarwal, Richa; Soni, Kapil Dev

    2015-01-01

    Complications of central venous catheter can become life threatening if not managed timely. We present a case of massive hydrothorax that developed few hours after placement of the central venous pressure line. The diagnosis was little delayed because the catheter was normally placed initially and later got displaced within few hours of shifting to the intensive care unit. However, the patient was managed timely. Our case report suggests that the position of the catheter should be checked frequently in the intensive care unit and particularly so after shifting and positioning of the patient and the associated complications should be kept in mind. PMID:26335220

  1. Something's missing: peripheral intravenous catheter fracture.

    PubMed

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

    2013-01-01

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

  2. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  3. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  4. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  5. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  6. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  7. Venous Ulcers

    PubMed Central

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  8. Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP).

    PubMed

    Giordano, Paola; Saracco, Paola; Grassi, Massimo; Luciani, Matteo; Banov, Laura; Carraro, Francesca; Crocoli, Alessandro; Cesaro, Simone; Zanazzo, Giulio Andrea; Molinari, Angelo Claudio

    2015-11-01

    Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders. PMID:26300457

  9. Value of Superficial Cultures for Prediction of Catheter-Related Bloodstream Infection in Long-Term Catheters: a Prospective Study

    PubMed Central

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

    2013-01-01

    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

  10. Temporary hemodialysis catheters: recent advances

    PubMed Central

    Clark, Edward G; Barsuk, Jeffrey H

    2014-01-01

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

  11. Venous Port Salvage Utilizing Low Dose tPA

    SciTech Connect

    Whigham, Cliff J.; Lindsey, Jason I.; Goodman, Chad J.; Fisher, Richard G.

    2002-12-15

    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.

  12. Advances in venous access devices and nursing management strategies.

    PubMed

    Wickham, R S

    1990-06-01

    VADs are indicated for many persons who require reliable long-term venous access. Nontunneled, tunneled, and venous access ports are constructed of silicone or polyurethane, the most biocompatible materials identified thus far. These devices are inserted in a similar fashion and are extremely versatile. Although VADs represent a major advance in catheter technology, they are not without problems. The most serious and frequently reported complications include infection, thrombosis, and extravasation. Catheter occlusions are another frequent problem, and may be caused by clotted blood or precipitated drug within the catheter. Nursing care centers on prevention and intervention to remove the occlusion. Catheter-related infections may occur at one or more points along the catheter. The most serious are those occurring in the tunnel or as a result of a mural or catheter-tip thrombus. Normal skin flora are most commonly cultured with catheter-related infections. These organisms may be introduced into the body through the catheter hub or less often by migrating along the external catheter. Infections differ in their severity, prognosis, and treatment. Actions to minimize risk (scrupulous care and patient teaching), prompt recognition, and appropriate interventions are crucial. Thrombotic events include fibrin sheaths, patchy thrombotic plaques on the cannulated venous intima, and totally occlusive mural thromboses. Problems associated with these can range from withdrawal occlusion to obstruction of the great vessels and symptoms of superior vena cava syndrome. Mural thrombosis, which probably occurs more frequently than previously suspected, is the most significant risk factor for infection and may also potentiate extravasation. Prompt initiation of therapy will resolve symptoms and maintain the functioning of the catheter. Extravasation can result in transient discomfort or major tissue damage, pain, and functional loss. Needle dislodgment from ports is the most frequent cause. Adequate stabilization of needles and use of nonsiliconized needles are recommended to decrease this risk. Thrombosis at the catheter tip with back tracking of infusate out of the vein to subcutaneous tissues is the second most frequent cause of extravasation and has been reported with tunneled catheters as well as ports. It should be noted that catheter-tip displacement and catheter damage infrequently lead to extravasation. When extravasation is suspected, the infusion is stopped, and the nurse notifies the physician so diagnostic procedures and treatment can be initiated. Other complications occur infrequently but may contribute to patient discomfort, morbidity, and mortality. These include phlebitis, which resolves with conservative management in most instances, and pneumothorax, which occurs in a small percentage of patients within a short period after catheter placement.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2110664

  13. American Venous Forum

    MedlinePLUS

    ... Complete free venous disease assessment Promoting venous and lymphatic health through education and disease awareness. Addressing your ... disease questions and needs. Learn about venous and lymphatic diseases Get a free access to the Layman's ...

  14. 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...

  15. [The use of the Export Catheter device in a patient with acute myocardial infarction for thrombotic occlusion of the venous graft on the left anterior descending coronary artery: a case report].

    PubMed

    Romano, Michele; Buffoli, Francesca; Lettieri, Corrado; Rosiello, Renato; Aroldi, Marco; Kuwornu, Helène; Tomasi, Luca; Baccaglioni, Nicola; Zanini, Roberto

    2005-06-01

    Coronary angioplasty, eventually followed by stent implantation, represents the gold standard of acute myocardial infarction (AMI) treatment. Optimal reperfusion implies both patency of the infarct-related artery and a good myocardial microrevascularization with normal tissue reperfusion. The so called no-reflow phenomenon mainly occurs in the presence of highly thrombotic lesions, especially during primary angioplasty and it represents a negative prognostic factor of the outcome of AMI patients treated with angioplasty. A 77-year-old high-risk male patient, previous coronary artery bypass graft with the saphenous vein graft to the left anterior descending coronary artery for post-AMI angina in 1984, aided by 118 ambulance for anterior AMI was admitted to our cath-lab for primary coronary angioplasty. During the transport he was given aspirin i.v. 300 mg, heparin 5000 IU and abciximab (9.4 ml bolus plus infusion for 12 hours). The time of treatment (from symptom onset to first inflation) was about 90 min. Coronary angiography showed a massive thrombus occlusion of the vein graft with TIMI 0 distal flow. We employed the Export Catheter for mechanical aspiration of the occluding thrombus. The procedure was completed with direct stent implantation with good angiographic outcome. The use of thrombus aspiration and protection devices (filters or occlusive balloons) associated or not with the use of glycoprotein IIb/IIIa receptor blockers, has reduced the risk of distal embolization and of no-reflow phenomenon. PMID:16013434

  16. Endovascular Removal of Long-Term Hemodialysis Catheters

    SciTech Connect

    Foley, Peter T.; Carter, Ranjana M.; Uberoi, Raman

    2007-09-15

    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.

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

    SciTech Connect

    Walser, Eric M.

    2012-08-15

    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.

  18. Sonographically guided placement of intravenous catheters in minipigs.

    PubMed

    Pinkernelle, Jens; Raschzok, Nathanael; Teichgräber, Ulf K M

    2009-07-01

    Many procedures in minipigs require establishment of reliable deep venous access with a large-bore catheter. In animal experiments, such catheters are typically implanted surgically. In clinical settings, however, ultrasound imaging is routinely used to facilitate safe, minimally invasive puncture of deep vessels. The authors describe a technique for using ultrasound guidance to puncture and cannulate the minipig femoral vein. They carried out the procedure in six minipigs for the purpose of injecting contrast agents for subsequent imaging scans. The procedure was ultimately successful in all pigs, took 10 min on average and resulted in no physiological complications. In one minipig, however, a 10-cm-long catheter became dislodged from the femoral vein; use of a longer (25-cm-long) catheter was optimal for establishing reliable intravenous access. PMID:19543262

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-09-16

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

  2. Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients

    SciTech Connect

    Bodner, Leonard J.; Nosher, John L.; Patel, Kaushik M.; Siegel, Randall L.; Biswal, Rajiv; Gribbin, Christopher E.; Tokarz, Robert

    2000-03-15

    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.

  3. Deep Venous Thrombosis in Teen With Crouzon Syndrome Post-Le Fort III Osteotomy With Rigid External Distraction.

    PubMed

    Roussel, Lauren O; Myers, Rene P; Girotto, John A

    2015-11-01

    Venous thromboembolic events are rare in pediatric patients. Risk factors associated with the development of venous thromboembolic events in pediatric patients include the use of central venous catheters, hospitalization, cancer, sepsis, trauma, surgery, and congenital prothrombotic disorders.The authors present the case of a 14-year-old man with Crouzon syndrome who required Le Fort III osteotomy with rigid external distraction for significant midface hypoplasia who presented postoperatively with an extensive deep venous thrombosis. This is the first reported case of symptomatic venous thrombosis post-Le Fort III osteotomy and rigid external distraction. Although rare, surgeons should be aware of this potential complication. PMID:26595005

  4. Assessment of reused catheters.

    PubMed

    Mussivand, T; Duguay, D G; Valadares, M J; Rajagopalan, K; Mackenzie, A M; Blohon, R; Marquis, J F; Beanlands, D S; Keon, W J

    1995-01-01

    Demands for health care cost containment have prompted the assessment of recycling medical devices, including catheters. The investigation of catheter reuse for effectiveness and safety began at the University of Ottawa Heart Institute in early 1994. This report provides the preliminary results from this ongoing assessment on the feasibility of catheter reuse. Burst tests were conducted to detect changes in catheter mechanical integrity. Scanning electron microscopy (SEM) was performed to assess surface changes and protein deposition after use and the subsequent cleaning process. Results of burst testing showed no significant difference in burst patterns or burst pressures between single use and unused catheters. Surface differences were observed between used and unused catheters. SEM studies detected physical changes such as scratches, gouges, cuts, and deposits on the used catheters. Unused balloon surfaces appeared to be clean and uniform compared to used ones. Residue and cracking were identified on other used devices. In conclusion, the methods used can assess various effects of recycling. A blind study of large samples of used catheters is planned to establish statistically the level and variance of structural damage to catheters during typical use. PMID:8573878

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

    SciTech Connect

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

    2009-07-15

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

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

    SciTech Connect

    Saettele, Megan R.; Morelli, John N.; Chesis, Paul; Wible, Brandt C.

    2013-12-15

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

  7. Tsukamurella catheter-related bloodstream infection in a pediatric patient with pulmonary hypertension

    PubMed Central

    Wendorf, Kristen A.; Espinosa, Claudia M.; LeBar, William D.; Weinberg, Jason B.

    2010-01-01

    Catheter-related bloodstream infections (CR-BSI) are important complications in patients with long-term indwelling central venous catheters. In this report, we present the case of a 14-year-old male with pulmonary hypertension treated with continuous treprostinil infusion, who presented with a CR-BSI caused by a Tsukamurella species. This case highlights the potential for this unusual organism to cause infection in immunocompetent patients. PMID:24470887

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

    PubMed Central

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

    2012-01-01

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

  9. Persistent bloodstream infection with Kocuria rhizophila related to a damaged central catheter.

    PubMed

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

    2012-04-01

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

  10. Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route?

    PubMed

    Wu, Ching-Yang; Fu, Jui-Ying; Wu, Ching-Feng; Ko, Po-Jen; Liu, Yun-Hen; Kao, Tsung-Chi; Yu, Shang-Yueh

    2015-12-01

    Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20?mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P?=?0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P?=?0.02), and longer implanted catheter length (P?=?0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy. PMID:26656351

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

    SciTech Connect

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

    2011-02-15

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

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

    SciTech Connect

    Nazir, Sarfraz Ahmed Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman

    2009-09-15

    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.

  13. Cerebral venous angiomas

    SciTech Connect

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

    1984-04-01

    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.

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

    SciTech Connect

    Lorenz, Jonathan M. Regalado, Sidney; Navuluri, Rakesh Zangan, Steven; Thuong Van Ha; Funaki, Brian

    2010-06-15

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

  15. Worsening of Obstructive Sleep Apnea Associated with Catheter-Related Superior Vena Cava Syndrome

    PubMed Central

    Jouvenot, Marie; Willoteaux, Serge; Meslier, Nicole; Gagnadoux, Frédéric

    2015-01-01

    There is growing evidence that fluid accumulation in the neck contributes to the pathogenesis of obstructive sleep apnea (OSA). We describe a case of catheter-related superior v ena cava (SVC) thrombosis revealed by rapid onset of typical symptoms of OSA. A marked improvement in OSA severity was observed after central venous catheter removal, anticoagulant therapy, and SVC angioplasty Citation: Jouvenot M, Willoteaux S, Meslier N, Gagnadoux F. Worsening of obstructive sleep apnea associated with catheter-related superior vena cava syndrome. J Clin Sleep Med 2015;11(6):681–682. PMID:25766698

  16. Sinuplasty (Balloon Catheter Dilation)

    MedlinePLUS

    ... development of the balloon dilating catheter and its adaptation to sinus surgery. In the 1980s, the field ... used in endoscopic sinus surgery. It is the adaptation or application of minimally-invasive balloon technology to ...

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

    SciTech Connect

    Butler, Philip J. Sood, Shreya; Mojibian, Hamid; Tal, Michael G.

    2011-02-15

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

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

    PubMed

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

    2014-09-01

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

  19. Microbial diversity on intravascular catheters from paediatric patients.

    PubMed

    Zhang, L; Marsh, N; Long, D; Wei, M; Morrison, M; Rickard, C M

    2015-12-01

    Microorganisms play important roles in intravascular catheter (IVC)-related infections, which are the most serious complications in children with IVCs, leading to increased hospitalisation, intensive care admissions, extensive antibiotic treatment and mortality. A greater understanding of bacterial communities is needed in order to improve the management of infections. We describe here the systematic culture-independent evaluation of IVC bacteriology in IVC biofilms. Twenty-four IVC samples (six peripherally inserted central catheters, eight central venous catheters and ten arterial catheters) were collected from 24 paediatric patients aged 0 to 14 years old. Barcoded amplicon libraries produced from genes coding 16S rRNA and roll-plate culture methods were used to determine the microbial composition of these samples. From a total of 1,043,406 high-quality sequence reads, eight microbial phyla and 136 diverse microbial genera were detected, separated into 12,224 operational taxonomic units (OTUs). Three phyla (Actinobacteria, Firmicutes and Proteobacteria) predominate the microorganism on the IVC surfaces, with Firmicutes representing nearly half of the OTUs found. Among the Firmicutes, Staphylococcus (15.0 % of 16S rRNA reads), Streptococcus (9.6 %) and Bacillus (6.1 %) were the most common. Community composition did not appear to be affected by patients' age, gender, antibiotic treatment or IVC type. Differences in IVC microbiota were more likely associated with events arising from catheter dwell time, rather than the type of IVC used. PMID:26515578

  20. How to deal with dialysis catheters in the ICU setting

    PubMed Central

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

    Heye, Sam Maleux, Geert; Goossens, G. A.; Vaninbroukx, Johan; Jerome, M.; Stas, M.

    2012-06-15

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

  3. Venous thrombosis - series (image)

    MedlinePLUS

    ... with a history of stroke or bleeding), a filter is placed in the large vein leading from ... that may embolize up toward the heart. These filters can be inserted through a catheter inserted in ...

  4. Balloon Catheter Prevents Contamination

    NASA Technical Reports Server (NTRS)

    Higginson, Gregory A.; Bouffard, Marc R.; Hoehicke, Beth S.; King, Bradley D.; Peterson, Sandra L.

    1994-01-01

    Balloon catheter similar to that used in such medical procedures as angioplasty and heart surgery protects small orifices against contamination and blockage by chips generated in machining operations. Includes small, inflatable balloon at end of thin, flexible tube. Contains additional features adapting it to anticontamination service: balloon larger to fit wider channel it must block; made of polyurethane (rather than latex), which does not fragment if bursts; material made thicker to resist abrasion better; and kink-resistant axial wire helps catheter negotiate tight bends.

  5. Postintervention duration of anticoagulation in venous surgery.

    PubMed

    Ten Cate-Hoek, A J; Prins, M H; Wittens, C H A; ten Cate, H

    2013-03-01

    For a substantial proportion of patients with deep venous thrombosis (DVT), current treatment strategies are suboptimal and new treatment options are needed. Especially for the group of patients who are at the highest risk for post-thrombotic syndrome, new treatment modalities such as catheter-directed thrombolysis and additional stenting are being investigated. With current clinical studies addressing new technical options, the medical management of patients following these interventions deserves attention. The duration of anticoagulant treatment following surgical or radiological interventions for DVT seems not to be influenced by the presence of a venous stent. According to recent ACCP 2012 guidelines the anticoagulant management in patients who have had any method of thrombus removal performed, the same intensity and duration of anticoagulant therapy as in comparable patients who do not undergo thrombosis removal is recommended (Grade 1B). In the acute phase of thrombosis, irrespective of the technique and whether or not stenting is applied, immediate anticoagulation following the procedure is pertinent to reduce the risk of recurrent thrombosis and thrombus propagation. The long-term treatment duration after venous interventions therefore may be tailored based on common risk factors for recurrent thrombosis and the individual risk for bleeding. Selected thrombophilia factors, d-dimer assessment and residual venous thrombosis provide markers for recurrent DVT. Currently, vitamin K antagonists) provide the main anticoagulants for (prolonged) anticoagulation, while the new oral anticoagulants emerge as promising alternatives. In case prolonged anticoagulation after unprovoked DVT is not indicated, cardiovascular risk management is warranted because of an increased rate of arterial thrombotic events after DVT; aspirin may be indicated as secondary prevention against recurrent thrombosis (while providing primary prevention against arterial thrombosis). PMID:23482544

  6. Mesenteric venous thrombosis

    MedlinePLUS

    Intestinal ischemia is a serious complication of mesenteric venous thrombosis. Some or all of the intestine dies because of ... Brandt LJ, Feuerstadt P. Instestinal ischemia. In: Feldman M, ... Pathophysiology/Diagnosis/Management. 9th ed. Philadelphia, ...

  7. Chronic Venous Insufficiency

    MedlinePLUS

    ... aid of a hand-held instrument called a Doppler. This allows the examiner to listen to the blood flow. The most accurate and detailed test, however, is a venous duplex ultrasound exam. This provides an ultra - sound image or ...

  8. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion.

    PubMed

    Haage, Patrick; Krings, Timo; Schmitz-Rode, Thomas

    2002-11-01

    Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting.First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access.In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is preferred because it is noninvasive, does not require contrast agent, carries no exposure to ionizing radiation, and is highly accurate and reproducible. Apart from catheter-directed thrombolysis, mechanical thrombectomy has proven to be a quick and safe treatment modality by enabling the recanalization of thrombotic occlusions in conjunction with minimal invasiveness and a low bleeding risk. Mechanical thrombectomy devices should only be used in conjunction with a temporary cava filter.Contrast-enhanced CT is at present considered the examination of choice for acute mesenteric vein occlusion which has mortality rates as high as 80%. Patients with proven acute mesenteric venous occlusion and contraindications to surgical therapy and no identified bleeding disposition without looming bowel ischemia or infarction are possible contenders to the less invasive percutaneous approach either by (in)direct thrombolysis or mechanical means. Ultrasonography is the primary imaging modality for the diagnosis of upper extremity thrombosis. Computed tomography and MRI are in addition helpful in diagnosing central chest vein occlusions. The interventionalist is rarely involved in the treatment of this entity. Catheter-directed thrombolysis is known to improve lysis rates. Together with balloon angioplasty good results have been obtained. If stenosis or thrombus remains after thrombolysis and angioplasty, stent placement should follow. Within the first two weeks, thrombosed dural sinus and cerebral venous vessels are typically hyperdense on CT compared with brain parenchyma; after the course of 2 weeks, the thrombus will become isodense. In MRI an axial fluid-attenuated inversion recovery sequence, an axial diffusion-weighted MRI, coronal T1-weighted spin-echo and T2-weighted turbo-spin-echo sequences, a coronal gradient-echo and a 3D phase-contrast venous angiogram should be performed. Local thrombolysis is needed only when patients have an exacerbation of clinical symptoms or imaging signs of worsening disease despite sufficient anticoagulation therapy. Acute occlusions of dia

  9. Preliminary clinical investigations of a new noninvasive venous pulse oximeter

    NASA Astrophysics Data System (ADS)

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

    2003-10-01

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

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

    SciTech Connect

    1995-03-01

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

  11. Advanced management of acute iliofemoral deep venous thrombosis: emergency department and beyond.

    PubMed

    Pollack, Charles V

    2011-06-01

    Recent attention to the increasing incidence of venous thromboembolism has included a call to action from the surgeon general and new guidelines from various specialty organizations. The standard of care for treatment of deep venous thrombosis in the emergency department (ED), supported by the 2008 American College of Chest Physicians (ACCP) guidelines, involves initiation of anticoagulation with low-molecular-weight heparin, pentasaccharide, or unfractionated heparin. For selected appropriate patients with extensive acute proximal deep venous thrombosis, the ACCP guidelines now recommend thrombolysis in addition to anticoagulation to reduce not only the risk of pulmonary embolism but also the risk of subsequent postthrombotic syndrome and recurrent deep venous thrombosis. Postthrombotic syndrome is a potentially debilitating chronic cluster of lower-extremity symptoms occurring in 20% to 50% of deep venous thrombosis patients subsequent to the acute insult, sometimes not until years later. A strategy of early thrombus burden reduction or frank removal might reduce the incidence of postthrombotic syndrome, as per natural history studies, venous thrombectomy data, observations after systemic and catheter-directed thrombolysis, and the still-limited number of randomized trials of catheter-directed thrombolysis (with anticoagulation) versus anticoagulation alone. Contemporary invasive (endovascular) treatments mitigate the drawbacks historically associated with thrombolytic approaches by means of intrathrombus delivery of drugs with greater fibrin specificity and lower allergenicity, followed by mechanical dispersion to accelerate lysis and then aspiration of remaining drug and clot debris. With a 2016 target completion date, the National Heart, Lung, and Blood Institute--sponsored Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis trial is comparing the safety and efficacy, in terms of both deep venous thrombosis and postthrombotic syndrome parameters, of the most evolved pharmacomechanical catheter-directed thrombolysis devices versus standard anticoagulation therapy alone. This article reviews the grounds for use of adjunctive thrombolysis in patients with acute proximal deep venous thrombosis and begins to identify types of deep venous thrombosis patients encountered in the ED who might benefit most from multidisciplinary consideration of early referral for possible endovascular therapy. PMID:21306786

  12. Antigenicity of venous allografts.

    PubMed Central

    Axthelm, S C; Porter, J M; Strickland, S; Baur, G M

    1979-01-01

    With isolated exceptions, the clinical use of venous allografts has been disappointing. Considerable evidence indicates that allograft antigenicity plays a major role in the failure of venous allografts when used as arterial replacements. Recent reports suggest that DMSO-cryopreservation of venous allografts may reduce allograft antigenicity while preserving allograft viability. The present study examines the effect of modifications of vein allografts on subsequent allograft antigenicity. Skin grafts were transplanted from ACI to Lewis inbred strains of male rats. Primary skin graft rejection occurred in 9.0 +/- 1.0 days. Subcutaneous implantation of fresh inferior vena cava from ACI rate into Lewis rats resulted in subsequent skin graft rejection in 5.0 +/- 1.0 days, confirming the antigenicity of venous tissue. Cryopreservation of ACI inferior vena cava for seven days prior to implantation, with or without 15% DMSO, resulted in subsequent skin graft rejection in 5.0 +/- 1.0 days. Treatment of ACI inferior vena cava with 0.30% gluteraldehyde for 20 minutes prior to implantation in Lewis rats resulted in skin graft rejection in 9.0 +/- 1.0 days, the same time as a first set rejection. This study indicates that unmodified veins are normally antigenic and that this antigenicity is not eliminated by cryopreservation with or without DMSO. Gluteraldehyde treatment appears to reduce allograft antigenicity, but results in a nonviable graft. At the present time, there is no known way to reduce the antigenicity of viable venous allografts. PMID:106782

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

    PubMed

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

    2001-01-01

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

  14. Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model.

    PubMed

    Hu, Mei-Hua; Chan, Wei-Hung; Chen, Yao-Chang; Cherng, Chen-Hwan; Lin, Chih-Kung; Tsai, Chien-Sung; Chou, Yu-Ching; Huang, Go-Shine

    2016-01-01

    The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury. PMID:26674456

  15. Venous dynamics in leg lymphedema.

    PubMed

    Kim, D I; Huh, S; Hwang, J H; Kim, Y I; Lee, B B

    1999-03-01

    To determine whether there is anatomical and/or functional impairment to venous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer was used for computer analysis of leg volume, a color Duplex Doppler scanner was used to determine deep vein patency and skin thickness, and Air-plethysmography was used to assess ambulatory venous pressure, venous volume, venous filling index and the ejection fraction. In the lymphedematous leg, volume and skin thickness were uniformly increased (126.4 +/- 21.3% and 156.9 +/- 44.5%) (mean +/- S.D.), respectively. The ambulatory venous pressure was also increased (134 +/- 60.7%) as was the venous volume (124.5 +/- 37.5%), and the venous filling index (134.5 +/- 50.5%). The ejection fraction was decreased (94.9 +/- 26.1%). Greater leg volume correlated with increased venous volume and venous filling index (values = 0.327, 0.241, respectively) and decreased ejection fraction (r = -0.133). Increased subcutaneous thickness correlated with increased venous filling index and venous volume (r = 0.307, 0.126, respectively) and decreased ejection fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradually impedes venous return which in turn aggravates the underlying lymphedema. PMID:10197322

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

    SciTech Connect

    Goltz, Jan P. Scholl, Anne; Ritter, Christian O.; Wittenberg, Guenther; Hahn, Dietbert; Kickuth, Ralph

    2010-12-15

    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.

  17. Pathophysiology of venous thrombosis.

    PubMed

    Myers, D D

    2015-03-01

    In this chapter, an overview of some of the prominent risk factors that contribute to the pathophysiology of venous thrombosis will be discussed. In 1856, Dr Rudolf Virchow developed the concept outlining the genesis of intravascular thrombosis. Dr Virchow hypothesized that circulatory stasis due to interrupted blood flow, changes in the blood leading to blood coagulation, and irritation or damage to the vascular endothelium would initiate acute venous thrombus generation. Presently, it is known that these above-mentioned risk factors are influenced by increasing age, gender, and obesity. The current chapter will focus on recent preclinical and clinical investigations that will give the reader insight into the prothrombotic mechanisms that lead to acute venous thrombosis. PMID:25729062

  18. Endovascular treatments for cerebral venous sinus thrombosis.

    PubMed

    Qiu, Zhongming; Sang, Hongfei; Dai, Qiliang; Xu, Gelin

    2015-10-01

    Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially fatal condition. CVST usually occurs young adults with a female predominance. The current mainstay for treating CVST is anticoagulation with heparin. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are non-responsive to heparin and other anticoagulants. Endovascular approaches include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy, all of which may rapidly recanalize the occluded venous sinus, restore the blood flow, reduce the increased intracranial pressure, and subsequently relieve the corresponding symptoms. However, as an invasive strategy, endovascular procedures per se may cause complications, such as intracranial hemorrhage, vessel dissection and pulmonary embolization, which may substantially decrease the benefit-risk ratio of the treatment. Due to the rareness of the condition and the limited indication of this invasive strategy, safety and efficacy of endovascular procedures in treating CVST are less feasible to be evaluated in large randomized clinical trails. Therefore, the evidences for justifying this treatment strategy are largely derived from case reports, cohort studies and clinical observations. PMID:25771984

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

    PubMed Central

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

    2013-01-01

    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. PMID:23022540

  20. The Role of Echinocandins in Candida Biofilm-Related Vascular Catheter Infections: In Vitro and In Vivo Model Systems.

    PubMed

    Ghannoum, Mahmoud; Roilides, Emmanuel; Katragkou, Aspasia; Petraitis, Vidmantas; Walsh, Thomas J

    2015-12-01

    Candida biofilm-associated infections of central venous catheters are a challenging therapeutic problem. Recent in vitro and in vivo studies of the structure, formation, pathogenesis, and treatment establish a rationale for new approaches to management of these tenacious infections. PMID:26567279

  1. Placement of a Retrievable Guenther Tulip Filter in the Superior Vena Cava for Upper Extremity Deep Venous Thrombosis

    SciTech Connect

    Nadkarni, Sanjay; Macdonald, Sumaira; Cleveland, Trevor J.; Gaines, Peter A.

    2002-12-15

    A retrievable Guenther Tulip caval filter(William Cook, Europe) was successfully placed and retrieved in the superior vena cava for upper extremity deep venous thrombosis in a 56-year-old woman. Bilateral subclavian and internal jugular venous thromboses thought secondary to placement of multiple central venous catheters were present. There have been reports of the use of permanent Greenfield filters and a single case report of a temporary filter in the superior vena cava. As far as we are aware this is the first reported placement and successful retrieval of a filter in these circumstances.

  2. The prevention, diagnosis and management of central venous line infections in children.

    PubMed

    Chesshyre, Emily; Goff, Zoy; Bowen, Asha; Carapetis, Jonathan

    2015-06-01

    With advancing paediatric healthcare, the use of central venous lines has become a fundamental part of management of neonates and children. Uses include haemodynamic monitoring and the delivery of lifesaving treatments such as intravenous fluids, blood products, antibiotics, chemotherapy, haemodialysis and total parenteral nutrition (TPN). Despite preventative measures, central venous catheter-related infections are common, with rates of 0.5-2.8/1000 catheter days in children and 0.6-2.5/1000 catheter days in neonates. Central line infections in children are associated with increased mortality, increased length of hospital and intensive care unit stay, treatment interruptions, and increased complications. Prevention is paramount, using a variety of measures including tunnelling of long-term devices, chlorhexidine antisepsis, maximum sterile barriers, aseptic non-touch technique, minimal line accessing, and evidence-based care bundles. Diagnosis of central line infections in children is challenging. Available samples are often limited to a single central line blood culture, as clinicians are reluctant to perform painful venepuncture on children with a central, pain-free, access device. With the advancing evidence basis for antibiotic lock therapy for treatment, paediatricians are pushing the boundaries of line retention if safe to do so, due to among other reasons, often limited venous access sites. This review evaluates the available paediatric studies on management of central venous line infections and refers to consensus guidelines such as those of the Infectious Diseases Society of America (IDSA). PMID:25934326

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

    SciTech Connect

    Liang, C.-D. Ko, S.-F.; Huang, C.-F.; Chien, S.J.; Tiao, M.M.

    2005-12-15

    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.

  4. Catheter-Associated Urinary Tract Infections

    MedlinePLUS

    ... Share Compartir Frequently Asked Questions about Catheter-associated Urinary Tract Infections What is a urinary catheter? What is a urinary tract infection? What is a catheter-associated urinary tract infection? ...

  5. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Catheter introducer. (a) Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery. (b) Classification. Class II (performance...

  6. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Catheter introducer. (a) Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery. (b) Classification. Class II (performance...

  7. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Catheter introducer. (a) Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery. (b) Classification. Class II (performance...

  8. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Catheter introducer. (a) Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery. (b) Classification. Class II (performance...

  9. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Catheter introducer. (a) Identification. A catheter introducer is a sheath used to facilitate placing a catheter through the skin into a vein or artery. (b) Classification. Class II (performance...

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

    NASA Astrophysics Data System (ADS)

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

    2013-02-01

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

  11. Cerebral venous air embolism during epidural injection in adult

    PubMed Central

    Sinha, Sharmili; Ray, Banambar

    2015-01-01

    A bolus of 0.125% bupivacaine (8ml) was given for post-operative analgesia with considerable resistance. It was immediately followed by hemodynamic deterioration along with fall in sensorium. After resuscitation, CT brain revealed pneumoencephalus around the brainstem. The higher force generated during injection could have injured epidural venous plexus and air inadvertently entered the veins. The source of air could have been from the epidural catheter or injection syringe. Hence it is suggested that position and patency of the epidural catheter must be checked each time before administration of injections especially after position changes. On presence of slightest resistance, injections should be withheld till the cause is ascertained by a trained personnel. PMID:25722555

  12. 21 CFR 870.1300 - Catheter cannula.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  13. Development of Needle Insertion Manipulator for Central Venous Catheterization

    NASA Astrophysics Data System (ADS)

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

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

  14. Endovascular management of porto-mesenteric venous thrombosis developing after trans-arterial occlusion of a superior mesenteric arteriovenous fistula.

    PubMed

    Garg, Deepak; Lopera, Jorge Enrique; Goei, Anthony D

    2013-09-01

    Porto-mesenteric venous thrombosis following a trans-arterial occlusion of a superior mesenteric arteriovenous fistula is a rare occurrence. We present a case of endovascular management of one such case treated pharmacomechanically with catheter-directed mesenteric thrombolysis and transjugular intrahepatic portosystemic shunt creation without long-term successful outcome. PMID:23475546

  15. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  16. Retrograde leptomeningeal venous approach for dural arteriovenous fistulas at foramen magnum.

    PubMed

    Mendes, George Ac; Caire, François; Saleme, Suzana; Ponomarjova, Sanita; Mounayer, Charbel

    2015-04-01

    A 72-year-old man presented with sudden right homonymous hemianopsia. Work-up imaging revealed a left occipital haematoma and an arteriovenous fistula supplied by the meningeal branches to the clivus from the left vertebral artery (VA) with a rostral venous reflux into cortical veins. A microcatheter was advanced through brainstem veins into the venous collector. A compliant balloon was placed in the left VA facing the origin of feeders. The balloon was inflated to protect the vertebrobasilar circulation from embolic migration. Onyx was injected by the transvenous catheter. Control angiogram revealed exclusion of the lesion. Informed consent was obtained from the patient. PMID:25964442

  17. Gastrin in portal and peripheral venous blood after feeding in man

    PubMed Central

    Dencker, H.; Håkanson, R.; Liedberg, G.; Norryd, C.; Oscarson, J.; Rehfeld, J. F.; Stadil, F.

    1973-01-01

    The concentrations of immunoreactive gastrin in serum from portal and peripheral venous blood were determined in 10 patients with indwelling portal catheters before and after feeding. No significant differences were found between the gastrin concentrations in portal and peripheral serum. Gel filtration studies of serum did not reveal any differences between the gastrin components of portal and peripheral venous serum. Since neither the concentrations of immunoreactive gastrin nor the four gastrin components differed between portal and peripheral serum it is suggested that the liver is without effect on gastrin metabolism. PMID:4761604

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

    SciTech Connect

    Turmel-Rodrigues, Luc A E-mail: cim.stgatien@wanadoo.fr

    2005-01-15

    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.

  19. Case of Catheter Sepsis with Ralstonia gilardii in a Child with Acute Lymphoblastic Leukemia

    PubMed Central

    Wauters, Georges; Claeys, Geert; Verschraegen, Gerda; De Baere, Thierry; Vandecruys, Els; Van Simaey, Leen; De Ganck, Catharine; Vaneechoutte, Mario

    2001-01-01

    Acute lymphoblastic leukemia was diagnosed in a 7-year-old girl. Two months after insertion of a central venous catheter, she developed fever and complained of headache and abdominal pain. Physical examination revealed no focus of infection. A gram-negative nonfermenting bacillus was recurrently cultured from blood. Extensive biochemical testing and 16S ribosomal DNA sequencing led to the identification of Ralstonia gilardii. PMID:11724891

  20. Catheter management of occluded superior baffle after atrial switch procedures for transposition of great vessels.

    PubMed

    Ebeid, Makram R; Gaymes, Charles H; McMullan, Michael R; Shores, Jennifer C; Smith, J Clinton; Joransen, James A

    2005-03-15

    We present successful catheter intervention in 4 patients with total occlusion of the superior baffle after an atrial switch procedure. A transseptal needle (in addition to the transhepatic route in 1 patient with known occluded femoral veins) was used to open the occluded segments and place stents. Additionally, we report the regression of multiple systemic-to-pulmonary venous fistulas that developed as a result of the occluded baffle. PMID:15757613

  1. Femoral Arteriovenous Fistula Associated With Leg Swelling 6 Months After Removal of a Hemodialysis Catheter

    PubMed Central

    Jin, Lie; Wang, Jian; Wu, Chuifen; shao, Chuxiao; Yu, Xueping; Lei, Wenhui

    2015-01-01

    Abstract Double-lumen catheters have been used widely to obtain temporary access in patients who are in need of acute hemodialysis (HD) because of acute renal failure. Several complications are associated with the insertion of these catheters, including bleeding, infection, injuries to arteries, and deep venous thrombosis. An arteriovenous fistula (AVF) is a rare but significant complication following catheterization for temporary HD. Herein, we present a case of AVF associated with leg swelling 6 months after the removal of a double-lumen HD catheter. We describe a special case of a 42-year-old man who experienced acute renal failure secondary to diabetic ketoacidosis (DKA). A 12-Fr dialysis catheter was inserted in the right femoral vein. Six months after catheter removal, the patient was admitted for pain and swelling in the right leg. Color Doppler ultrasound and three-dimensional computed tomography (CT) revealed an AVF between the right femoral vein and the right femoral superficial artery. The fistula was repaired successfully by vascular surgeons. This case highlights that an AVF is a rare but significant complication after catheterization for temporary HD. The nephrologist should be wary of the potential of this complication and perform clinical and medical examinations at the insertion and removal of temporary HD catheters. PMID:26448032

  2. Balloon catheter coronary angioplasty

    SciTech Connect

    Angelini, P.

    1987-01-01

    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.

  3. [Catheter-related infections: microbiology].

    PubMed

    Timsit, J F

    2005-03-01

    Coagulase negative staphylococci, Staphylococcus aureus and Pseudomonas sp. are the most frequent microorganisms responsible for catheter-related infections. A relative frequency of microorganisms varies according to the countries, microenvironment and outbreaks of multiresistant bacterias. Infections due to fungi, S. aureus and Pseudomonas sp. are associated with the more severe complications. Recent data suggest that chlorhexidine, either used for cutaneous antisepsis or for catheter impregnation decreases infections due to gram positive cocci. Ecological data should be taken into account when deciding a probabilistic treatment in case of suspicion of catheter-related infection. PMID:15792563

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

    SciTech Connect

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

    2012-06-15

    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.

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

    PubMed

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

    2014-06-01

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

  6. CATHETER SURFACE INTERACTIONS WITH HUMAN

    E-print Network

    Müftü, Sinan

    Polymers Coated with friction reducing materials in order to reduce tissue trauma. ** = Primary catheter pores. Some infrequent particulate present. #12;Hydrogel Coefficient of Friction COF of Hydrogel Regularly 1956 ­ Forssmann Rewarded #12;Tribological Issues Frictional Resistance Damaged tissue Infection

  7. Peripherally inserted central catheter - flushing

    MedlinePLUS

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

  8. Venous air embolism and selective denervation for torticollis.

    PubMed

    Lobato, E B; Black, S; De Soto, H

    1997-03-01

    Selective denervation to relieve severe torticollis requires surgery with the patient in the sitting position. Nerve stimulation is used to guide the procedure; therefore, patients undergo general anesthesia without muscle relaxation. Because of the risk of venous air embolism (VAE), monitoring with precordial Doppler and a multiorifice right atrial catheter has been recommended. To document the incidence of VAE and, thus, the effectiveness of monitors to detect it, consecutive patients who underwent selective peripheral denervation for torticollis between June 1993 and July 1994 were studied retrospectively, and those who underwent the procedure between August 1994 and February 1996 were studied prospectively. No VAE was documented in the retrospective group (n = 31). In the prospective group (n = 69), precordial Doppler detected one episode of VAE that lasted < 20 s and had no clinical sequelae. The incidence of complications from right atrial catheter insertion was 8% (carotid puncture, hematoma, inability to cannulate) but with no permanent sequelae. We conclude that VAE is infrequent and self-limited in association with selective denervation for torticollis. While monitoring with precordial Doppler for patients undergoing denervation for torticollis is indicated, the use of a right atrial catheter is of limited value because of associated complications and increased operating room time and cost. PMID:9052299

  9. Reductions in tissue plasminogen activator and thrombomodulin in blood draining veins damaged by venous access devices.

    PubMed

    Horne, M K; Merryman, P K; Mayo, D J; Gralnick, H R; Chang, R C; Alexander, H R

    1995-08-15

    A frequent complication of venous access devices (VADs) is axillary-subclavian venous thrombosis. To study this problem we have compared blood drawn through VADs with peripheral blood samples in a group of oncology patients with venographically demonstrated venous damage (N = 14) and a group with normal venograms (N = 21). The samples were assayed for a battery of proteins believed to be involved in thrombogenesis. After approximately six weeks of catheterization the venographically abnormal patients had significantly less thrombomodulin (P = 0.0055) and significantly higher PAI:tPA (P = 0.022) in catheter-drawn samples as compared with the venographically normal group. Although the data are inconclusive, it is hypothesized that these changes resulted from local endothelial injury. PMID:7482440

  10. Catheter infection risk related to the distance between insertion site and burned area.

    PubMed

    Ramos, Guillermo E; Bolgiani, Alberto N; Patiño, Osvaldo; Prezzavento, Gustavo E; Guastavino, Paula; Durlach, Ricardo; Fernandez Canigia, Liliana B; Benaim, Fortunato

    2002-01-01

    A prospective observational study of central venous catheters (CVC) was carried out in order to determine if a CVC inserted near an open burn wound increases catheter infection risk in burned patients. The study was carried out during a 12-month period (1998-1999) at the Benaim Foundation's Burn Unit in Buenos Aires (C.E.P.A.Q.). Eighty-three CVCs were inserted in 20 burned patients during the study period. Twenty-six catheters were inserted near an open wound (NOW) and 57 far from an open wound (FOW). NOW CVCs were considered when 25 cm2 surrounding the catheter's insertion site overlapped the wound. Colonization rates were 84% (22/26 CVCs) in those inserted NOW and 47% (27/57 CVCs) in FOW (P = 0.001). Colonization relative risk of NOW-CVCs was 1.79 (95% confidence interval, 1.3-2.46). Bacteremia rates were 27% (7/26 CVCs) in CVCs inserted NOW and 6% (3/57 CVCs) in FOW (P = 0.004). Bacteremic risk of NOW-CVCs was 5.12 (95% confidence interval, 1.44-18.22). Colonization rates were higher and sooner in NOW-CVCs than in FOW-CVCs. We suggest that insertion of catheters near an open burn wound should be avoided and, if inevitable, should not be left in place for period exceeding 3 days. PMID:12142579

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

    PubMed

    Mönnig, Gerold; Eckardt, Lars

    2014-12-01

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

  12. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., coude catheters, balloon retention type catheters, straight catheters, upper urinary tract catheters... device that is inserted through the urethra and used to pass fluids to or from the urinary tract....

  13. FAQs about Catheter-Associated Urinary Tract Infection

    MedlinePLUS

    ... an infection can occur. If you have a urinary catheter, germs can travel along the catheter and cause ... tract infection (or “CA-UTI”). What is a urinary catheter? A urinary catheter is a thin tube placed ...

  14. Varicose Veins and Venous Insufficiency

    MedlinePLUS

    ... catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter (SIRspecialists) YouTube RSS Feeds Radiation Safety ... Talking People Are Talking: Know Your Treatment Options! Social Media Connect With SIR Vision to Heal: SIR Blog ...

  15. Catheter-based photoacoustic endoscope

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

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

  16. 21 CFR 880.5200 - Intravascular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term...

  17. 21 CFR 880.5200 - Intravascular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term...

  18. 21 CFR 880.5200 - Intravascular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term...

  19. 21 CFR 880.5200 - Intravascular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term...

  20. 21 CFR 880.5200 - Intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...880.5200 Intravascular catheter. (a) Identification. An intravascular catheter is a device that consists of a slender tube and any necessary connecting fittings and that is inserted into the patient's vascular system for short term...

  1. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  2. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  3. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  4. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  5. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

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

    SciTech Connect

    Kroepil, Patric; Lanzman, Rotem S. Miese, Falk R.; Blondin, Dirk; Winter, Joachim; Scherer, Axel; Fuerst, Guenter

    2011-04-15

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

  7. Pycnogenol® in chronic venous insufficiency and related venous disorders.

    PubMed

    Gulati, Om P

    2014-03-01

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

  8. Venous Thromboembolism and Marathon Athletes

    MedlinePLUS

    ... Sign In Cardiology Patient Page Venous Thromboembolism and Marathon Athletes Claire M. Hull , PhD ; Julia A. Harris , ... general adult population are indisputable. However, for the marathon athlete who trains intensively and for long periods ...

  9. Cytometric Catheter for Neurosurgical Applications

    SciTech Connect

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

    2010-01-01

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

  10. [Thromboprophylaxis of venous thromboembolism].

    PubMed

    Kobayashi, Takao

    2014-07-01

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

  11. Hemodialysis catheter insertion using transrenal approach.

    PubMed

    Law, Wai Ping; Cheung, Chi Yuen; Chan, Hoi Wong; Kwok, Philip Chong-Hei; Chak, Wai Leung; Chau, Ka Foon

    2015-10-01

    We report a patient suffering from end-stage renal disease (ESRD) because of lupus nephritis presented with exhausted vascular access after multiple arteriovenous grafts creation and hemodialysis catheters insertion. A rare percutaneous transrenal approach was finally used for the insertion of dialysis catheter. After 2 years, this hemodialysis catheter was complicated by blockage but was successfully replaced by a new catheter via the same site. Our report shows that the transrenal route of hemodialysis catheter insertion can provide a glimpse of hope for those ESRD patients with exhausted vascular access. PMID:25582448

  12. Systematic review of anticoagulant treatment of catheter-related thrombosis.

    PubMed

    Baumann Kreuziger, Lisa; Onwuemene, Oluwatoyosi; Kolesar, Emma; Crowther, Mark; Lim, Wendy

    2015-12-01

    Central venous catheter-related thrombosis (CRT) is a complication seen in patients requiring long-term intravenous access. Treatment of CRT is not standardized and international guidelines for treatment are based on extrapolation of evidence from lower extremity thrombosis. We performed a systematic review of the literature to evaluate if duration of anticoagulation affects the risk of recurrent venous thrombosis, post-thrombotic syndrome, or major hemorrhage. We searched PubMed, Embase, Medline, CINAHL, Cochrane, and ACP Journal club for studies of CRT treated with anticoagulation. Of 1648 titles and abstracts, 23 studies met our inclusion criteria. No randomized trials were identified. Duration of anticoagulation varied from 8days to more than 6months. Outcomes of patients with upper extremity thrombosis due to CRT or other etiologies were often combined. The incidence of post-thrombotic syndrome varied between 0 and 75% depending on the definition used. Seven percent of patients with upper extremity thrombosis treated with anticoagulation experienced recurrent deep vein thrombosis and 2.8% experienced pulmonary embolism. Major hemorrhage was reported in 2.8-4.9% of anticoagulated patients. Prospective studies evaluating the optimal duration of anticoagulation in patients with CRT are needed. PMID:26342400

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

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

  14. Which is the easiest and safest technique for central venous access? A retrospective survey of more than 5,400 cases.

    PubMed

    Pittiruti, M; Malerba, M; Carriero, C; Tazza, L; Gui, D

    2000-01-01

    There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent in-sertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the 'low lateral' approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arte-rial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the 'low lateral' approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation. PMID:17638235

  15. Systemic venous drainage: can we help Newton?

    PubMed

    Corno, Antonio F

    2007-06-01

    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

  16. The Impact of Implementation of Bundle to Reduce Catheter-Related Bloodstream Infection Rates

    PubMed Central

    Menegueti, Mayra Goncalves; Ardison, Kym Marcel Martins; Bellissimo-Rodrigues, Fernando; Gaspar, Gilberto Gambero; Martins-Filho, Olindo Assis; Puga, Marcelo Lourencini; Laus, Ana Maria; Basile-Filho, Anibal; Auxiliadora-Martins, Maria

    2015-01-01

    Background The aim of the study was to investigate how control bundles reduce the rate of central venous catheter-associated bloodstream infections (CVC-BSIs) rates in critically ill patients. Methods This is a prospective before-and-after study designed to evaluate whether a set of control measures (bundle) can help prevent CVC-BSI. The bundles included a checklist that aimed to correct practices related to CVC insertion, manipulation, and maintenance based on guidelines of the Center for Disease Control and Prevention (CDC). Results We examined 123 checklists before and 155 checklists after implementation of the training program. Compared with the pre-intervention period, CVC-BSI rates decreased. Hand hygiene techniques were used correctly. CVC-BSI incidence was 9.3 and 5.1 per 1,000 catheter-days before and after the training program, respectively. Conclusions The implementation of a bundle and training program effectively reduces CVC-BSI rates. PMID:26491498

  17. Intravenous Catheter-Associated Candidemia due to Candida membranaefaciens: The First Iranian Case.

    PubMed

    Aghili, Seyed Reza; Shokohi, Tahereh; Boroumand, Mohammad Ali; Hashemi Fesharaki, Shirinsadat; Salmanian, Bahar

    2015-04-01

    The incidence of candidemia due to the uncommon non-albicans Candida species appears to be increasing, and certain species such as Candida (C.) membranaefaciens have been reported in some clinical researches. Vascular catheters are considered the likely culprit for the sudden emergence of hospital-acquired candidemia. The identification of C. membranaefaciens can be problematic in clinical practice owing to its phenotypic resemblance to C. guilliermondii. We report the first case of C. membranaefaciens in Iran, which occurred in a 70-year-old woman, who had coronary artery bypass grafting (CABG). We isolated germ-tube negative yeast from both blood culture and central venous catheter (CVC) tip culture on brain-heart infusion agar, Sabouraud dextrose agar plates, and biphasic brain-heart infusion media bottle; it developed smooth, pink colonies on CHROMagar Candida. By using the polymerase chain reaction and sequencing of theinternal transcribed spacer region of rDNA, we identified C. membranaefaciens. After the removal of the CVC and initiation of Fluconazole treatment, the patient's condition gradually improved and she was discharged from the hospital. The early detection of organisms in the catheter, removal of the catheter, and treatment with anti-fungal antibiotics have an important role in controlling disease and preventing septicemia after CABG. As C. membranaefaciens is an opportunistic Candida species, both clinicians and microbiologists should be aware of the factors that confer fast diagnosis and appropriate treatment. PMID:26110010

  18. Intravenous Catheter-Associated Candidemia due to Candida membranaefaciens: The First Iranian Case

    PubMed Central

    Aghili, Seyed Reza; Shokohi, Tahereh; Boroumand, Mohammad Ali; Hashemi Fesharaki, Shirinsadat; Salmanian, Bahar

    2015-01-01

    The incidence of candidemia due to the uncommon non-albicans Candida species appears to be increasing, and certain species such as Candida (C.) membranaefaciens have been reported in some clinical researches. Vascular catheters are considered the likely culprit for the sudden emergence of hospital-acquired candidemia. The identification of C. membranaefaciens can be problematic in clinical practice owing to its phenotypic resemblance to C. guilliermondii. We report the first case of C. membranaefaciens in Iran, which occurred in a 70-year-old woman, who had coronary artery bypass grafting (CABG). We isolated germ-tube negative yeast from both blood culture and central venous catheter (CVC) tip culture on brain-heart infusion agar, Sabouraud dextrose agar plates, and biphasic brain-heart infusion media bottle; it developed smooth, pink colonies on CHROMagar Candida. By using the polymerase chain reaction and sequencing of theinternal transcribed spacer region of rDNA, we identified C. membranaefaciens. After the removal of the CVC and initiation of Fluconazole treatment, the patient's condition gradually improved and she was discharged from the hospital. The early detection of organisms in the catheter, removal of the catheter, and treatment with anti-fungal antibiotics have an important role in controlling disease and preventing septicemia after CABG. As C. membranaefaciens is an opportunistic Candida species, both clinicians and microbiologists should be aware of the factors that confer fast diagnosis and appropriate treatment. PMID:26110010

  19. Cerebral venous thrombosis: diagnosis dilemma

    PubMed Central

    Chiewvit, Pipat; Piyapittayanan, Siriwan; Poungvarin, Niphon

    2011-01-01

    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. PMID:22368772

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

    SciTech Connect

    Franklin, Iain Gilmore, Christopher

    2015-06-15

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

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

    SciTech Connect

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

    2005-06-15

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

  2. Distended Bladder Presenting with Altered Mental Status and Venous Obstruction

    PubMed Central

    Washco, Vaughan; Engel, Lee; Smith, David L.; McCarron, Ross

    2015-01-01

    Background New onset or acute worsening of bilateral lower extremity swelling is commonly caused by venous congestion from decompensated heart failure, pulmonary disease, liver dysfunction, or kidney insufficiency. A thromboembolic event, lymphatic obstruction, or even external compression of venous flow can also be the culprit. Case Report We report the case of an 83-year-old male with a history of myelodysplastic syndrome that progressed to acute myeloid leukemia, bipolar disorder, and benign prostatic hypertrophy. He presented with altered mental status and new onset lower extremity edema caused by acute bladder outflow obstruction. Computed tomography of the abdomen and pelvis showed the patient's distended bladder compressing bilateral external iliac veins. Conclusion Insertion of a Foley catheter resulted in several liters of urine output and marked improvement in his lower extremity edema and mental status a few hours later. Our extensive workup failed to reveal a cause of the patient's acute change in mental status, and we attributed it to a concept known as cystocerebral syndrome. PMID:25829883

  3. A new device for continuous ambulatory central venous pressure measurement.

    PubMed

    Buckey, J C; Goble, R L; Blomqvist, C G

    1987-08-01

    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

  4. Dual-lumen catheters for continuous venovenous hemofiltration: limits for blood delivery via femoral vein access and a potential alternative in an experimental setting in anesthetized pigs

    PubMed Central

    Unger, Juliane K; Pietzner, Klaus; Francis, Roland C; Birnbaum, Juergen; Theisen, Marc Michael; Lemke, Arne-Joern; Niehues, Stefan M

    2007-01-01

    Introduction Small intravascular volume, pathophysiological hemorheology, and/or low cardiac output [CO] are assumed to reduce available blood flow rates via common dual-lumen catheters (except for those with a right atrium catheter tip position) in the critically ill patient. We performed an experimental animal study to verify these assumptions. Methods Anesthetized, ventilated pigs (35 to 50 kg) were allocated to different hemorheological conditions based on the application of different volume substitutes (that is, colloids and crystalloids, n = 6 to 7 per volume substitute). In a second step, allocation to the final study group was performed after the determination of the highest values for access flow (Qa) via an axial dual-lumen catheter (11 French, 20 cm long, side holes) placed in the femoral vein. High Qa rates (>300 ml/minute) were allocated to the dual-lumen catheter group; low Qa rates were switched to a 'dual-vein approach' using an alternative catheter (8.5-French sheath) for separate blood delivery. Hemodynamics (CO and central venous pressure [CVP]) and blood composition (blood cell counts, plasma proteins, and colloid osmotic pressure) were measured. Catheter tip positions and vessel diameters were exemplified by computed tomography. Results Forty-four percent of the animals required an alternative vascular access due to only minimal Qa via the dual-lumen catheter. Neither hemorheologically relevant aspects nor CO and CVP correlated with the Qa achievable via the femoral vein access. Even though the catheter tip of the alternative catheter provided common iliac vein but not caval vein access, this catheter type enabled higher Qa than the dual-lumen catheter positioned in the caval vein. Conclusion With respect to the femoral vein approach, none of the commonly assumed reasons for limited Qa via the arterial line of an axial dual-lumen catheter could be confirmed. The 8.5-French sheath, though not engineered for that purpose, performed quite well as an alternative catheter. Thus, in patients lacking right jugular vein access with tip positioning of large-French dual-lumen catheters in the right atrium, it would be of interest to obtain clinical data re-evaluating the 'dual-vein approach' with separate blood delivery via a tip-hole catheter in order to provide high-volume hemofiltration. PMID:17302971

  5. Percutaneous transhepatic biliary drainage using a ligated catheter for recurrent catheter obstruction: antireflux technique.

    PubMed

    Hamada, Tsuyoshi; Tsujino, Takeshi; Isayama, Hiroyuki; Hakuta, Ryunosuke; Ito, Yukiko; Nakata, Ryo; Koike, Kazuhiko

    2013-03-01

    Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter. PMID:23560165

  6. Housestaff Knowledge Related to Urinary Catheter Use and Catheter-Associated Urinary Tract Infections.

    PubMed

    Paras, Molly L; Shenoy, Erica S; Hsu, Heather E; Walensky, Rochelle P; Hooper, David C

    2015-11-01

    Despite published catheter-associated urinary tract infection prevention guidelines, inappropriate catheter use is common. We surveyed housestaff about their knowledge of catheter-associated urinary tract infections at a teaching hospital and found most are aware of prevention guidelines; however, their application to clinical scenarios and catheter practices fall short of national goals. Infect. Control Hosp. Epidemiol. 2015;36(11):1355-1357. PMID:26278269

  7. 21 CFR 870.5150 - Embolectomy catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  8. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  9. Multiple venous aneurysms of neck

    PubMed Central

    Swaika, Sweta; Basu, Sudipta; Bhadra, Ram C.; Maitra, Sujay

    2013-01-01

    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. PMID:23599580

  10. Air travel and venous thromboembolism.

    PubMed Central

    Mendis, Shanthi; Yach, Derek; Alwan, Ala

    2002-01-01

    There has recently been increased publicity on the risk of venous thrombosis after long-haul flights. This paper reviews the evidence base related to the association between air travel and venous thromboembolism. The evidence consists only of case reports, clinical case-control studies and observational studies involving the use of intermediate end-points, or expert opinion. Some studies have suggested that there is no clear association, whereas others have indicated a strong relationship. On the whole it appears that there is probably a link between air travel and venous thrombosis. However, the link is likely to be weak, mainly affecting passengers with additional risk factors for venous thromboembolism. The available evidence is not adequate to allow quantification of the risk. There are insufficient scientific data on which to base specific recommendations for prevention, other than that leg exercise should be taken during travel. Further studies are urgently needed in order to identify prospectively the incidence of the condition and those at risk. PMID:12077617

  11. Chronic Venous Disease and Comorbidities.

    PubMed

    Matic, P; Jolic, S; Tanaskovic, S; Soldatovic, I; Katsiki, N; Isenovic, E; Radak, Dj

    2015-07-01

    We report the relations between comorbidities and chronic venous disease. In this cross-sectional study, information was gathered from 1679 Serbian patients. The majority (65.0%) of patients were women. Mild forms of chronic venous disease (clinical, etiologic, anatomic and pathophysiologic [CEAP] classification; C0s-C1) were more frequent in women (11.6%), while severe forms (CEAP C4-C6) were more commonly encountered in men (42.1%). The most frequent comorbidity was emphysema/chronic obstructive pulmonary disease in both groups (74.3% in males and 70.6% in females). For females, diabetes mellitus (P < .005), arterial hypertension (P < .000), and skeletal/joint diseases (P < .042) were more commonly found in the C4 to C6 category. Both males and females, with severe form of chronic venous disease, may benefit from additional screening for comorbidities. Further studies are needed to clarify the nature of association among comorbidities and chronic venous disease. PMID:25005764

  12. Transcatheter closure of patent vertical vein after repair of total anomalous pulmonary venous connection

    PubMed Central

    Verma, Sudeep; Subramanian, Anand; Saileela, Rajan; Koneti, Nageswara Rao

    2015-01-01

    Background: Vertical vein is left patent in some cases of supra-cardiac total anomalous pulmonary venous connection (TAPVC) when there is hemodynamic instability due to noncompliant left atrium and ventricle. After the peri-operative period, this results in features of pre-tricuspid shunt. Materials and Methods: Three cases with patent vertical vein following repair of supra-cardiac TAPVC presented with features of pre-tricuspid shunt on follow-up. Trans-catheter closure of patent vertical vein was performed using vascular plug in all three subjects. Results: The procedure was technically successful in all the patients. There was a complication related to catheter tip breakage in one of them, which was successfully managed. There was no impingement on pulmonary vein in any of the patients. Conclusion: Patent vertical vein following TAPVC repair results in features of pre-tricuspid shunt. Transcatheter closure of the patent vein is feasible. PMID:26556968

  13. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...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)...

  14. 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 Section 876...Therapeutic Devices § 876.5030 Continent ileostomy catheter. (a) Identification. A continent ileostomy catheter is a flexible tubular...

  15. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  16. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  17. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  18. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  19. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  20. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Suprapubic urological catheter and accessories. ...suprapubic urological catheter and accessories is...abdominal wall into the urinary bladder with the aid...fluids to and from the urinary tract. This generic...includes the suprapubic catheter and tube, Malecot...

  1. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Suprapubic urological catheter and accessories. ...suprapubic urological catheter and accessories is...abdominal wall into the urinary bladder with the aid...fluids to and from the urinary tract. This generic...includes the suprapubic catheter and tube, Malecot...

  2. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Suprapubic urological catheter and accessories. ...suprapubic urological catheter and accessories is...abdominal wall into the urinary bladder with the aid...fluids to and from the urinary tract. This generic...includes the suprapubic catheter and tube, Malecot...

  3. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Suprapubic urological catheter and accessories. ...suprapubic urological catheter and accessories is...abdominal wall into the urinary bladder with the aid...fluids to and from the urinary tract. This generic...includes the suprapubic catheter and tube, Malecot...

  4. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Suprapubic urological catheter and accessories. ...suprapubic urological catheter and accessories is...abdominal wall into the urinary bladder with the aid...fluids to and from the urinary tract. This generic...includes the suprapubic catheter and tube, Malecot...

  5. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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,...

  6. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 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,...

  7. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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,...

  8. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 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,...

  9. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 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,...

  10. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 2010-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be...

  11. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2011-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be...

  12. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 2013-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be...

  13. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 2014-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be...

  14. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 2012-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be...

  15. Glyceryl trinitrate complements citrate and ethanol in a novel antimicrobial catheter lock solution to eradicate biofilm organisms.

    PubMed

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

    2013-08-01

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

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

    SciTech Connect

    Powell, Steven; Chan, Tze Yuan; Bhat, Rammohan; Lam, Kimberly; Narlawar, Ranjeet S.; Cullen, Nicola; Littler, Peter

    2010-08-15

    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.

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

    SciTech Connect

    Stockland, Andrew H.; Willingham, Darrin L.; Paz-Fumagalli, Ricardo; Grewal, Hani P.; McKinney, J. Mark; Hughes, Christopher B.; Walser, Eric M.

    2009-03-15

    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.

  18. Case of Cerebral Venous Thrombosis with Unusual Venous Infarcts

    PubMed Central

    Kamaraju, Susheel Kumar; Pasupaleti, Bhimeswarao; Juluri, Naganarasimharaju

    2015-01-01

    Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed. PMID:26023623

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

    SciTech Connect

    Behrendt, Florian F. Bruners, Philipp; Keil, Sebastian; Plumhans, Cedric; Mahnken, Andreas H.; Stanzel, Sven; Das, Marco; Guenther, Rolf W.; Muehlenbruch, Georg

    2009-01-15

    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.

  20. Anticoagulant therapies versus heparin for the prevention of hemodialysis catheter-related complications: systematic review and meta-analysis of prospective randomized controlled trials

    PubMed Central

    Liu, Jinrui; Wang, Chang’an; Zhao, Hongfei; Zhang, Jinghua; Ma, Jie; Hou, Yuanyuan; Zou, Hongbin

    2015-01-01

    Locking of central venous catheters with heparin is an accepted practice to maintain catheter patency between dialysis sessions. However, this practice may cause other adverse reactions. Although many studies suggest benefits of other catheter lock solutions over heparin on these grounds, no consensus has been reached for clinical practice. A systematic review and meta-analysis was performed of randomized controlled trials (RCT) that compared antimicrobial-containing or citrate-alone catheter lock solutions with heparin alone in patients undergoing hemodialysis with central venous catheters. Medline, Cochrane Central Register of Controlled Trials from EMBASE, and PubMed were searched for articles published through June 2014. The primary outcomes were catheter-related bacteremia (CRB) and catheter malfunction (CM). The secondary outcomes were bleeding, exit-site infection (ESI), clinical sepsis, and all-cause mortality. Seventeen RCTs met the inclusion criteria. The meta-analysis showed that antimicrobial-containing and citrate-alone lock solutions were superior to heparin for preventing CRB (both P < 0.01). Although antimicrobial-containing lock solutions significantly affected clinical sepsis (P < 0.01), they did not affect ESI, bleeding, or all-cause mortality. Incidence of CM episodes was lower in patients receiving antibiotics + heparin and gentamicin + citrate (both P < 0.05), while other antimicrobial-containing and citrate-alone lock solutions showed no difference. Only citrate-alone lock solutions significantly decreased bleeding and ESI episodes (both P < 0.05). Compared with heparin, antimicrobial-containing lock solutions more effectively prevent CRB and clinical sepsis. Antibiotics + heparin and gentamicin + citrate solutions showing better prevention of CM. Citrate-alone lock solutions result in fewer CRB, bleeding and ESI episodes. PMID:26550111

  1. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 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....

  2. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 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....

  3. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 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....

  4. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 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....

  5. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasopharyngeal catheter. 874.4175 Section 874.4175 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....

  6. 21 CFR 878.4200 - Introduction/drainage catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  7. Cerebral venous development in relation to developmental venous anomalies and Vein of Galen aneurysmal malformations.

    PubMed

    Pearl, Monica; Gregg, Lydia; Gandhi, Dheeraj

    2011-06-01

    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

  8. Development of Bend Sensor for Catheter Tip

    NASA Astrophysics Data System (ADS)

    Nagano, Yoshitaka; Sano, Akihito; Fujimoto, Hideo

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

  9. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  10. Venous allografts for vascular reconstructions.

    PubMed

    Vermassen, F; Degrieck, N; De Kock, L; Goubeau, J; Van Landuyt, K; Derom, F

    1992-01-01

    In order to evaluate various protocols for the preservation of venous allografts 162 arterial reconstructions were performed in mongrel dogs bypassing their ligated femoral arteries. The cumulative 6-month patency-rates as determined by weekly palpation and regular angiography were. Group I = Synthetic grafts: (a) Dacron 48%, (b) PTFE 53%. Group II = Fresh venous grafts: (a) autografts 100%, (b) allografts 37%. Group III = Veins preserved in saline at 4 degrees C for 1 month: (a) autografts 44%, (b) allografts 34%. Group IV = Veins preserved in saline at -70 degrees C: (a) autografts 58%, (b) allografts 47%. Group V = Veins preserved in glutaraldehyde solution: (a) autografts 26%, (b) allografts 22%. Group VI = Veins preserved in Hanks-solution with 15% DMSO at -160 degrees C: (a) autografts 77%, (b) allografts 35%. Histological as well as immunological studies suggest that these results are determined by the preservation protocol in Groups III, IV and V and by the presence of rejection in Groups I and VI. As the results with the allografts are not superior to those obtained with synthetic grafts, their use should be confined to those cases where the use of synthetic materials should be avoided at any price. Further experiments with immunosuppression and antigenic matching are indicated to see whether this would improve the results obtained with viable venous allografts. PMID:1287000

  11. Experience with penile venous surgery.

    PubMed

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

    1993-01-01

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

  12. Catheter-related blood stream infection caused by Dermacoccus barathri, representing the first case of Dermacoccus infection in humans.

    PubMed

    Takahashi, Nobuhiro; Shinjoh, Masayoshi; Tomita, Hirofumi; Fujino, Akihiro; Sugita, Kayoko; Katohno, Yasuhiro; Kuroda, Tatsuo; Kikuchi, Ken

    2015-08-01

    A 7-year-old boy undergoing home parenteral nutrition with totally implantable central venous access device for chronic intestinal pseudo-obstruction experienced repeated episodes of fever with a temperature above 39.0 °C despite the antibiotic treatment. The fever was considered to be catheter-related blood stream infections, as no other etiology could be justified. Repeated blood culture tests revealed negative after 1-week incubation, whereas some samples of blood collected from the central venous catheter yielded positive and gram-positive rods were detected. These bacteria were detected repeatedly, then the central venous access device was removed with consideration for the possibility of this bacteria being a pathogen. Thereafter, the fever did not recur and the blood culture tests were negative. The causative agent was identified as Dermacoccus barathri based on the 16S rRNA gene sequence and phylogenetic analysis of 6118-bp concatenated sequences of 4 housekeeping genes. Genus Dermacoccus are one form of Actinomycetes isolated from human skin and water, but human infection with Dermacoccus spp. has not been previously reported and the pathogenicity of the bacteria remains unclear. To our knowledge, this is the first reported case of Dermacoccus infection in humans. PMID:26044303

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

    PubMed Central

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

    2014-01-01

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

  14. Generalized training subset selection for statistical estimation of epicardial activation maps from intravenous catheter measurements.

    PubMed

    Yilmaz, Bülent; MacLeod, Robert S

    2007-03-01

    Catheter-based electrophysiological studies of the epicardium are limited to regions near the coronary vessels or require transthoracic access. We have developed a statistical approach by which to estimate high-resolution maps of epicardial activation from very low-resolution multi-electrode venous catheter measurements. This technique uses a linear estimation model that derives a relationship between venous catheter measurements and unmeasured epicardial sites from a set of previously recorded, high-resolution epicardial activation-time maps used as a training data set based on the spatial covariance of the measurement sites. We performed 14 dog experiments with various interventions to create an epicardial activation-time map database. This database included a total of 592 epicardial activation maps which were recorded using a sock array placed on the ventricles of dog hearts. We present five approaches, which examined sequential addition and removal of maps to select a generalized training set for the estimation technique. The selection consisted of choosing a subset of epicardial ectopic activation-time maps from the database of beats which resulted in estimation accuracy levels better than or at least similar to using all the maps in database. Our aim was to minimize the redundancy in the database and to be able to guide the eventual procedures required to obtain training data from open-chest surgery patients. The results from this study illustrated this redundancy and suggested that by including an optimal subset (around 100 maps) of the full database the estimation technique was able to perform as well as and even in some cases better than including all the maps in the database. The results also suggest that such an approach is feasible for providing accurate reconstruction of complete epicardial activation-time maps in a clinical setting and with fewer maps we can obtain similar reconstruction accuracy levels. PMID:16701613

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

    SciTech Connect

    Sahni, Vikram Kaniyur, Sunil; Malhotra, Anmol; Fan, Stanley; Blakeney, Charles; Fotheringham, Tim; Sobeh, Mohammed; Matson, Matthew

    2005-12-15

    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.

  16. Optimizing Venous Drainage Using an Ultrasonic Flow Probe on the Venous Line

    PubMed Central

    Walker, Joshua L.; Young, Haven A.; Lawson, D. Scott; Husain, S. Adil; Calhoon, John H.

    2011-01-01

    Abstract: The use of smaller cannulae for minimally invasive surgery techniques and/or aggressive miniaturization of the cardiopulmonary bypass (CPB) circuitry has necessitated the need to augment venous drainage to achieve adequate flow rates. Vacuum assisted venous drainage (VAVD) has become the dominant method to augment venous drainage. VAVD, however, has been associated with a number of known side effects including increased transmission of gaseous microemboli to the patient, venous line chatter, and increased arterial to venous shunts in the circuit. Historically, our practice has been to monitor the arterial output flow rate and to monitor VAVD by observing venous line chatter and changes in the venous reservoir level. In 2008 our pediatric cardiothoracic service began monitoring venous line flow rates by using a second ultrasonic flow probe placed on the venous line. After 12 months, our staff perfusionists reviewed the impact of monitoring venous line flow rates on VAVD and its known side effects on daily clinical practice. When monitoring venous line flow rates, empiric observation revealed that less overall vacuum pressure was needed for our CPB cases. This novel approach to monitoring venous drainage has aided us in providing optimal vacuum levels and therefore, may reduce some of the known side effects experienced with excessive VAVD. PMID:22164455

  17. [Prevention of catheter-related infections].

    PubMed

    Schwaiger, K; Christ, M; Battegay, M; Widmer, A

    2012-10-01

    Bloodstream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, are one of the major sources of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the right materials, thorough follow-up and education of the medical and nursing staff. Thus it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system. PMID:23080356

  18. [Prevention of catheter-related infections].

    PubMed

    Schwaiger, K; Christ, M; Battegay, M; Widmer, A

    2012-06-01

    Bloodstream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, are one of the major sources of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the right materials, thorough follow-up and education of the medical and nursing staff. Thus it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system. PMID:22562110

  19. Preventing catheter-associated urinary tract infection.

    PubMed

    Gould, Dinah

    2015-11-01

    Urinary tract infections (UTIs) are common in hospital and community settings. The major risk factor for developing a UTI is having a urethral catheter in situ. The longer the catheter remains in place, the higher the risk of infection. The consensus in guidelines is that indwelling urethral catheters should not be used unless necessary and should be removed within 24 hours if possible. The care of patients and nursing home residents who are catheterised for long periods could be improved if guidelines were implemented fully. PMID:26530593

  20. [Catheter-associated urinary tract infections].

    PubMed

    Liedl, B

    2015-09-01

    In patients with indwelling urethral catheters significant bacteriuria develops within 4 weeks of indwelling time in practically 100% of the cases. Catheter encrustation and obstruction can occur in approximately 40% of patients. Symptomatic ascending urinary tract infections, urethral complications and urolithiasis can occur in significant numbers in the long term. Regular educational and surveillance programs in nursing homes, hospitals and in home care are important to instruct personnel in hygiene procedures, to learn the indications for catheterization, to keep the indwelling time of catheters as short as possible, to detect any complications early and to initiate appropriate diagnostics and therapy by the urologist. PMID:26275988

  1. Catheter access for hemodialysis: an overview.

    PubMed

    Butterly, D W; Schwab, S J

    2001-01-01

    The provision of hemodialysis requires repeated, reliable access to the central circulatory system. Long-term hemodialysis has best been provided by arteriovenous fistulae and arteriovenous grafts. In recent years, more and more patients have been chronically dialyzed with tunneled dialysis catheters. These catheters, which were originally developed as a short-term bridge to permanent vascular access, have made up an increasing percentage of maintenance vascular access. While these catheters have the advantage of ease of placement and are immediately ready for use, they substantially increase the risk of bacteremia, stenosis of central veins, and even mortality. PMID:11851925

  2. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  4. Saphenous Venous Ablation with Hot Contrast in a Canine Model

    SciTech Connect

    Prasad, Amit Qian Zhong; Kirsch, David; Eissa, Marna; Narra, Pavan; Lopera, Jorge; Espinoza, Carmen G.; Castaneda, Wifrido

    2008-01-15

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

  5. Task-Space Motion Planning of MRI-Actuated Catheters for Catheter Ablation of Atrial Fibrillation.

    PubMed

    Greigarn, Tipakorn; Cavu?o?lu, M Cenk

    2014-09-01

    This paper presents a motion planning algorithm for Magnetic Resonance Imaging (MRI) actuated catheters for catheter ablation of atrial fibrillation. The MRI-actuated catheters is a new robotic catheter concept which utilizes MRI for remote steering and guidance. Magnetic moments generated by a set of coils wound near the tip are used to steer the catheter under MRI scanner magnetic field. The catheter during an ablation procedure is modeled as a constrained robotic manipulator with flexible joints, and the proposed motion-planning algorithm calculates a sequence of magnetic moments based on the manipulator model to move the tip of the catheter along a predefined trajectory on the surface of the left atrium. The difficulties in motion planning of the catheter are due to kinematic redundancy and underactuation. The proposed motion planning algorithm overcomes the challenges by operating in the task space instead of the configuration space. The catheter is then regulated around this nominal trajectory using feedback control to reduce the effect of uncertainties. PMID:25485168

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

    PubMed Central

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

    2013-01-01

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

  7. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  8. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  9. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  10. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  11. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  12. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  13. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  14. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...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....

  15. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...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....

  16. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...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....

  17. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...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....

  18. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...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....

  19. Percutaneous catheter balloons: failure to deflate.

    PubMed

    Schneider, J R; Johnsrude, I S; Lund, G; Rysavy, J; Anderson, R W; Amplatz, K

    1985-06-01

    Three examples of permanently inflated transluminal catheter balloons are presented. Two of these occurred during attempted percutaneous transluminal angioplasty. Nonsurgical solutions, which were successful in each case, are described. Percutaneous puncture with a needle or a larger diameter coaxial catheter under fluoroscopic guidance may be useful when this complication occurs during attempted balloon angioplasty or embolization with proximal balloon occlusion in large vessels. PMID:3159040

  20. Percutaneous Selective Embolectomy using a Fogarty Thru-Lumen Catheter for Pancreas Graft Thrombosis: A Case Report

    SciTech Connect

    Izaki, Kenta Yamaguchi, Masato; Matsumoto, Ippei; Shinzeki, Makoto; Ku, Yonson; Sugimura, Kazuro; Sugimoto, Koji

    2011-06-15

    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.

  1. Presence of a Physician Safety Champion Is Associated with a Reduction in Urinary Catheter Utilization in the Pediatric Intensive Care Unit

    PubMed Central

    Zavalkoff, Samara; Korah, Nadine; Quach, Caroline

    2015-01-01

    Background Safety champions are effective in a variety of safety initiatives; however, there are no reports of their role in hospital-acquired infections prevention. Objective We aimed to describe the association of the presence of a physician safety champion with our urinary catheter device utilization ratios (DUR) in the Pediatric Intensive Care Unit (PICU). Methods Our PICU has incidence rates of catheter-associated urinary tract infections (CAUTI) and urinary catheter DUR above the 90th percentile. Using a quasi-experimental design, we compared our DUR when the PICU team was exposed and unexposed (champion’s maternity leaves) to a physician safety champion. Hospital acquired infection (HAI) surveillance of all PICU admissions between April 1st 2009 and June 29th 2013 was done prospectively. To ensure stable acuity of the patient population over time, we used the central venous catheter (CVC) DUR as a control. Results The urinary catheter DUR was 0.44 (95% confidence interval [CI] 0.42–0.45) during the unexposed period versus 0.39 (95%CI 0.38–0.40) during the exposed period, for an absolute difference of 0.05 (95%CI 0.03–0.06; p<0.0001). The overall CVC DUR increased from 0.57 (95%CI 0.55–0.58) during the unexposed period to 0.63 (95%CI 0.61–0.64) during the exposed period, an absolute increase of 0.06 (95%CI 0.04–0.08; p<0.0001). Comparing the exposed and unexposed periods, adjusting for time trend, we observed a 17% decrease in the urinary catheter DUR when the safety champion was present (odds ratio [OR] 0.83; 95%CI 0.77–0.90). The rate of catheter-associated urinary tract infections did not change. Conclusions The presence of a unit-based safety champion can have a positive impact on urinary catheter DUR in a PICU. PMID:26666216

  2. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

    Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl

    1997-09-15

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

  3. The venous circulation: a piscine perspective.

    PubMed

    Sandblom, Erik; Axelsson, Michael

    2007-12-01

    Vascular capacitance describes the pressure-volume relationship of the circulatory system. The venous vasculature, which is the main capacitive region in the circulation, is actively controlled by various neurohumoral systems. In terrestrial animals, vascular capacitance control is crucial to prevent orthostatic blood pooling in dependent limbs, while in aquatic animals like fish, the effects of gravity are cancelled out by hydrostatic forces making orthostatic blood pooling an unlikely concern for these animals. Nevertheless, changes in venous capacitance have important implications on cardiovascular homeostasis in fish since it affects venous return and cardiac filling pressure (i.e. central venous blood pressure), which in turn may affect cardiac output. The mean circulatory filling pressure is used to estimate vascular capacitance. In unanaesthetized animals, it is measured as the central venous plateau pressure during a transient stoppage of cardiac output. So far, most studies of venous function in fish have addressed the situation in teleosts (notably the rainbow trout, Oncorhynchus mykiss), while any information on elasmobranchs, cyclostomes and air-breathing fishes is more limited. This review describes venous haemodynamic concepts and neurohumoral control systems in fish. Particular emphasis is placed on venous responses to natural cardiovascular challenges such as exercise, environmental hypoxia and temperature changes. PMID:17920321

  4. Aseptic non-touch technique and catheter-related bloodstream infection in children receiving parenteral nutrition at home

    PubMed Central

    Evans, Victoria; Hughes, Anna; Hill, Susan

    2015-01-01

    Objectives Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. Methods We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. Results Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000?line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000?line-days. Conclusion In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN. PMID:26279849

  5. Blood flow in hemodialysis catheters: a numerical simulation and microscopic analysis of in vivo-formed fibrin.

    PubMed

    Lucas, Thabata Coaglio; Tessarolo, Francesco; Jakitsch, Victor; Caola, Iole; Brunori, Giuliano; Nollo, Giandomenico; Huebner, Rudolf

    2014-07-01

    Although catheters with side holes allow high flow rate during hemodialysis, they also induce flow disturbances and create a critical hemodynamic environment that can favor fibrin deposition and thrombus formation. This study compared the blood flow and analyzed the influence of shear stress and shear rate in fibrin deposition and thrombus formation in nontunneled hemodialysis catheters with unobstructed side holes (unobstructed device) or with some side holes obstructed by blood thrombi (obstructed device). Computational fluid dynamics (CFD) was performed to simulate realistic blood flow under laminar and turbulent conditions. The results from the numerical simulations were compared with the fibrin distribution and thrombus architecture data obtained from scanning electron microscopy (SEM) and two photons laser scanning microscopy (TPLSM) on human thrombus formed in catheters removed from patients. CFD showed that regions of flow eddies and separation were mainly found in the venous holes region. TPLSM characterization of thrombi and fibrin structure in patient samples showed fibrin formations in accordance with simulated flux dynamics. Under laminar flow conditions, the wall shear stress close to border holes increased from 87.3±0.2?Pa in the unobstructed device to 176.2±0.5?Pa in the obstructed one. Under turbulent flow conditions, the shear stress increased by 47% when comparing the obstructed to the unobstructed catheter. The shear rates were generally higher than 5000/s and therefore sufficient to induce fibrin deposition. This findings were supported by SEM data documenting a preferential fibrin arrangement on side hole walls. PMID:24341622

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

    PubMed Central

    2013-01-01

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

  7. Venous pressure in man during weightlessness

    NASA Technical Reports Server (NTRS)

    Kirsch, K. A.; Roecker, L.; Gauer, O. H.; Krause, R.; Wicke, H. J.; Leach, C.; Landry, R.

    1984-01-01

    To determine whether the body fluid shift from the lower limbs toward the head that occurs during spaceflight leads to lasting increases of venous pressure in the upper body, venous pressure and hematocrit measurements were made on four astronauts before flight and 1 and 12 hours after recovery and compared with measurements in space. During the mission the hematocrit was elevated and the venous pressure lowered by 1 to 8 centimeters of water as compared with the preflight data. One hour after landing the hematocrit decreased, indicating a hemodilution, venous pressures were unexpectedly high, and a body weight loss of 4 to 5 percent was observed. Twelve hours later the venous pressures were the lowest recorded during the study. The fluid shift apparently takes place during the first several hours of spaceflight. Thereafter, the pressure in the peripheral veins and the central circulation is lower than that measured before flight.

  8. Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

    PubMed Central

    Hong, Tae Hee; Byun, Joung Hun; Yoo, Byung Ha; Hwang, Sang Won; Kim, Han Yong; Park, Jae Hong

    2015-01-01

    Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV) is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV) was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO. PMID:26078930

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

    PubMed Central

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

    2015-01-01

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

  10. Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models.

    PubMed

    Mahajerin, Arash; Branchford, Brian R; Amankwah, Ernest K; Raffini, Leslie; Chalmers, Elizabeth; van Ommen, C Heleen; Goldenberg, Neil A

    2015-08-01

    Hospital-associated venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is increasing in pediatric centers. The objective of this work was to systematically review literature on pediatric hospital-acquired venous thromboembolism risk factors and risk-assessment models, to inform future prevention research. We conducted a literature search on pediatric venous thromboembolism risk via PubMed (1946-2014) and Embase (1980-2014). Data on risk factors and risk-assessment models were extracted from case-control studies, while prevalence data on clinical characteristics were obtained from registries, large (n>40) retrospective case series, and cohort studies. Meta-analyses were conducted for risk factors or clinical characteristics reported in at least three studies. Heterogeneity among studies was assessed with the Cochran Q test and quantified by the I(2) statistic. From 394 initial articles, 60 met the final inclusion criteria (20 case-control studies and 40 registries/large case series/cohort studies). Significant risk factors among case-control studies were: intensive care unit stay (OR: 2.14, 95% CI: 1.97-2.32); central venous catheter (OR: 2.12, 95% CI: 2.00-2.25); mechanical ventilation (OR: 1.56, 95%CI: 1.42-1.72); and length of stay in hospital (per each additional day, OR: 1.03, 95% CI: 1.03-1.03). Three studies developed/applied risk-assessment models from a combination of these risk factors. Fourteen significant clinical characteristics were identified through non-case-control studies. This meta-analysis confirms central venous catheter, intensive care unit stay, mechanical ventilation, and length of stay as risk factors. A few pediatric hospital-acquired venous thromboembolism risk scores have emerged employing these factors. Prospective validation is necessary to inform risk-stratified prevention trials. PMID:26001789

  11. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.

    1996-01-01

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

  12. Nonholonomic catheter path reconstruction using electromagnetic tracking

    NASA Astrophysics Data System (ADS)

    Lugez, Elodie; Sadjadi, Hossein; Akl, Selim G.; Fichtinger, Gabor

    2015-03-01

    Catheter path reconstruction is a necessary step in many clinical procedures, such as cardiovascular interventions and high-dose-rate brachytherapy. To overcome limitations of standard imaging modalities, electromagnetic tracking has been employed to reconstruct catheter paths. However, tracking errors pose a challenge in accurate path reconstructions. We address this challenge by means of a filtering technique incorporating the electromagnetic measurements with the nonholonomic motion constraints of the sensor inside a catheter. The nonholonomic motion model of the sensor within the catheter and the electromagnetic measurement data were integrated using an extended Kalman filter. The performance of our proposed approach was experimentally evaluated using the Ascension's 3D Guidance trakStar electromagnetic tracker. Sensor measurements were recorded during insertions of an electromagnetic sensor (model 55) along ten predefined ground truth paths. Our method was implemented in MATLAB and applied to the measurement data. Our reconstruction results were compared to raw measurements as well as filtered measurements provided by the manufacturer. The mean of the root-mean-square (RMS) errors along the ten paths was 3.7 mm for the raw measurements, and 3.3 mm with manufacturer's filters. Our approach effectively reduced the mean RMS error to 2.7 mm. Compared to other filtering methods, our approach successfully improved the path reconstruction accuracy by exploiting the sensor's nonholonomic motion constraints in its formulation. Our approach seems promising for a variety of clinical procedures involving reconstruction of a catheter path.

  13. The possibility for use of venous flaps in plastic surgery

    NASA Astrophysics Data System (ADS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  14. Catheter tip force transducer for cardiovascular research

    NASA Technical Reports Server (NTRS)

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

    1976-01-01

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

  15. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

    SciTech Connect

    Tsai, Fong Y. Kostanian, Varoujan; Rivera, Monica; Lee, Kwo-Whie; Chen, Clayton C.; Nguyen, Thong H.

    2007-07-15

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

  16. A Retained Epidural Catheter Fragment Treated by Surgery

    PubMed Central

    Tarukado, Kiyoshi; Oda, Takaaki; Tono, Osamu; Suetsugu, Hiroyuki

    2015-01-01

    The breakage of an epidural catheter is an extremely rare complication. We describe a unique case where a retained epidural catheter fragment after epidural anesthesia was treated by surgery. The epidural catheter broke during its removal, requiring surgery to remove the retained catheter. Intraoperatively, the removal of the catheter was attempted by simple traction, but was impossible because of the adhesion. The adhesion of the dura mater surface was carefully exfoliated and the successful removal of the catheter was accomplished. Conventionally, it was said that this follow-up was enough for the retained catheter. However, if a catheter is retained within the spinal canal, surgical removal should thus be considered before the adhesion advances. PMID:26097665

  17. Intravascular magnetic resonance imaging using a loopless catheter antenna.

    PubMed

    Ocali, O; Atalar, E

    1997-01-01

    Recently, intravascular catheter probes have been developed to increase signal-to-noise ratio (SNR) for MR imaging of blood vessels. Miniaturization of these catheter probes without degrading their performances is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop incorporated in their structure and have limitations in physical dimensions and electromagnetic properties. The use of a loopless intravascular catheter antenna is proposed to overcome these problems. The catheter antenna is essentially a dipole, which makes a very thin diameter possible, and its electronic circuitry can be placed outside the blood vessels without performance degradation. The theoretical foundation for the design and operation of the catheter antenna is presented. Several catheter antennae, as small as 1.5 French, were constructed and tested on phantoms and rabbits with great success. The catheter antenna has a simple structure and is easy to design, implement, and operate. PMID:8978639

  18. Multi-turn, tension-stiffening catheter navigation system

    E-print Network

    Gupta, Rajiv

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

  19. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device...fiberoptic bundle that emits light throughout its length and...the ureter to be seen during lower abdominal or pelvic...

  20. Electrophysiological Study and Catheter Ablation with 3D Mapping

    MedlinePLUS

    ... then perform the ablation, in which radio frequency energy is delivered through a catheter that is in ... the actual catheter that delivers the radio frequency energy to cause the burns in the heart that ...

  1. 21 CFR 870.1200 - Diagnostic intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...catheter. (a) Identification. An intravascular diagnostic catheter is a device used to record intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are...

  2. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Devices § 870.2870 Catheter tip pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated...properties change in relation to changes in blood pressure. These changes are transmitted to...

  3. Development of an Electrophysiology (EP)-Enabled Intracardiac Ultrasound Catheter Integrated With NavX 3-Dimensional Electrofield Mapping for Guiding Cardiac EP Interventions

    PubMed Central

    Li, Xiao Kui; Pemberton, James; Thomenius, Kai; Dentinger, Aaron; Lowe, Robert I.; Ashraf, Muhammad; Shung, K. Kirk; Chia, Raymond; Stephens, Douglas N.; O'Donnell, Matthew; Mahajan, Aman; Balaji, Seshadri; Shivkumar, Kalyanam; Sahn, David J.

    2015-01-01

    Objective We have developed an integrated high-resolution intracardiac echocardiography (ICE) catheter for electrophysiology (EP) testing, which can be coregistered in 3-dimensional space with EP testing and ablation catheters using electrofield sensing. Methods Twelve open-chest pigs (34–55 kg) and 3 closed-chest pigs were studied. After introduction from the jugular or femoral venous locations, the 9F side-looking, highly steerable (0°–180°), 64-element array catheters could be manipulated easily throughout the right side of the heart. Multisite cardiac pacing was performed for assessing left ventricular (LV) synchrony using tissue Doppler methods. Also, in the open-chest pigs, right atrial (RA) and right ventricular (RV) ablations were performed with a separate radio frequency catheter under fluoroscopic guidance and visualized with ICE to characterize the changes. In the 3 closed-chest pigs, electrofield NavX 3-dimensional coregistration (St Jude Medical Corp, Minneapolis, MN) allowed us to test whether this additional feature could shorten the time necessary to perform 4 targeted ablations in each animal while imaging the ablation catheter and the adjacent region by ICE. Results Intracardiac anatomy, tricuspid, aortic, pulmonary, and mitral valve function, and pulmonary vein flow were all imaged reproducibly from scanning locations in the RA or RV in all animals, along with assessment of cardiac motion and the effects of multisite pacing. Three-dimensional electrofield displays detailed the spatial relationship between the ICE catheter and ablation catheters such that the time to visualize and ablate 4 sites in each of the 3 closed-chest animals was reduced. Conclusions This new technology is a first step in the integration of ICE with EP procedures. PMID:17957051

  4. Chronic Venous Disease (Beyond the Basics)

    MedlinePLUS

    ... from the surface of the legs to the deep leg veins, from which calf muscles pump blood ... is located in the superficial veins or the deep veins. (See "Diagnostic evaluation of chronic venous insufficiency" .) ...

  5. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    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 the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  6. Venous access in the management of hemophilia.

    PubMed

    Valentino, Leonard A; Kawji, Mohammad; Grygotis, Michele

    2011-01-01

    Venous access is an essential aspect of hemophilia care. When peripheral venipuncture is not feasible, central venous access devices (CVADs) or the creation of an arteriovenous fistula (AVF) allow the infusion of clotting factor concentrate to treat or prevent bleeding events or eliminate inhibitors. Infection is the primary complication associated with CVADs and the most common reason for their removal. Complications of AVF include occlusion and limb length discrepancies. PMID:21030121

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

    USGS Publications Warehouse

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

    1993-01-01

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

  8. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  9. 21 CFR 870.1330 - Catheter guide wire.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter guide wire. 870.1330 Section 870.1330...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1330 Catheter guide wire. (a) Identification. A catheter guide wire is a coiled wire that is designed to fit inside...

  10. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  11. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  12. Why should I have to use a catheter?

    PubMed

    Trueland, Jennifer

    2015-07-01

    The No Catheter – No CAUTI campaign urges all clinicians to keep catheter use to a minimum and ensure that when they are used, they are used properly. Supporters want a revolution in awareness, putting catheters and associated infections on the same level as, for example, handwashing and drip-line infections. PMID:26153946

  13. Catheter-associated fungemia due to Wangiella (Exophiala) dermatitidis.

    PubMed Central

    Nachman, S; Alpan, O; Malowitz, R; Spitzer, E D

    1996-01-01

    We describe a case of catheter-associated Wangiella (Exophiala) dermatitidis fungemia in a human immunodeficiency virus-infected child who was successfully treated with antifungal therapy and catheter removal. Catheter-associated W. dermatitidis fungemia appears to be distinct from previously described cases of disseminated infection with organ involvement. PMID:8815072

  14. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  15. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  16. 21 CFR 868.5350 - Nasal oxygen catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasal oxygen catheter. 868.5350 Section 868.5350...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5350 Nasal oxygen catheter. (a) Identification. A nasal oxygen catheter is a device intended to be inserted through a patient's nostril...

  17. Intravascular Magnetic Resonance Imaging Using a Loopless Catheter Antenna

    E-print Network

    Atalar, Ergin

    Intravascular Magnetic Resonance Imaging Using a Loopless Catheter Antenna Ogan Ocali, Ergin Atalar is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop.The use of a loopless intravascularcatheter antenna is proposed to overcomethese problems. The catheter

  18. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  19. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  20. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  1. 21 CFR 876.4020 - Fiberoptic light ureteral catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fiberoptic light ureteral catheter. 876.4020... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic light ureteral catheter. (a) Identification. A fiberoptic light ureteral catheter is a device that consists of...

  2. Growth in catheter biofilms and antibiotic resistance of Mycobacterium avium

    E-print Network

    Falkinham, Joseph

    Growth in catheter biofilms and antibiotic resistance of Mycobacterium avium Joseph O. Falkinham that biofilm-grown cells of M. avium in catheters are relatively antibiotic-resistant compared to cells grown resistant to clarithromycin and rifamycin than cells grown in suspension. INTRODUCTION Catheter

  3. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urological catheter and accessories. 876.5130... catheter and accessories. (a) Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract....

  4. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary...

  5. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary...

  6. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Urological catheter and accessories. 876.5130... catheter and accessories. (a) Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract....

  7. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary...

  8. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Urological catheter and accessories. 876.5130... catheter and accessories. (a) Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract....

  9. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary...

  10. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Urological catheter and accessories. 876.5130... catheter and accessories. (a) Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract....

  11. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary...

  12. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  13. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  14. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  15. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  16. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to...

  17. Venous catheterization with ultrasound navigation

    NASA Astrophysics Data System (ADS)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  18. Ultrasound-Guided Radiological Placement of Central Venous Port via the Subclavian Vein: A Retrospective Analysis of 500 Cases at a Single Institute

    SciTech Connect

    Sakamoto, Noriaki Arai, Yasuaki Takeuchi, Yoshito Takahashi, Masahide Tsurusaki, Masakatsu; Sugimura, Kazuro

    2010-10-15

    The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with ultrasound (US)-guided radiological placement (RP) of a central venous port (CVP) via the subclavian vein (SCV). Between April 2006 and May 2007, a total of 500 US-guided RPs of a CVP via the SCV were scheduled in 486 cancer patients (mean age {+-} SD, 54.1 {+-} 18.1 years) at our institute. Referring to the interventional radiology report database and patients' records, technical success rate and AEs relevant to CVP placement were evaluated retrospectively. The technical success rate was 98.6% (493/500). AEs occurred in 26 cases (5.2%) during follow-up (range, 1-1080 days; mean {+-} SD, 304.0 {+-} 292.1 days). AEs within 24 h postprocedure occurred in five patients: pneumothorax (n = 2), arterial puncture (n = 1), hematoma formation at the pocket site (n = 2), and catheter tip migration into the internal mammary vein (n = 1). There were seven early AEs: hematoma formation at the pocket site (n = 2), fibrin sheath formation around the indwelling catheter (n = 2), and catheter-related infections (n = 3). There were 13 delayed AEs: catheter-related infections (n = 7), catheter detachments (n = 3), catheter occlusion (n = 1), symptomatic thrombus in the SCV (n = 1), and catheter migration (n = 1). No major AEs, such as procedure-related death, air embolism, or events requiring surgical intervention, were observed. In conclusion, US-guided RP of a CVP via the SCV is highly appropriate, based on its high technical success rate and the limited number of AEs.

  19. Left ventricular volumetric conductance catheter for rats.

    PubMed

    Ito, H; Takaki, M; Yamaguchi, H; Tachibana, H; Suga, H

    1996-04-01

    Left ventricular (LV) volume (V) is an essential parameter for assessment of the cardiac pump function. Measurement of LVV in situ by a conductance catheter method has been widely used in dogs and humans but not yet in small experimental animals such as rats. We instituted a miniaturized six-electrode conductance catheter (3-F) for rat LVV measurement and its signal processing apparatus. We compared stroke volumes (SVs) simultaneously measured with this conductance catheter introduced into the LV through the apex and an electromagnetic flow probe placed on the ascending aorta during gradual decreases in LVV by an inferior vena caval occlusion. A high and linear correlation (r = 0.982) was obtained between these differently measured by SVs pooled from six rats. In another group of three rats, LV pressure was simultaneously measured with a 3-F catheter-tip micromanometer introduced into the LV through the apex. We obtained the slope of the end-systolic pressure-volume (P-V) relationship (Emax) by a gradual ascending aortic occlusion. After administration of propranolol, Emax obviously decreased with no change in volume intercept of the P-V relationship. The conductance volumetry proved to be useful in rats. PMID:8967395

  20. Ultraminiature manometer-tipped cardiac catheter

    NASA Technical Reports Server (NTRS)

    Coon, G. W.

    1967-01-01

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

  1. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  2. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter introducer. 870.1340 Section 870.1340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... the skin into a vein or artery. (b) Classification. Class II (performance standards)....

  3. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter introducer. 870.1340 Section 870.1340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... the skin into a vein or artery. (b) Classification. Class II (performance standards)....

  4. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  5. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  6. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  7. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for injection of material into, or removal of material from, the brain. (b) Classification. Class II...

  8. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  9. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  10. 21 CFR 870.5175 - Septostomy catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Septostomy catheter. 870.5175 Section 870.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... enlarge the atrial septal defect found in the heart of certain infants. (b) Classification. Class...

  11. Antimicrobial activity and cytocompatibility of silver nanoparticles coated catheters via a biomimetic surface functionalization strategy

    PubMed Central

    Wu, Ke; Yang, Yun; Zhang, Yanmei; Deng, Jiexi; Lin, Changjian

    2015-01-01

    Catheter-related bloodstream infections are a significant problem in the clinic and may result in a serious infection. Here, we developed a facile and green procedure for buildup of silver nanoparticles (AgNPs) on the central venous catheters (CVCs) surface. Inspired by mussel adhesive proteins, dopamine was used to form a thin polydopamine layer and induce AgNPs formation without additional reductants or stabilizers. The chemical and physicochemical properties of AgNPs coated CVCs were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, and water contact angle. The Staphylococcus aureus culture experiment was used to study the antibacterial properties. The cytocompatibility was assessed by water soluble tetrazolium salts (WST-1) assay, fluorescence staining, and scanning electron microscopy analysis. The results indicated that the CVCs surface was successfully coated with compact AgNPs. AgNPs were significantly well separated and spherical with a size of 30–50 nm. The density of AgNPs could be modulated by the concentration of silver nitrate solution. The antibacterial activity was dependent on the AgNPs dose. The high dose of AgNPs showed excellent antibacterial activity while associated with increased cytotoxicity. The appropriate density of AgNPs coated CVCs could exhibit improved biocompatibility and maintained evident sterilization effect. It is promising to design mussel-inspired silver releasing CVCs with both significant antimicrobial efficacy and appropriate biological safety. PMID:26664115

  12. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

    Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance. PMID:2062096

  13. Noninvasive measurement of central venous pressure

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

  14. Current Status of the Application of Intracranial Venous Sinus Stenting

    PubMed Central

    Xu, Kan; Yu, Tiecheng; Yuan, Yongjie; Yu, Jinlu

    2015-01-01

    The intracranial venous sinus is an important component of vascular disease. Many diseases involve the venous sinus and are accompanied by venous sinus stenosis (VSS), which leads to increased venous pressure and high intracranial pressure. Recent research has focused on stenting as a treatment for VSS related to these diseases. However, a systematic understanding of venous sinus stenting (VS-Stenting) is lacking. Herein, the literature on idiopathic intracranial hypertension (IIH), venous pulsatile tinnitus, sinus thrombosis, high draining venous pressure in dural arteriovenous fistula (AVF) and arteriovenous malformation (AVM), and tumor-caused VSS was reviewed and analyzed to summarize experiences with VS-Stenting as a treatment. The literature review showed that satisfactory therapeutic effects can be achieved through stent angioplasty. Thus, the present study suggests that selective stent release in the venous sinus can effectively treat these diseases and provide new possibilities for treating intracranial vascular disease. PMID:26516306

  15. Multifunctional Catheters Combining Intracardiac Ultrasound Imaging and Electrophysiology Sensing

    PubMed Central

    Stephens, Douglas N.; Cannata, Jonathan; Liu, Ruibin; Zhao, Jian Zhong; Shung, K. Kirk; Nguyen, Hien; Chia, Raymond; Dentinger, Aaron; Wildes, Douglas; Thomenius, Kai E.; Mahajan, Aman; Shivkumar, Kalyanam; Kim, Kang; O’Donnell, Matthew; Nikoozadeh, Amin; Oralkan, Omer; Khuri-Yakub, Pierre T.; Sahn, David J.

    2015-01-01

    A family of 3 multifunctional intracardiac imaging and electrophysiology (EP) mapping catheters has been in development to help guide diagnostic and therapeutic intracardiac EP procedures. The catheter tip on the first device includes a 7.5 MHz, 64-element, side-looking phased array for high resolution sector scanning. The second device is a forward-looking catheter with a 24-element 14 MHz phased array. Both of these catheters operate on a commercial imaging system with standard software. Multiple EP mapping sensors were mounted as ring electrodes near the arrays for electrocardiographic synchronization of ultrasound images and used for unique integration with EP mapping technologies. To help establish the catheters’ ability for integration with EP interventional procedures, tests were performed in vivo in a porcine animal model to demonstrate both useful intracardiac echocardiographic (ICE) visualization and simultaneous 3-D positional information using integrated electroanatomical mapping techniques. The catheters also performed well in high frame rate imaging, color flow imaging, and strain rate imaging of atrial and ventricular structures. The companion paper of this work discusses the catheter design of the side-looking catheter with special attention to acoustic lens design. The third device in development is a 10 MHz forward-looking ring array that is to be mounted at the distal tip of a 9F catheter to permit use of the available catheter lumen for adjunctive therapy tools. PMID:18986948

  16. [Valvular insufficiency after venous thrombosis. Experimental study].

    PubMed

    Pouchè, A; Gafà, M; Guadagni, G

    1977-01-01

    Venous thrombosis can produce lesions of valvular cusps which are generally ascribe to the phase of thrombus organization. Valvular lesions hold a very important role in the genesis of the post phlebitic chronic venous insufficiency. Experimental thrombosis had been induced in dogs with electrical stimulation of femoral veins to study morphological aspects of valvular cusps in various evolutive phases of thrombosis. Results emphasize too early onset and quick evolution of valvular damage. It can contribute to explain frequent failures of attempted therapy about prevention of post phlebitic syndromes. PMID:610713

  17. Percutaneous catheter drainage for malignant pericardial effusion.

    PubMed

    Gatenby, R A; Hartz, W H; Kessler, H B

    1991-02-01

    Ultrasound (US)-guided and fluoroscopically guided pericardial catheter placement was performed in 12 patients with known underlying malignancy who had clinical and radiographic evidence of a significant pericardial effusion. US guidance facilitated placement of a 22-gauge needle by means of a subxyphoid or transthoracic approach. The tract was subsequently dilated over a wire under fluoroscopic guidance with placement of either an 8.5- or 10-F catheter. This technique successfully established pericardial drainage in all patients with excellent symptomatic relief. Cytologic findings were positive for malignancy in 10 of the 12 patients. Radiologically guided pericardiocentesis allowed safe, rapid stabilization of the condition of patients with symptoms from pericardial effusion. This resulted in excellent palliation in patients with terminal disease and improvement in the clinical status of other patients so that additional therapies, such as sclerosis with tetracycline or surgical placement of a pericardial window, could be performed on an elective basis. PMID:1799745

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

    PubMed

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

    2014-10-01

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

  19. Soft Robotic Concepts in Catheter Design: an On-demand Fouling-release Urinary Catheter

    PubMed Central

    Leveri, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; L00F3;pez, Gabriel P.

    2014-01-01

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

  20. Retinal venous oxygen saturation and cardiac output during controlled hemorrhage and resuscitation.

    PubMed

    Denninghoff, Kurt R; Smith, Matthew H; Lompado, Art; Hillman, Lloyd W

    2003-03-01

    The objective was to test calibration of an eye oximeter (EOX) in a vitiligo swine eye and correlate retinal venous oxygen saturation (Srv(O(2))), mixed venous oxygen saturation (Sv(O(2))), and cardiac output (CO) during robust changes in blood volume. Ten anesthetized adult Sinclair swine with retinal vitiligo were placed on stepwise decreasing amounts of oxygen. At each oxygen level, femoral artery oxygen saturation (Sa(O(2))) and retinal artery oxygen saturation (Sra(O(2))) were obtained. After equilibration on 100% O(2), subjects were bled at 1.4 ml. kg(-1). min(-1) for 20 min. Subsequently, anticoagulated shed blood was reinfused at the same rate. During graded hypoxia, exsanguination, and reinfusion, Sra(O(2)) and Srv(O(2)) were measured by using the EOX, and CO and Sv(O(2)) were measured by using a pulmonary artery catheter. During graded hypoxia, Sra(O(2)) correlated with Sa(O(2)) (r = 0.92). Srv(O(2)) correlated with Sv(O(2)) (r = 0.89) during exsanguination and reinfusion. Sv(O(2)) and Srv(O(2)) correlated with CO during blood removal and resuscitation (r = 0.92). Use of vitiligo retinas improved the calibration of EOX measurements. In this robust hemorrhage model, Srv(O(2)) correlates with CO and Sv(O(2)) across the range of exsanguination and resuscitation. PMID:12571124

  1. Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

    PubMed Central

    Easaw, J.C.; Shea–Budgell, M.A.; Wu, C.M.J.; Czaykowski, P.M.; Kassis, J.; Kuehl, B.; Lim, H.J.; MacNeil, M.; Martinusen, D.; McFarlane, P.A.; Meek, E.; Moodley, O.; Shivakumar, S.; Tagalakis, V.; Welch, S.; Kavan, P.

    2015-01-01

    Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy is used to treat vte; however, patients with cancer have unique clinical circumstances that can often make decisions surrounding the administration of therapeutic anticoagulation complicated. No national Canadian guidelines on the management of established cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin is the treatment of choice for cancer patients with established vte. Direct oral anticoagulants are not recommended for the treatment of vte at this time. Specific clinical scenarios, including the presence of an indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant modifications in the therapeutic administration of anticoagulation therapy. Patients with recurrent vte should receive extended (>3 months) anticoagulant therapy. Incidental vte should generally be treated in the same manner as symptomatic vte. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, levels of anti–factor Xa could be checked at baseline and periodically thereafter in patients with renal insufficiency. Follow-up and education about the signs and symptoms of vte are important components of ongoing patient care. PMID:25908913

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

    PubMed Central

    2014-01-01

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

  3. Delaying urinary catheter insertion in the reception and resuscitation of blunt multitrauma and using a full bladder to tamponade pelvic bleeding.

    PubMed

    Huang, Sean; Vohora, Ashray; Russ, Matthias K; Mathew, Joseph K; Johnny, Cecil S; Stevens, Jeremy; Fitzgerald, Mark C

    2015-06-01

    This article proposes a counter-argument to standard Advanced Trauma Life Support (ATLS) training--which advocates bladder catheterisation to be performed as an adjunct to the primary survey and resuscitation for early decompression of the bladder and urine output monitoring. We argue the case for delaying bladder catheterisation until after definitive truncal Computed Tomography (CT) imaging. To reduce pelvic volume and associated bleeding, our trauma team delay catheter insertion until after the initial CT scan. The benefits of a full bladder also include improved views on initial Focussed Assessment with Sonography in Trauma (FAST) scan and improved interpretation of injuries on CT. Our urinary catheter related infection rates anecdotally decreased when insertion was delayed and consequently performed in a more controlled, non-resuscitation setting following CT. Adult blunt multitrauma patients with pelvic ring fractures are at risk of significant haemorrhage. Venous, arterial and medullary injuries with associated bleeding may be potentiated by an increased pelvic volume with ring disruption, as well as a reduced pressure effect from retroperitoneal and intra-pelvic organs on bleeding sites. Various techniques are used to reduce intra-pelvic bleeding. For shocked patients who have sustained major pelvic injuries with no other signs of urinary tract trauma and minimal urine in the bladder on initial FAST scan, we advocate careful, aseptic Foley catheter insertion followed by bladder insufflation with 500-600 mL of Normal Saline (NS) and subsequent catheter clamping to tamponade pelvic bleeding. PMID:25805552

  4. Ultrasound catheters for circumferential cardiac ablation

    NASA Astrophysics Data System (ADS)

    Diederich, Chris J.; Nau, William H.; Taylor, Kevin; Maguire, Mark T.; Picazo, Guillermo; Gangu, Madhuri; Lesh, Michael D.

    1999-05-01

    The purpose of this study was to investigate performance characteristics of a catheter-based ultrasound applicator intended for circumferential ablation of cardiac tissue. The catheter design integrates a cylindrical ultrasound transducer within a distendable water filled balloon in order to produce circumferential lesions at sites in the atria (i.e., pulmonary vein ostia), intended for treatment of certain atrial arrhythmias. Biothermal simulations were used to investigate thermal lesion depths corresponding to variations in applied power, duration, balloon diameter, and acoustic efficiency. Prototype applicators of varying frequency (7 - 12 MHz) and balloon diameter were constructed and characterized using measurements of acoustic efficiency and rotational beam plots. In vitro studies were performed in freshly excised beef hearts to characterize the radial penetration, axial length, and angular uniformity of thermal lesions produced by these applicators. Selected applicators were tested in vivo within pulmonary veins, coronary sinus, and atrial appendage of canine and porcine hearts. These preliminary efforts have indicated that circumferential ablation of cardiac tissue using ultrasound balloon catheters is feasible, and devices between 7 - 12 MHz with balloon diameters of 1.5 - 2.0 cm are capable of producing uniform lesions between 1 - 5 mm depth or greater for treatment durations of 120 seconds or less.

  5. [Two catheters for one coronary perforation].

    PubMed

    Barbieri, Lucia; Verdoia, Monica; Schaffer, Alon; Marino, Paolo; De Luca, Giuseppe

    2015-02-01

    Coronary perforation is a severe complication of percutaneous coronary intervention (PCI) with high mortality and morbidity. The incidence of coronary perforation in patients undergoing PCI ranges from 0.1% to 0.5%. The use of long balloon inflation and reversal anticoagulation is associated with high mortality, periprocedural myocardial infarction and emergency coronary bypass surgery. We present a case of severe coronary perforation treated with the dual catheter technique through the radial and femoral approach. The dual catheter technique enabled rapid delivery of a covered stent without losing control of the perforation site. Our patient did not show pericardial effusion, hemodynamic instability or need for emergency bypass surgery. About 1h after PCI, he developed acute stent thrombosis treated with thromboaspiration and biolimus-eluting stent implantation. At 2 years of follow-up, he was asymptomatic without evidence of exercise-induced ischemia. We conclude that the dual catheter technique is a safe and effective approach to treat PCI-induced severe coronary perforation, and may significantly improve patient outcome compared to historical series. PMID:25805096

  6. Ultrasound-Guided Percutaneous Vein Access for Placement of Broviac Catheters in Extremely Low Birth Weight Neonates: A Series of 3 Successful Cases.

    PubMed

    Dambkowski, Carl L; Abrajano, Claire T; Wall, James

    2015-11-01

    As medical and surgical interventions to support premature infants have evolved, the need for long-term vascular access in extremely low birth weight infants has increased. The classic approach to Broviac(®) (C.R. Bard, Covington, GA) catheter placement in very small neonates has been through an open surgical cutdown technique. Ultrasound guidance has emerged as a potentially beneficial method for obtaining central venous access in children and is being applied to smaller and smaller infants. This case series reports the feasibility of using ultrasound-guided percutaneous vein access to obtain a long-term central venous line in three extremely low birth weight infants who all weighed less than 850?g at the time of line placement. PMID:26288340

  7. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

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

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

  9. Ultrasound-guided percutaneous central venous catheterization in infants: Learning curve and related complications

    PubMed Central

    Omid, Mohammad; Rafiei, Mohammad Hadi; Hosseinpour, Mehrdad; Memarzade, Mehrdad; Riahinejad, Maryam

    2015-01-01

    Background: This study was performed to evaluate the learning curve and related complications of ultrasound (US) guided central venous catheter (CVC) insertion in infants. Materials and Methods: This study was performed in Imam Hosein Hospital of Isfahan from September 2014 to March 2015. Participants were infants consecutively candidate for CVC insertion. Three steps were designed to complement the learning. For each step of learning, 20 patients were considered and for every patient one CVC was inserted: (1) In the first step, venous puncture and guide wire passage was performed by an experienced radiologist and the surgeon was taught how to do it, then CVC was placed by the surgeon. (2) In the second step, venous puncture and guide-wire passage was performed by the surgeon under the supervision of the same radiologist, and then CVC was placed by the surgeon. (3) In the third step, US-guided CVC insertion was performed by the surgeon completely, and the radiologist came to the operating room only if it was necessary. In each of these steps, the time spent of the US probe on the skin until the guide wire passage into the vein was recorded for every patient. All perioperative complications were recorded. Results: The mean point for the time spent of the US probe on the skin until the guide wire passage into the vein was 84.9 ± 13.6, 119.1 ± 15.2, and 90.3 ± 11.2 s in the step 1, 2 and 3, respectively (P = 0.04). There was no significant difference between the frequencies of complications among tree steps. Conclusion: US-guided percutaneous CVC insertion is a safe and reliable method which can be easily and rapidly learned. PMID:26601087

  10. Comparative Evaluation of Two Venous Sampling Techniques for the Assessment of Pancreatic Insulin and Zinc Release upon Glucose Challenge

    PubMed Central

    Pillai, Anil Kumar; Silvers, William; Christensen, Preston; Riegel, Matthew; Adams-Huet, Beverley; Lingvay, Ildiko; Sun, Xiankai; Öz, Orhan K.

    2015-01-01

    Advances in noninvasive imaging modalities have provided opportunities to study ? cell function through imaging zinc release from insulin secreting ? cells. Understanding the temporal secretory pattern of insulin and zinc corelease after a glucose challenge is essential for proper timing of administration of zinc sensing probes. Portal venous sampling is an essential part of pharmacological and nutritional studies in animal models. The purpose of this study was to compare two different percutaneous image-guided techniques: transhepatic ultrasound guided portal vein access and transsplenic fluoroscopy guided splenic vein access for ease of access, safety, and evaluation of temporal kinetics of insulin and zinc release into the venous effluent from the pancreas. Both techniques were safe, reproducible, and easy to perform. The mean time required to obtain desired catheter position for venous sampling was 15 minutes shorter using the transsplenic technique. A clear biphasic insulin release profile was observed in both techniques. Statistically higher insulin concentration but similar zinc release after a glucose challenge was observed from splenic vein samples, as compared to the ones from the portal vein. To our knowledge, this is the first report of percutaneous methods to assess zinc release kinetics from the porcine pancreas. PMID:26273676

  11. Comparative Evaluation of Two Venous Sampling Techniques for the Assessment of Pancreatic Insulin and Zinc Release upon Glucose Challenge.

    PubMed

    Pillai, Anil Kumar; Silvers, William; Christensen, Preston; Riegel, Matthew; Adams-Huet, Beverley; Lingvay, Ildiko; Sun, Xiankai; Öz, Orhan K

    2015-01-01

    Advances in noninvasive imaging modalities have provided opportunities to study ? cell function through imaging zinc release from insulin secreting ? cells. Understanding the temporal secretory pattern of insulin and zinc corelease after a glucose challenge is essential for proper timing of administration of zinc sensing probes. Portal venous sampling is an essential part of pharmacological and nutritional studies in animal models. The purpose of this study was to compare two different percutaneous image-guided techniques: transhepatic ultrasound guided portal vein access and transsplenic fluoroscopy guided splenic vein access for ease of access, safety, and evaluation of temporal kinetics of insulin and zinc release into the venous effluent from the pancreas. Both techniques were safe, reproducible, and easy to perform. The mean time required to obtain desired catheter position for venous sampling was 15 minutes shorter using the transsplenic technique. A clear biphasic insulin release profile was observed in both techniques. Statistically higher insulin concentration but similar zinc release after a glucose challenge was observed from splenic vein samples, as compared to the ones from the portal vein. To our knowledge, this is the first report of percutaneous methods to assess zinc release kinetics from the porcine pancreas. PMID:26273676

  12. Abstract--In poorly constrained extra-vascular environments such as hollow viscera, current catheter

    E-print Network

    catheter navigation techniques are restricted to simple paths and therefore limit a doctor's ability to position the catheter. This paper presents a new catheter positioning system that enables faster and more accurate catheter placement, with fewer scans. The proposed robotic catheter navigation system can execute

  13. Thrombotic Venous Diseases of the Liver

    PubMed Central

    Sabol, Timothy P.; Molina, Marco; Wu, George Y.

    2015-01-01

    Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

  14. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    PubMed

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration. PMID:19648868

  15. [Incidence and risk factors for infections from hemodialysis catheters].

    PubMed

    Jean, G

    2001-01-01

    We report here a revue of hemodialysis catheter-related infections data published since 1985. The reported prevalence of bacteremia is 1 to 20% of catheters, and incidence is 0.72 to 9/1000 catheter-days. Local infection is reported in 6 to 63% of catheters and in 1 to 5/1000 catheter-days. Tunneled catheters and implantables chambers reported less infection rate. The most severe complication is endocarditis (4% rate). Death occurs in 8 to 20% of cases. Reported microbial data show that Staphylococcus aureus (SA) is responsible for most infections ahead of non-aureus Staphylococcus. SA skin colonisation is a risk factor for catheter colonisation and the first step of infection. On the other hand, the host immunity impairment in hemodialysis patients seems a significant risk factor. Iron overload, specially after blood transfusions, older age, diabetes mellitus, low serum albumin level, previous history of bacteremia and immunosuppressive treatment have been frequently involved. Other catheter-related factors are time of use, absence of tunnel and use for parenteral nutrition. Nurses plans, dressing type and frequency, nurses work experience are also important. In spite of recent progress in risk factor understanding, hemodialysis-related infection remains frequent. Multicentre studies are necessary to better evaluated care protocols and new catheter material. PMID:11811006

  16. Magnetic Catheter Manipulation in the Interventional MRI Environment

    PubMed Central

    Wilson, Mark W.; Martin, Alastair B.; Lillaney, Prasheel; Losey, Aaron D.; Yee, Erin J.; Bernhardt, Anthony; Malba, Vincent; Evans, Lee; Sincic, Ryan; Saeed, Maythem; Arenson, Ronald L.; Hetts, Steven W.

    2013-01-01

    Purpose To evaluate deflection capability of a prototype endovascular catheter, which is remotely magnetically steerable, for use in the interventional MRI environment. Materials and Methods Copper coils were mounted on the tips of commercially available 2.3 – 3.0 Fr microcatheters. The coils were fabricated in a novel manner by plasma vapor deposition of a copper layer followed by laser lithography of the layer into coils. Orthogonal helical (solenoid) and saddle-shaped (Helmholtz) coils were mounted on a single catheter tip. Microcatheters were tested in water bath phantoms in a 1.5T clinical MRI scanner, with variable simultaneous currents applied to the coils. Catheter tip deflection was imaged in the axial plane utilizing a “real-time” steady-state free precession (SSFP) MRI sequence. Degree of deflection and catheter tip orientation were measured for each current application. Results The catheter tip was clearly visible in the longitudinal and axial planes. Magnetic field artifacts were visible when the orthogonal coils at the catheter tip were energized. Variable amounts of current applied to a single coil demonstrated consistent catheter deflection in all water bath experiments. Changing current polarity reversed the observed direction of deflection, whereas current applied to two different coils resulted in deflection represented by the composite vector of individual coil activations. Microcatheter navigation through the vascular phantom was successful through control of applied current to one or more coils. Conclusion Controlled catheter deflection is possible with laser lithographed multi-axis coil tipped catheters in the MRI environment. PMID:23707097

  17. 21 CFR 870.1370 - Catheter tip occluder.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  18. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  19. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  20. 21 CFR 870.1210 - Continuous flush catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  1. 21 CFR 870.1240 - Flow-directed catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  2. Pseudo interruption of the inferior vena cava complicating the device closure of patent ductus arteriosus: Case report and short review of venous system embryology

    PubMed Central

    Subramanian, Venkateshwaran; Mahadevan, Krishnamoorthy Kavassery; Sivasubramonian, Sivasankaran; Tharakan, Jaganmohan

    2014-01-01

    A nineteen-month-old girl was taken up for patent ductus arteriosus (PDA) device closure. A diagnostic catheter from the right femoral venous access entered the superior vena cava (SVC), through the azygos vein suggesting interruption of inferior vena caval with azygos continuity. Therefore, the PDA device was closed from the right jugular venous access. However, a postprocedure echocardiogram (echo) showed a patent inferior vena caval connection into the right atrium. An angiogram from femoral veins showed communication between the iliac veins and the azygos system, in addition to normal drainage into the inferior vena cava (IVC). Congenital communication between the iliac veins and the azygos system can mimic IVC interruption. An attempt to theoretically explain the embryological origin of the communication has been made. PMID:24701092

  3. A computer-based automated reminder increases the percentage of urinary catheters justified by an order and increases urinary catheter discontinuation orders.

    PubMed

    Nadelman, Rebecca V; Nadelman, Daniel A; Montecalvo, Marisa A

    2015-06-01

    Use of an automated reminder for an order to continue or to discontinue a urinary catheter resulted in a significant increase in the percentage of urinary catheters justified by an order and the percentage of urinary catheter discontinuation orders increased. This is an essential first step toward reducing inappropriate urinary catheter use. PMID:25840716

  4. Pulmonary artery catheter entrapment in cardiac surgery: a simple percutaneous solution.

    PubMed

    Divakaran, Vijay; Caldera, Angel; Stephens, Jack; Gonzalez, Rafael

    2015-10-01

    Pulmonary artery catheter entrapment is a reported complication after cardiac surgery from inadvertent suturing of the catheter to the vena-caval wall during surgery. This article reports a simple percutaneous technique to retrieve the trapped catheter. PMID:25547257

  5. Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER)

    PubMed Central

    Spirk, David; Husmann, Marc; Hayoz, Daniel; Baldi, Thomas; Frauchiger, Beat; Engelberger, Rolf; Amann-Vesti, Beatrice; Baumgartner, Iris; Kucher, Nils

    2012-01-01

    Aims Although acute venous thrombo-embolism (VTE) often afflicts patients with advanced age, the predictors of in-hospital mortality for elderly VTE patients are unknown. Methods and results Among 1247 consecutive patients with acute VTE from the prospective SWIss Venous ThromboEmbolism Registry (SWIVTER), 644 (52%) were elderly (?65 years of age). In comparison to younger patients, the elderly more often had pulmonary embolism (PE) (60 vs. 42%; P< 0.001), cancer (30 vs. 20%; P< 0.001), chronic lung disease (14 vs. 8%; P= 0.001), and congestive heart failure (12 vs. 2%; P< 0.001). Elderly VTE patients were more often hospitalized (75 vs. 52%; P< 0.001), and there was no difference in the use of thrombolysis, catheter intervention, or surgical embolectomy between the elderly and younger PE patients (5 vs. 6%; P= 0.54), despite a trend towards a higher rate of massive PE in the elderly (8 vs. 4%; P= 0.07). The overall in-hospital mortality rate was 6.6% in the elderly vs. 3.2% in the younger VTE patients (P= 0.033). Cancer was associated with in-hospital death both in the elderly [hazard ratio (HR) 4.91, 95% confidence interval (CI) 2.32–10.38; P< 0.001] and in the younger patients (HR 4.90, 95% CI 1.37–17.59; P= 0.015); massive PE was a predictor of in-hospital death in the elderly only (HR 3.77, 95% CI 1.63–8.74; P= 0.002). Conclusion Elderly patients had more serious VTE than younger patients, and massive PE was particularly life-threatening in the elderly. PMID:22036872

  6. Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

    PubMed Central

    Mouawad, Nicolas J.; Stein, Erica J.; Moran, Kenneth R.; Go, Michael R.; Papadimos, Thomas J.

    2015-01-01

    Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patient's catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool. PMID:26075106

  7. Urinary catheters: history, current status, adverse events and research agenda

    PubMed Central

    Feneley, Roger C. L.; Hopley, Ian B.; Wells, Peter N. T.

    2015-01-01

    Abstract For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0–2.5 billion and accounts for ?2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users. PMID:26383168

  8. Urinary catheters: history, current status, adverse events and research agenda.

    PubMed

    Feneley, Roger C L; Hopley, Ian B; Wells, Peter N T

    2015-11-01

    For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0-2.5 billion and accounts for ?2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users. PMID:26383168

  9. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    Oh, Jung Suk Lee, Hae Giu Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-10-15

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

  10. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  11. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  12. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated into... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment...

  13. Ultrasound Current Source Density Imaging Using a Clinical Intracardiac Catheter

    E-print Network

    Witte, Russell S.

    15260 USA Abstract-- Radiofrequency catheter ablation for treatment of cardiac arrhythmia requires pre in cylindrical gel (0.9% NaCl). Keywords-cardiac arrhythmia; catheter ablation; acousto- electric effect; ECG, EKG, multi-electrode recording I. BACKGROUND AND THEORY Cardiac arrhythmia is a serious health concern

  14. Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure-volume relationships in man.

    PubMed

    Kass, D A; Midei, M; Graves, W; Brinker, J A; Maughan, W L

    1988-01-01

    Determination of left ventricular pressure-volume relationships in situ ideally requires both a method for easy measurement of multiple pressure-volume loops and a rapid and reversible means of altering load. We report a technique, previously used in animals, that combines conductance catheter volumes and rapid inferior vena caval occlusion to permit routine measurement of calibrated P-V relationships in man for the first time. An 8F volume catheter with a 3F micromanometer tipped pressure catheter placed through its lumen was advanced to the left ventricular apex through a femoral artery. A thermodilution output catheter was placed through a 9F femoral venous sheath and later replaced with an IVC balloon occlusion catheter, through which a 2.5F bipolar wire was advanced for atrial pacing. A specialized data system facilitated collection, editing, and data analysis at the time of cardiac catheterization. Absolute volume calibration required cardiac output measurement and injection of hypertonic saline. IVC occlusion decreased peak left ventricular pressure by 42 +/- 17 (SD) (P less than .001) mm Hg in 15 patients. Endsystolic pressure-volume relationships (ESPVR) were determined with 5-8 cardiac cycles with an average of r2 of 0.94 +/- 0.05 and were generally reproducible. The slope of the ESPVR demonstrated consistency among a group of normal patients (n = 6), and was significantly lower than the slope derived from a group of patients with ventricular hypertrophy (n = 9). We conclude that left ventricular pressure-volume relationships can be easily and repeatedly determined as part of a routine cardiac catheterization in man. PMID:3197110

  15. Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study

    PubMed Central

    2013-01-01

    Background There is no established noninvasive or invasive diagnostic imaging modality at present that can serve as a ‘gold standard’ or “benchmark” for the detection of the venous anomalies, indicative of chronic cerebrospinal venous insufficiency (CCSVI). We investigated the sensitivity and specificity of 2 invasive vs. 2 noninvasive imaging techniques for the detection of extracranial venous anomalies in the internal jugular veins (IJVs) and azygos vein/vertebral veins (VVs) in patients with multiple sclerosis (MS). Methods The data for this multimodal imaging comparison pilot study was collected in phase 2 of the “Prospective Randomized Endovascular therapy in Multiple Sclerosis” (PREMiSe) study using standardized imaging techniques. Thirty MS subjects were screened initially with Doppler sonography (DS), out of which 10 did not fulfill noninvasive screening procedure requirements on DS that consisted of ?2 venous hemodynamic extracranial criteria. Accordingly, 20 MS patients with relapsing MS were enrolled into the multimodal diagnostic imaging study. For magnetic resonance venography (MRV), IJVs abnormal findings were considered absent or pinpoint flow, whereas abnormal VVs flow was classified as absent. Abnormalities of the VVs were determined only using non-invasive testing. Catheter venography (CV) was considered abnormal when ?50% lumen restriction was detected, while intravascular ultrasound (IVUS) was considered abnormal when ?50% restriction of the lumen or intra-luminal defects or reduced pulsatility was found. Non-invasive and invasive imaging modality comparisons between left, right and total IJVs and between the VVs and azygos vein were performed. Because there is no reliable way of non-invasively assessing the azygos vein, the VVs abnormalities detected by the non-invasive testing were compared to the azygos abnormalities detected by the invasive testing. All image modalities were analyzed in a blinded manner by more than one viewer, upon which consensus was reached. The sensitivity and specificity were calculated using contingency tables denoting the presence or absence of vein-specific abnormality findings between all imaging modalities used individually as the benchmark. Results The sensitivity of CV?+?IVUS was 68.4% for the right and 90% for the left IJV and 85.7% for the azygos vein/VVs, compared to venous anomalies detected on DS. Compared to the venous anomalies detected on MRV, the sensitivity of CV?+?IVUS was 71.4% in right and 100% in left IJVs and 100% in the azygos vein/VVs; however, the specificity was 38.5%, 38.9% and 11.8%, respectively. The sensitivity between the two invasive imaging techniques, used as benchmarks, ranged from 72.7% for the right IJV to 90% for the azygos vein but the IVUS showed a higher rate of venous anomalies than the CV. There was excellent correspondence between identifying collateral veins on MRV and CV. Conclusions Noninvasive DS screening for the detection of venous anomalies indicative of CCSVI may be a reliable approach for identifying patients eligible for further multimodal invasive imaging testing of the IJVs. However, the noninvasive screening methods were inadequate to depict the total amount of azygos vein/VVs anomalies identified with invasive testing. This pilot study, with limited sample size, shows that both a non-invasive and invasive multimodal imaging diagnostic approach should be recommended to depict a range of extracranial venous anomalies indicative of CCSVI. However, lack of invasive testing on the study subjects whose results were negative on the DS screening and of healthy controls, limits further generalizibility of our findings. In addition, the findings from the 2 invasive techniques confirmed the existence of severe extracranial venous anomalies that significantly impaired normal blood outflow from the brain in this group of MS patients. PMID:24139135

  16. Catheter-Based Sensing In The Airways

    NASA Astrophysics Data System (ADS)

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

    1988-04-01

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

  17. Catheter closure of secundum atrial septal defects.

    PubMed Central

    O'Laughlin, M P

    1997-01-01

    Catheter occlusion of atrial septal defects has its roots in the 1950s, with early devices being implanted during closed-heart surgery without cardiopulmonary bypass. For the past 20 years, various catheter-delivered devices have undergone testing and refinement. Designs have included single- and double-disk prostheses, with a variety of materials, delivery systems, and techniques. In this monograph, the history of atrial septal defect occluders and their evaluation, results, and prognoses will be outlined. The early work of King and Mills has been advanced in the forms of the Rashkind and Lock-USCI Clamshell occluders (USCI; Billerica, Mass), the "buttoned" device (custom made by E.B. Sideris), the Babic atrial septal defect occlusion system (Osypka, GmbH; Grenzach-Wyhlen, Germany), the Das-Angel Wings atrial septal defect occlusion device (Microvena Corporation; White Bear Lake, Minn), and others. The future holds promise for approved devices in the treatment of selected secundum atrial septal defects. Images PMID:9456481

  18. Medical catheters thermally manipulated by fiber optic bundles

    DOEpatents

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

    1992-01-01

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

  19. Medical catheters thermally manipulated by fiber optic bundles

    DOEpatents

    Chastagner, P.

    1992-10-06

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

  20. Porto-spleno-mesenteric venous thrombosis.

    PubMed

    Battistelli, S; Coratti, F; Gori, T

    2011-02-01

    Porto-spleno-mesenteric (PSM) venous thrombosis is a rare clinical condition that, while being mostly unrecognized, is nonetheless often severe with a high morbidity and mortality. PSM venous thrombosis is the cause of as many as 5-10% of all abdominal ischemic events, and it presents with a highly variable and non-specific pattern of abdominal symptoms. Such complex and non-specific presentation can delay diagnosis, determining the poor clinical outcome of this condition. This review article discusses the information available on the pathogenesis, clinical presentation, diagnosis and general management of PSM venous thrombosis, with a focus on a number of some clinical issues that remain unaddressed. In particular, the current understanding of the predisposing factors and the heterogeneous clinical manifestations of this condition are described in detail. The recent advances in imaging techniques, which are leading to an improved diagnostic accuracy and facilitate an early diagnosis are also presented. Further, the indications and limits of both pharmacological and surgical treatment options are discussed. PMID:21248667

  1. Transpulmonary passage of venous air emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Hills, B. A.

    1985-01-01

    Twenty-seven paralyzed anesthetized dogs were embolized with venous air to determine the effectiveness of the pulmonary vasculature for bubble filtration or trapping. Air doses ranged from 0.05 to 0.40 ml/kg min in 0.05-ml increments with ultrasonic Doppler monitors placed over arterial vessels to detect any microbubbles that crossed the lungs. Pulmonary vascular filtration of the venous air infusions was complete for the lower air doses ranging from 0.05 to 0.30 ml/kg min. When the air doses were increased to 0.35 ml/kg min, the filtration threshold was exceeded with arterial spillover of bubbles occurring in 50 percent of the animals and reaching 71 percent for 0.40 ml/kg min. Significant elevations were observed in pulmonary arterial pressure and pulmonary vascular resistance. Systemic blood pressure and cardiac output decreased, whereas left ventricular end-diastolic pressure remained unchanged. The results indicate that the filtration of venous bubbles by the pulmonary vasculature was complete when the air infusion rates were kept below a threshold value of 0.30 ml/kg min.

  2. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    PubMed Central

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J; Wilkerson, K; Speroff, T

    2005-01-01

    ??Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. Setting: Adult medical intensive care unit (MICU). Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real time. PMID:16076796

  3. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    ERIC Educational Resources Information Center

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  4. Core content for training in venous and lymphatic medicine

    PubMed Central

    Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F

    2014-01-01

    The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. PMID:25059735

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

    SciTech Connect

    Clark, Timothy W. I. Jacobs, David; Charles, Hearns W.; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph; Benstein, Judith A.

    2009-07-15

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

  6. Venous Leg Ulcer in a Sarcoidosis Patient: A Case Report

    PubMed Central

    Ohn, Jungyoon; Byun, Sang Young; Kim, In Su

    2015-01-01

    Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers. PMID:26719645

  7. Venous Leg Ulcer in a Sarcoidosis Patient: A Case Report.

    PubMed

    Ohn, Jungyoon; Byun, Sang Young; Kim, In Su; Park, Kyoung Chan

    2015-12-01

    Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers. PMID:26719645

  8. Transient reduction in venous susceptibility during posterior reversible encephalopathy syndrome.

    PubMed

    Ollivier, Morgan; Wanono, Emmanuelle; Leclercq, Delphine; Domont, Fanny; Trunet, Stéphanie; Dormont, Didier; Bertrand, Anne

    2015-11-15

    We report a case of posterior reversible encephalopathy syndrome (PRES) in which followed-up MRI demonstrated a transient reduction in venous signal on initial SWAN images. The progressive normalization of venous signal on D10 and D40 imaging paralleled the progressive decrease of hyperperfusion on CBF images. Decreased venous susceptibility has never been reported in PRES; it relates most likely to a transient BOLD effect induced by brain hyperperfusion. PMID:26434616

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

    PubMed Central

    Kettering, Klaus; Gramley, Felix

    2013-01-01

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

  10. New strategies to prevent catheter-associated urinary tract infections.

    PubMed

    Siddiq, Danish M; Darouiche, Rabih O

    2012-06-01

    Catheter-associated urinary tract infection (CAUTI) is the most common health-care-associated infection worldwide. Although not all cases of bacteriuria result in clinical infection, several hundred thousand episodes of CAUTI occur each year in the USA alone. The milieu in which the catheter is placed is highly conducive to bacterial colonization, biofilm formation on the catheter surface, and inevitable catheter-associated bacteriuria. A multitude of novel methods of CAUTI prevention have been described, including established approaches that are routinely recommended, such as the use of a secured, closed, silicone urinary catheter drainage system that mimics normal voiding, and newer strategies focusing on biocompatible catheter materials that cause minimal host inflammatory response and retard biofilm formation. Much recent research has focused on modification of the catheter surface by either coating or impregnation with antimicrobials or antiseptics. However, clinical trials that analyse cost-effectiveness and rates of antimicrobial resistance are awaited. More recently, innovative use of iontophoresis, vibroacoustic stimulation, bacterial interference and bacteriophage cocktails has been reported. PMID:22508462

  11. Techniques and methods for catheter endocardial fulguration.

    PubMed

    Fontaine, G; Cansell, A; Tonet, J L; Frank, R; Gallais, Y; Rougier, I; Grosgogeat, Y

    1988-05-01

    Fulguration is a new and promising technique for the treatment of cardiac arrhythmias. This paper discusses the methods and equipment used at Jean Rostand Hospital for invasive experimental research related to fulguration. The importance of catheter testing and selection is demonstrated. The most important features of the measurement techniques for both His bundle and ventricular tachycardia recordings are described. The main components of the protocols for fulguration and early post-operative surveillance are reported. The ODAM Fulgucor is used, augmented by the incorporation of additional pieces of equipment to allow monitoring of current and voltage curves. An electromechanical relay allows for automatic switching from the recording amplifier to the energy source. The video system used includes recording of the image of the last fluoroscopic event with a character generator and an electronic pointer superimposed (when necessary). Computer programs for appropriate timing of predominant events have been developed. PMID:2456538

  12. Distributed parameter statics of magnetic catheters.

    PubMed

    Tunay, Ilker

    2011-01-01

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

  13. Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

    PubMed Central

    Pereira, Keith; Osiason, Adam; Salsamendi, Jason

    2015-01-01

    The role of interventional radiology in the overall management of patients on dialysis continues to expand. In patients with end-stage renal disease (ESRD), the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an integral component of treatment plans. Unfortunately, long-term use of TDCs often leads to infections, acute occlusions, and chronic venous stenosis, depletion of the patient's conventional access routes, and prevention of their recanalization. In such situations, the progressive loss of venous access sites prompts a systematic approach to alternative sites to maximize patient survival and minimize complications. In this review, we discuss the advantages and disadvantages of each vascular access option. We illustrate the procedures with case histories and images from our own experience at a highly active dialysis and transplant center. We rank each vascular access option and classify them into tiers based on their relative degrees of effectiveness. The conventional approaches are the most preferred, followed by alternative approaches and finally the salvage approaches. It is our intent to have this review serve as a concise and informative reference for physicians managing patients who need vascular access for hemodialysis. PMID:26167389

  14. Catheter-directed Thrombolysis with Argatroban and tPA for Massive Iliac and Femoropopliteal Vein Thrombosis

    SciTech Connect

    Sharifi, Mohsen; Bay, Curt; Nowroozi, Sasan; Bentz, Suzanne; Valeros, Gayle; Memari, Sara

    2013-12-15

    Purpose: Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT. Methods: Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 {+-} 6 h of presentation. The dose of tPA was 0.75-1 mg/h through the infusion port and that of argatroban at 0.3-1 {mu}g/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months. Results: There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE. Conclusion: Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.

  15. Microdialysis based monitoring of subcutaneous interstitial and venous blood glucose in Type 1 diabetic subjects by mid-infrared spectrometry for intensive insulin therapy

    NASA Astrophysics Data System (ADS)

    Heise, H. Michael; Kondepati, Venkata Radhakrishna; Damm, Uwe; Licht, Michael; Feichtner, Franz; Mader, Julia Katharina; Ellmerer, Martin

    2008-02-01

    Implementing strict glycemic control can reduce the risk of serious complications in both diabetic and critically ill patients. For this purpose, many different blood glucose monitoring techniques and insulin infusion strategies have been tested towards the realization of an artificial pancreas under closed loop control. In contrast to competing subcutaneously implanted electrochemical biosensors, microdialysis based systems for sampling body fluids from either the interstitial adipose tissue compartment or from venous blood have been developed, which allow an ex-vivo glucose monitoring by mid-infrared spectrometry. For the first option, a commercially available, subcutaneously inserted CMA 60 microdialysis catheter has been used routinely. The vascular body interface includes a double-lumen venous catheter in combination with whole blood dilution using a heparin solution. The diluted whole blood is transported to a flow-through dialysis cell, where the harvesting of analytes across the microdialysis membrane takes place at high recovery rates. The dialysate is continuously transported to the IR-sensor. Ex-vivo measurements were conducted on type-1 diabetic subjects lasting up to 28 hours. Experiments have shown excellent agreement between the sensor readout and the reference blood glucose concentration values. The simultaneous assessment of dialysis recovery rates renders a reliable quantification of whole blood concentrations of glucose and metabolites (urea, lactate etc) after taking blood dilution into account. Our results from transmission spectrometry indicate, that the developed bed-side device enables reliable long-term glucose monitoring with reagent- and calibration-free operation.

  16. High-sensitivity detection and monitoring of microcirculation using cutaneous and catheter probes for Doppler optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Yang, Victor X.; Gordon, M. L.; Qi, B.; Yue, E. Seng; Tang, S.; Bisland, Stuart K.; Pekar, J.; Lo, S.; Marcon, Norman E.; Wilson, B.; Vitkin, Alex

    2003-07-01

    Background: Currently clinical Doppler ultrasound cannot detect microvascular blood flow and it is difficult to provide depth discrimination using laser Doppler flowmetry. Doppler optical coherence tomography (DOCT) is a novel technique for noninvasive subsurface imaging of microcirculation and tissue structure. Aims: To design handheld and catheter-based DOCT probes for clinical cutaneous and endoscopic imaging. To develop signal processing techniques for real-time detection and quantification of microvascular blood flow. Methods: A DOCT system, with interchangeable cutaneous and catheter probes, was developed. The axial spatial resolution was 10 ?m, and the velocity resolution was 20 ?m/s, using a 1300 nm broadband infrared light. The system achieved real-time imaging with frame rates up to 32 Hz at 512 x 256 pixels per frame. We used the system to detect microcirculation in human skin and rat esophagus, and to monitor microvascular responses to photodynamic therapy (PDT) in a rat tumor model. Results: We present experimental results from in vivo DOCT imaging of microcirculation in human skin arterio-venous malformations (AVM), normal rat esophagus, and a rat gliosarcoma PDT model. In the PDT model, we followed microvascular responses to PDT and observed differences in the microcirculation during and after therapy, which can have important implications for PDT dosimetry and treatment optimization. Conclusions: To our knowledge, this is the first demonstration of endoscopic catheter-based DOCT detection of microcirculation in vivo. In addition, AVM can be detected using handheld cutaneous DOCT probes under clinical settings. DOCT may serve as a real-time monitoring tool for PDT dosimetry, especially for vascular targeting photosensitizers.

  17. Steerable Catheter Microcoils for Interventional MRI: Reducing Resistive Heating

    PubMed Central

    Bernhardt, Anthony; Wilson, Mark W.; Settecase, Fabio; Evans, Leland; Malba, Vincent; Martin, Alastair J.; Saeed, Maythem; Roberts, Timothy P. L.; Arenson, Ronald L.; Hetts, Steven W.

    2010-01-01

    PURPOSE To assess resistive heating of microwires used for remote catheter steering in interventional magnetic resonance imaging. To investigate the use of alumina to facilitate heat transfer to saline flowing in the catheter lumen. MATERIALS AND METHODS A microcoil was fabricated using a laser lathe onto polyimide-tipped or alumina-tipped endovascular catheters. In vitro testing was performed in a 1.5 T MR system using a vessel phantom, body RF coil, and steady state pulse sequence. Resistive heating was measured with water flowing over a polyimide tip catheter, or saline flowing through the lumen of an alumina-tip catheter. Preliminary in vivo testing in porcine common carotid arteries was conducted with normal blood flow or after arterial ligation when current was applied to an alumnia-tip catheter for up to 5 minutes. RESULTS After application of up to 1 W of DC power, clinically significant temperature increases were noted with the polyimide-tip catheter: 23°C/W at zero flow, 13°C/W at 0.28 cc/s, and 7.9°C/W at 1 cc/s. Using the alumina-tip catheter, the effluent temperature rise using the lowest flow rate (0.12 cc/s) was 2.3°C/W. In vivo testing demonstrated no thermal injury to vessel walls at normal and zero arterial flow. CONCLUSION Resistive heating in current carrying wire pairs can be dissipated by saline coolant flowing within the lumen of a catheter tip composed of material that facilitates heat transfer. PMID:21075017

  18. Antibiofilm surface functionalization of catheters by magnesium fluoride nanoparticles

    PubMed Central

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

    2012-01-01

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

  19. The effect of elastic modulus on ablation catheter contact area

    NASA Astrophysics Data System (ADS)

    Camp, Jon J.; Linte, Cristian A.; Rettmann, Maryam E.; Sun, Deyu; Packer, Douglas L.; Robb, Richard A.; Holmes, David R.

    2015-03-01

    Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrodetissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel[1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.

  20. Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Pihl, Maria; Davies, Julia R.; Johansson, Ann-Cathrine; Svensäter, Gunnel

    2013-01-01

    ? Background: Peritonitis is the leading cause of morbidity for peritoneal dialysis (PD) patients, and microbial biofilms have previously been identified on catheters from infected patients. However, few studies of catheters from patients without clinical signs of infection have been undertaken. The aim of the present study was to investigate the extent to which bacteria are present on catheters from PD patients with no symptoms of infection. ? Methods: Microbiologic culturing under aerobic and anaerobic conditions and confocal laser scanning microscopy were used to determine the distribution of bacteria on PD catheters from 15 patients without clinical signs of infection and on catheters from 2 infected patients. The 16S rRNA gene sequencing technique was used to identify cultured bacteria. ? Results: Bacteria were detected on 12 of the 15 catheters from patients without signs of infection and on the 2 catheters from infected patients. Single-species and mixed-microbial communities containing up to 5 species were present on both the inside and the outside along the whole length of the colonized catheters. The bacterial species most commonly found were the skin commensals Staphylococcus epidermidis and Propionibacterium acnes, followed by S. warneri and S. lugdunensis. The strains of these micro-organisms, particularly those of S. epidermidis, varied in phenotype with respect to their tolerance of the major classes of antibiotics. ? Conclusions: Bacteria were common on catheters from patients without symptoms of infection. Up to 4 different bacterial species were found in close association and may represent a risk factor for the future development of peritonitis in patients hosting such micro-organisms. PMID:22855889

  1. Percutaneous Untying of a Knot in a Retained Swan-Ganz Catheter

    SciTech Connect

    Bhatti, Waqar A.; Sinha, Sankar; Rowlands, Peter

    2000-03-15

    A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the catheter to be removed without trauma.

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

    SciTech Connect

    Burton, Kirsteen R.; Guo, Lancia L. Q.; Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K.

    2012-12-15

    Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

  3. Ion beam sputter-etched ventricular catheter for hydrocephalus shunt

    NASA Technical Reports Server (NTRS)

    Banks, B. A. (inventor)

    1983-01-01

    A cerebrospinal fluid shunt in the form of a ventricular catheter for controlling the condition of hydrocephalus by relieving the excessive cerebrospinal fluid pressure is described. A method for fabrication of the catheter and shunting the cerebral fluid from the cerebral ventricles to other areas of the body is also considered. Shunt flow failure occurs if the ventricle collapse due to improper valve function causing overdrainage. The ventricular catheter comprises a multiplicity of inlet microtubules. Each microtubule has both a large openings at its inlet end and a multiplicity of microscopic openings along its lateral surfaces.

  4. Sickle Cell Trait Causing Splanchnic Venous Thrombosis.

    PubMed

    Saxena, Priyanka; Dhiman, Pratibha; Bihari, Chhagan; Rastogi, Archana

    2015-01-01

    Sickle cell trait is considered as a benign condition as these individuals carry only one defective gene and typically have their life span similar to the normal population without any health problems related to sickle cell. Only under extreme conditions, red cells become sickled and can cause clinical complications including hematuria and splenic infarction. Although twofold increased risk of venous thrombosis has been described in African Americans, there is no data available from Indian population. We here report a case of sickle cell trait from India whose index presentation was thrombosis of unusual vascular territory. PMID:26221548

  5. Sickle Cell Trait Causing Splanchnic Venous Thrombosis

    PubMed Central

    Saxena, Priyanka; Dhiman, Pratibha; Bihari, Chhagan; Rastogi, Archana

    2015-01-01

    Sickle cell trait is considered as a benign condition as these individuals carry only one defective gene and typically have their life span similar to the normal population without any health problems related to sickle cell. Only under extreme conditions, red cells become sickled and can cause clinical complications including hematuria and splenic infarction. Although twofold increased risk of venous thrombosis has been described in African Americans, there is no data available from Indian population. We here report a case of sickle cell trait from India whose index presentation was thrombosis of unusual vascular territory. PMID:26221548

  6. Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria

    PubMed Central

    Meppiel, Elodie; Crassard, Isabelle; de Latour, Régis Peffault; de Guibert, Sophie; Terriou, Louis; Chabriat, Hugues; Socié, Gérard; Bousser, Marie-Germaine

    2015-01-01

    Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of hematopoietic stem cells characterized by hemolytic anemia, marrow failure, and a high incidence of life-threatening venous thrombosis. Cerebral venous system is the second most frequent location of thrombosis after hepatic veins. However, data about PNH-related cerebral venous thrombosis (CVT) are very scarce because of the rarity of both the disorders. We report a French study about PNH patients with CVT. Patients were recruited retrospectively, from the Société Française d’Hématologie (SFH) registry of 465 patients with PNH; the Lariboisière registry of 399 patients with CVT; and a direct contact with 26 French Hematology Units. We review cases reported since 1938 in the English and French language literature. We then compared patients of our series with cases from the literature, with non-PNH-related CVT cases from Lariboisière registry, and with PNH patients without CVT from SFH registry. Fifteen patients were included between 1990 and 2012. Most patients were women (12/15) and half of them presented associated hormonal venous thrombosis risk factors. Three patients had concomitant hepatic vein thrombosis. CVT was the first manifestation of PNH in 4 patients. No major difference in CVT characteristics was found compared with non-PNH-related CVT cases, except for a younger age at diagnosis in PNH patients (P?

  7. [A technique for inserting inadvertently removed tunneled hemodialysis catheters through the original exit site].

    PubMed

    Lomonte, Carlo; Casucci, Francesco; Libutti, Pasquale; Lisi, Piero; Losurdo, Nicola; Basile, Carlo

    2013-01-01

    Accidental loss of tunneled hemodialysis (HD) central venous catheters (CVCs) is a rare complication. In the absence of other sites available for positioning a new CVC, the lack of a vascular access exposes the patient to a high risk of mortality. The technique for inserting inadvertently removed tunneled CVCs using the original exit site has never gained popularity and has been used, although with good results, in selected cases only. The purpose of this case report is to describe our experience in similar cases, and to propose a variant of the procedure described above: in 4 cases occurring over the last 12 months, our technique permitted recovery of vascular access for up to 72 hours after the loss of the CVC, with placement of a new cuffed CVC performed in the space of a few minutes. There were no cases of bleeding nor episodes of infection. The patients resumed their regular HD program with adequate performance of the CVC during a follow-up period that ranged from 3 to 12 months.In conclusion, we believe that this simple manoeuvre can help the nephrologist solve one of the dialysis room's moments of genuine emergency. PMID:23832470

  8. [Definition, classification and diagnosis of chronic venous insufficiency - part II].

    PubMed

    Kasperczak, Jaros?aw; Ropacka-Lesiak, Mariola; Breborowicz, H Grzegorz

    2013-01-01

    Venous insufficiency can be defined as a fixed venous outflow disturbance of the limbs. It is caused by the malfunction of the venous system, that may or may not be associated with venous valvular insufficiency and may involve the superficial or deep venous system of the lower limbs, or both. The CEAP scale includes clinical, etiologic, anatomic and pathophysiologic aspects and has been used in the assessment of venous insufficiency Clinical classification comprises of 7 groups. It takes into account the appearance of the skin of the lower limbs, presence of edema, teleangiectasis and varicose ulcers. CLINICAL GRADING: Group C0 - no visible changes in the clinical examination; Group C1 - telangiectasis, reticular veins, redness of the skin around the ankles; Group C2 - varicose veins, Group C3 - the presence of edema without skin changes; Group C4 - lesions dependent of venous diseases (discoloration, blemishes, lipodermatosclerosis); C5 Group - skin changes described above with signs of healed venous ulcers; Group C6 - skin lesions such as in groups C1 to C4 plus active venous ulcers. ETIOLOGICAL CLASSIFICATION INCLUDES: Ec - congenital defects of the venous system, Ep - primary pathological changes of the venous system, without identification of their causes; Es - secondary causes of venous insufficiency of known etiology (post-thrombotic, post-traumatic, etc.). There are many methods of assessing the venous system. One of the most accurate methods is an ascending phlebography which is especially useful in determining detailed anatomy of the venous system, venous patency and identification of perforans veins. The second method may be a descending phlebography useful in determining the venous reflux and morphology of venous valves. Another radiological method is varicography in which the injection of the contrast medium directly into the veins is performed. It is especially useful in the ,,mapping" of venous connections. Trans-uterine phlebography when contrast medium is injected into the bottom of the uterus and its flow is observed, is a very rare test. A similar method is used in a selective phlebography of the ovarian vein and internal iliac vein. This examination is performed when there is a suspicion of connections between varicose veins of the inferior extremities and the pelvis, in case of the occluded iliac and femoral veins. However these tests are highly invasive, causing a lot of discomfort and are connected with numerous complications, particularly the development of venous thromboembolism. An invasive study but not exposing to the emission of ionizing radiation, is a measurement of the marching pressure (known also as ambulatory venous pressure - AVP). Ultrasound Doppler is the "gold standard" in the diagnosis of venous system. Color Doppler technique is irreplaceable due to its non-invasiveness, availability constantly improving of the ultrasound machines and is the method of choice in pregnancy Unfortunately clinical correlation of Doppler ultrasound and thrombosis is bad. Invasive methods, which include various types of phlebographies, have been reserved only for cases of very high diagnostic doubt. PMID:23488310

  9. Antimicrobial lock solutions: an approach to reduce catheter-related bacteremia.

    PubMed

    Kulawik, Deuzimar

    2010-01-01

    Catheters create a highway for bacteria to migrate into the bloodstream and are associated with increased mortality. Infections associated with catheter use contribute to making infection the second leading cause of death in patients with ESRD. This article reviews the growing research that indicates antimicrobial catheter-locking solutions are effective at preventing catheter-related bacteremia by inhibiting the growth of biofilm containing organisms in a catheter lumen and preventing colonization of bacteria. PMID:20973310

  10. Placing Large Catheter in Vein Under Collarbone Best, Study Finds

    MedlinePLUS

    ... news/fullstory_154774.html Placing Large Catheter in Vein Under Collarbone Best, Study Finds Compared to neck ... can receive medications easily, one placed in the vein under the collarbone appears to lower the risk ...

  11. Upward Migration of a Peritoneal Catheter Following Ventriculoperitoneal Shunt

    PubMed Central

    Cho, Kyung Rae; Yeon, Je Young

    2013-01-01

    We present an unusual case of peritoneal catheter migration following a ventriculoperitoneal shunt operation. A 7-month-old infant, who had suffered from intraventricular hemorrhage at birth, was shunted for progressive hydrocephalus. The peritoneal catheter, connected to an 'ultra small, low pressure valve system' (Strata®; PS Medical,Gola, CA, USA) at the subgaleal space, was placed into the peritoneal cavity about 30 cm in length. The patient returned to our hospital due to scalp swelling 21 days after the surgery. Simple X-ray images revealed total upward migration and coiling of the peritoneal catheter around the valve. Possible mechanisms leading to proximal upward migration of a peritoneal catheter are discussed. PMID:24003378

  12. Offering patients a choice of urinary catheter drainage system.

    PubMed

    Gibney, Linda

    The aim of this article is to promote understanding of the benefits, assessment process and suitability of catheter valves, as a form of urinary drainage for patients. A literature review on the benefits of catheter valves provides the opportunity for an in-depth discussion that compares and contrasts different urinary drainage systems. On the evidence of the literature review, all patients require a holistic assessment which considers a number of factors, and provides the nurse with the essential objective data to ascertain the suitability of the catheter valve. These data can be transferred into an easy step-by-step algorithm to help guide the nurse in making the decision, with the patient, on the most appropriate urinary catheter drainage system. PMID:20966861

  13. Review of advanced catheter technologies in radiation oncology brachytherapy procedures

    PubMed Central

    Zhou, Jun; Zamdborg, Leonid; Sebastian, Evelyn

    2015-01-01

    The development of new catheter and applicator technologies in recent years has significantly improved treatment accuracy, efficiency, and outcomes in brachytherapy. In this paper, we review these advances, focusing on the performance of catheter imaging and reconstruction techniques in brachytherapy procedures using magnetic resonance images and electromagnetic tracking. The accuracy of catheter reconstruction, imaging artifacts, and other notable properties of plastic and titanium applicators in gynecologic treatments are reviewed. The accuracy, noise performance, and limitations of electromagnetic tracking for catheter reconstruction are discussed. Several newly developed applicators for accelerated partial breast irradiation and gynecologic treatments are also reviewed. New hypofractionated high dose rate treatment schemes in prostate cancer and accelerated partial breast irradiation are presented. PMID:26203277

  14. Percutaneous transcolonic puncture of retained Foley balloon catheter.

    PubMed Central

    Lloyd, S. N.; Godwin, R. J.

    1989-01-01

    A case of large bowel obstruction complicated by a retained intracolonic Foley balloon catheter is reported, and the minimally invasive technique for removal is described. Images Figure 1 PMID:2616422

  15. Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

    SciTech Connect

    Rosebrough, S.F.; Grossman, Z.D.; McAfee, J.G.; Kudryk, B.J.; Subramanian, G.; Ritter-Hrncirik, C.A.; Witanowski, L.S.; Tillapaugh-Fay, G.; Urrutia, E.

    1987-02-01

    Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.

  16. Prevention of venous thromboembolism in patients with hemorrhagic stroke.

    PubMed

    Chaudhry, Farrukh S; Schneck, Michael J; Morales-Vidal, Sarkis; Javaid, Furqan; Ruland, Sean

    2013-01-01

    Deep venous thrombosis (DVT) and pulmonary embolism (PE) are part of the spectrum of venous thromboembolism (VTE). It is one of the most frequent medical complications in stroke patients. The risk of VTE is even higher after hemorrhagic stroke. This article reviews various screening methods, diagnostic techniques, and pharmacologic as well as nonpharmacologic means of preventing VTE after hemorrhagic stroke. PMID:23611851

  17. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    SciTech Connect

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J.

    2009-01-15

    Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V{sub 100}{sup Prostate}>90%) and organ-at-risk dose sparing (V{sub 75}{sup Bladder}<1 cc, V{sub 75}{sup Rectum}<1 cc, V{sub 125}{sup Urethra}<<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of catheter insertion. In addition, alternative catheter patterns may decrease toxicity by avoidance of the critical structures near the penile bulb while still fulfilling the RTOG criteria.

  18. [Venous thromboembolism prophylaxis in internal medicine].

    PubMed

    Malý, J; Widimský, J; Dulícek, P

    2009-03-01

    Many of medical patients are significant risk of venous thromboembolism (VTE). VTE is the most common cause of preventable death in hospitalized patients. Prophylaxis is highly effective in reducing the risk of deep vein thrombosis and pulmonary embolism and should be used in most hospitalized patients. Various strategies improve adherence to evidence-based guidelines on the use of prophylaxis, including audit and feedback, and automatic reminders. The important clinical risk factors for PE (or venous thromboembolism VTE) include advanced age, general anaesthesia, prolonged immobility or paralysis, previous VTE, cancer, duration of surgery, orthopaedic surgery of lower limb leg, hip or pelvic fracture, major trauma, stroke, obesity, varicose veins, postoperative infection and heart failure. Medical patients ad bed rest or who are sick are in moderate risk of VTE and evidence based guidelines recommended thromboprophylaxis with low molecular weight heparin, or low dose of unfractionated heparin or Fondaparinux. For all situations both guidelines recommended against the use of aspirin for VTE prevention. PMID:19378845

  19. [Cerebral venous thrombosis. Report of 76 cases].

    PubMed

    Bousser, M G

    1991-01-01

    Progress in neuroimaging has led to a considerable change in our knowledge of cerebral venous thrombosis (CVT). Together with a series of 76 cases, a review of literature is presented. CVT is a far from negligible variety of stroke. It may occur at any age and despite numerous causes (nowadays mostly non infective), the proportion of cases of unknown aetiology remains around 25%. Superior sagittal sinus and lateral sinus are the most frequently involved, often associated with cortical vein thrombosis. Cavernous sinus thrombosis remains the most common form of septic thrombosis. Thrombosis of the galenic system and of cerebellar veins are uncommon. The clinical picture is extremely variable with a mixture of focal signs (deficits or seizures) and symptoms of raised intracranial pressure. The mode of onset is also variable, over hours, days, weeks or months. The presentation can thus be very misleading, simulating an arterial stroke or an abscess, an encephalitis, a tumor or a pseudo-tumor cerebri. CT scan is crucial to rule out other conditions and angiography to confirm the diagnosis of cerebral venous thrombosis. MRI is very performing since it visualizes the thrombus itself and allows a non invasive follow up. Most cases have a benign course but mortality is still around 30% in infective cases and 10% in non infective ones. Although it has long been debated, the benefit of anticoagulant (heparin) is now well established. PMID:1940650

  20. Papilloedema associated with dural venous sinus thrombosis.

    PubMed

    O'Rourke, Tara Leigh; Slagle, W Scott; Elkins, Meghan; Eckermann, Daniel; Musick, Angela

    2014-03-01

    Papilloedema is a diagnostic term used exclusively to describe optic disc oedema associated with increased intracranial pressure. Septic cerebral venous sinus thrombosis has become an increasingly rare cause of papilloedema because of the widespread availability of antimicrobial agents; however, it is imperative for optometrists to maintain vigilance for this pathologic process. Presented is a case of a 77-year-old Caucasian male with a complaint of blurred vision and non-specific, diffuse headache. He had a right sixth cranial nerve palsy and bilateral disc oedema. Raised intracranial pressure was confirmed by lumbar puncture. Neuroimaging, including magnetic resonance imaging and magnetic resonance venography in conjunction with cytological assessment of the cerebral spinal fluid led to a probable diagnosis of mastoiditis causing multiple dural venous sinus thrombi of the superior sagittal and right transverse sinuses. Sequential evaluation of this complex case is displayed along with pertinent differential diagnoses for optic disc oedema and a review of current standards for diagnosis and management of papilloedema from dural sinus thrombosis. PMID:23865959

  1. Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

    PubMed Central

    Khorana, Alok A.; Streiff, Michael B.; Farge, Dominique; Mandala, Mario; Debourdeau, Philippe; Cajfinger, Francis; Marty, Michel; Falanga, Anna; Lyman, Gary H.

    2009-01-01

    Purpose Venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer. Design The Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research. Results There is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival. Conclusion We call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer. PMID:19720907

  2. [Calcification of a double-J ureteral catheter].

    PubMed

    Regué Aldosa, R M; Prats López, J; Serrate Aguilera, R G

    1991-01-01

    Two cases of stone formation on double J ureteral catheter are described. Resolution was achieved by ESWL in one and by simple endoscopic removal in the other case with calcification in the distal J. The appearance of calcareous encrustation is frequent and depends on various factors especially the length of time the catheter is left indwelling, urinary stasis and infection. The efficacy of extracorporeal lithotripsy in resolving this complication is discussed. PMID:1772283

  3. Urinary catheter with polyurethane coating modified by ion implantation

    NASA Astrophysics Data System (ADS)

    Kondyurina, I.; Nechitailo, G. S.; Svistkov, A. L.; Kondyurin, A.; Bilek, M.

    2015-01-01

    A low friction urinary catheter that could be used without a lubricant is proposed in this work. A polyurethane coating was synthesised on the surface of a metal guide wire catheter. Ion implantation was applied to surface modify the polyurethane coating. FTIR ATR, wetting angle, AFM and friction tests were used for analysis. Low friction was found to be provided by the formation of a hard carbonised layer on the polyurethane surface.

  4. Endovascular Treatment of Phlegmasia Cerulea Dolens with Impending Venous Gangrene: Manual Aspiration Thrombectomy as the First-Line Thrombus Removal Method

    SciTech Connect

    Oguzkurt, Levent Ozkan, Ugur; Demirturk, Orhan S.; Gur, Serkan

    2011-12-15

    Purpose: Our purpose was to report the outcome of endovascular treatment with manual aspiration thrombectomy as the first-line thromboablative method for phlegmasia cerulea dolens. Methods: Between October 2006 and May 2010, seven consecutive patients (5 women, 2 men; age range, 31-80 years) with the diagnosis of phlegmasia cerulea dolens secondary to acute iliofemoral deep venous thrombosis had endovascular treatment with manual aspiration thrombectomy. Catheter-directed thrombolysis and stent placement were used as adjunctive procedures. Phlegmasia was left-sided in five and right-sided in two patients. Results: All patients had associated great saphenous vein thrombosis in addition to iliofemoral deep vein thrombosis (DVT). Aspiration thrombectomy completely removed the thrombus from the popliteal vein to the inferior vena cava (IVC) in all cases. Three patients with May-Thurner syndrome had stent placement in the left common iliac vein. Two patients had early recurrences. Repeated aspiration thrombectomy was unsuccessful in one patient. There were no complications related to the procedure. One patient who had been successfully treated died of sepsis and another patient who had unsuccessful repeated interventions had below-the-knee amputation. Overall, the clinical success and survival rates of patients in this study were 86%. On follow-up, three patients with successful treatment were asymptomatic with no deep venous insufficiency. One of these patients died during the 4-month follow-up period. Two patients had mild ankle swelling with deep venous insufficiency. Conclusions: Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.

  5. Unilateral Loss of Spontaneous Venous Pulsations in an Astronaut

    NASA Technical Reports Server (NTRS)

    Mader, Thomas H.; Gibson, C. Robert; Lee, Andrew G.; Patel, Nimesh; Hart, Steven; Pettit, Donald R.

    2014-01-01

    Spontaneous venous pulsations seen on the optic nerve head (optic disc) are presumed to be caused by fluctuations in the pressure gradient between the intraocular and retrolaminar venous systems. The disappearance of previously documented spontaneous venous pulsations is a well-recognized clinical sign usually associated with a rise in intracranial pressure and a concomitant bilateral elevation of pressure in the subarachnoid space surrounding the optic nerves. In this correspondence we report the unilateral loss of spontaneous venous pulsations in an astronaut 5 months into a long duration space flight. We documented a normal lumbar puncture opening pressure 8 days post mission. The spontaneous venous pulsations were also documented to be absent 21 months following return to Earth.. We hypothesize that these changes may have resulted from a chronic unilateral rise in optic nerve sheath pressure caused by a microgravity-induced optic nerve sheath compartment syndrome.

  6. Venous return curves obtained from graded series of valsalva maneuvers

    NASA Technical Reports Server (NTRS)

    Mastenbrook, S. M., Jr.

    1974-01-01

    The effects were studied of a graded series of valsalva-like maneuvers on the venous return, which was measured transcutaneously in the jugular vein of an anesthetized dog, with the animal serving as its own control. At each of five different levels of central venous pressure, the airway pressure which just stopped venous return during each series of maneuvers was determined. It was found that this end-point airway pressure is not a good estimator of the animal's resting central venous pressure prior to the simulated valsalva maneuver. It was further found that the measured change in right atrial pressure during a valsalva maneuver is less than the change in airway pressure during the same maneuver, instead of being equal, as had been expected. Relative venous return curves were constructed from the data obtained during the graded series of valsalva maneuvers.

  7. Cryo-balloon catheter localization in fluoroscopic images

    NASA Astrophysics Data System (ADS)

    Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

  8. Post-procedural evaluation of catheter contact force characteristics

    NASA Astrophysics Data System (ADS)

    Koch, Martin; Brost, Alexander; Kiraly, Atilla; Strobel, Norbert; Hornegger, Joachim

    2012-03-01

    Minimally invasive catheter ablation of electric foci, performed in electrophysiology labs, is an attractive treatment option for atrial fibrillation (AF) - in particular if drug therapy is no longer effective or tolerated. There are different strategies to eliminate the electric foci inducing the arrhythmia. Independent of the particular strategy, it is essential to place transmural lesions. The impact of catheter contact force on the generated lesion quality has been investigated recently, and first results are promising. There are different approaches to measure catheter-tissue contact. Besides traditional haptic feedback, there are new technologies either relying on catheter tip-to-tissue contact force or on local impedance measurements at the tip of the catheter. In this paper, we present a novel tool for post-procedural ablation point evaluation and visualization of contact force characteristics. Our method is based on localizing ablation points set during AF ablation procedures. The 3-D point positions are stored together with lesion specific catheter contact force (CF) values recorded during the ablation. The force records are mapped to the spatial 3-D positions, where the energy has been applied. The tracked positions of the ablation points can be further used to generate a 3-D mesh model of the left atrium (LA). Since our approach facilitates visualization of different force characteristics for post-procedural evaluation and verification, it has the potential to improve outcome by highlighting areas where lesion quality may be less than desired.

  9. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    SciTech Connect

    Ganguli, Suvranu Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil; Grabowski, Eric F.; Wicky, Stephan

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  10. Fiber optic pressure catheter for cardiovascular applications

    NASA Astrophysics Data System (ADS)

    Lin, Yuping; Sawatari, Takeo; Hartley, Craig J.

    1998-07-01

    We developed a fiber optic pressure catheter which has the potential to exceed the performance and cost-effectiveness of any currently available pressure measurement system in cardiovascular applications. Our design is based on a movable metallic ribbon, which works as a reflector, to transform the pressure into a light signal. The sensor has a diameter of 0.8 mm and is covered by medical grade polyurethane. In the laboratory tests, our sensors consistently showed high sensitivity and low noise (about 1 mmHg) over the pressure range of 0 to 300 mmHg. The time constant of the sensor, which is limited by the current software is about 20 mseconds (50 Hz). Using a mechanical heart simulator to generate pressure pulses, the pressure reading was independent of temperature change over a 30 degree Celsius range, and the drift was minimal during the 72-hour pressure pulse tests. A preliminary animal test was carried out with our sensors inserted into the artery of a dog. The comparison with an external reference sensor showed basic sensor performance. The sensor can also be used in brain, lung, and bladder pressure measurement applications.

  11. Catheter guided by optical coherence domain reflectometry

    DOEpatents

    Everett, Matthew (Pleasanton, CA); Colston, Billy W. (Livermore, CA); Da Silva, Luiz B. (Danville, CA); Matthews, Dennis (Moss Beach, CA)

    2002-01-01

    A guidance and viewing system based on multiplexed optical coherence domain reflectometry is incorporated into a catheter, endoscope, or other medical device to measure the location, thickness, and structure of the arterial walls or other intra-cavity regions at discrete points on the medical device during minimally invasive medical procedures. The information will be used both to guide the device through the body and to evaluate the tissue through which the device is being passed. Multiple optical fibers are situated along the circumference of the device. Light from the distal end of each fiber is directed onto the interior cavity walls via small diameter optics (such as gradient index lenses and mirrored corner cubes). Both forward viewing and side viewing fibers can be included. The light reflected or scattered from the cavity walls is then collected by the fibers and multiplexed at the proximal end to the sample arm of an optical low coherence reflectometer. The system may also be implemented in a nonmedical inspection device.

  12. Venous thromboembolism in neonates and children.

    PubMed

    Kenet, Gili; Nowak-Göttl, Ulrike

    2012-09-01

    Thrombosis in children is gaining increased awareness, as advanced medical care has increased treatment intensity of hospitalized pediatric patients. Guidelines for diagnosis and treatment of children and neonates with venous thromboembolism (VTE) are mostly extrapolated from adult data, despite the uniqueness of their hemostatic system. Whereas inherited thrombophilia (IT) have been established as risk factors for VTE in adults, in children with idiopathic VTE and in pediatric populations in which thromboses were associated with medical diseases, IT have been described as additional risk factors. Follow-up data for VTE recurrence in children suggest a recurrence rate between 3% (neonates) and 21% (idiopathic VTE). Apart from underlying medical conditions, recently reported systematic reviews on pediatric VTE and stroke have shown significant associations between thrombosis and presence of factor V G1691A, factor II G20210A, protein C-, protein S- and antithrombin deficiency, even more pronounced when combined IT were involved. The pooled odds ratios (OR: single IT) for VTE onset ranged from 2.4 for the factor II G20210A mutation (cerebrovascular occlusion) to 9.4 in children with antithrombin deficiency (venous VTE). In addition, the pooled OR for persistent antiphospholipid antibodies/lupus anticoagulants was 6.6 for children with cerebrovascular occlusion and 4.9 for pediatric cases with venous VTE. The factor II G20210A mutation (OR: 2.1), protein C- (OR: 2.4), S- (OR: 3.1), and antithrombin deficiency (OR: 3.0) did also play a significant role at recurrence. Among primarily asymptomatic family members of pediatric VTE index cases annual VTE incidences were 2.82% (95% confidence interval [95% CI], 1.63-4.80%) in carriers of antithrombin, protein C, or protein S-deficiency, 0.42% (0.12-0.53%) for factor II G202010A, 0.25% (0.12-0.53%) for factor V G1691A, and 0.10% (0.06-0.17%) in relatives with no IT. Based on these data diagnosis, screening and treatment issues will be discussed. PMID:22959549

  13. A new venous infusion pathway monitoring system.

    PubMed

    Maki, Hiromichi; Yonezawa, Yoshiharu; Ogawa, Hidekuni; Ninomiya, Ishio; Sata, Koji; Hamada, Shingo; Caldwell, W Morton

    2007-01-01

    A new infusion catheter pathway monitoring system employing linear integrated circuits and a low-power 8-bit single chip microcomputer has been developed for hospital and home use. The sensor consists of coaxial three-layer conductive tapes wrapped around the polyvinyl chloride infusion tube. The inner tape is the main electrode, which records an AC (alternating current) voltage induced on the patient's body by electrostatic coupling from the normal 100 volt, 60 Hz AC power line wiring field in the patient's room. The outside tape layer is a reference electrode to monitor the AC voltage around the main electrode. The center tape layer is connected to system ground and functions as a shield. The microcomputer calculates the ratio of the induced AC voltages recorded by the main and reference electrodes and if the ratio indicates a detached infusion, alerts the nursing station, via the nurse call system or low transmitting power mobile phone. PMID:18002453

  14. Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies

    PubMed Central

    Jeng, Long-Bin; Thorat, Ashok; Yang, Horng-Ren; Li, Ping-Chun

    2015-01-01

    The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed. PMID:26722643

  15. Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies.

    PubMed

    Jeng, Long-Bin; Thorat, Ashok; Yang, Horng-Ren; Li, Ping-Chun

    2015-12-24

    The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed. PMID:26722643

  16. Cerebral Venous Sinus Thrombosis and Venous Hemorrhagic Infarction in a Young Woman

    PubMed Central

    Choe, Yuri; Lee, Jun-Beom; Kim, Young-Jin

    2014-01-01

    Cerebral venous sinus thrombosis (CVST) is an uncommon cause of cerebral infarction, compared to arterial diseases. It is often unrecognized at initial presentation due to the diversity of causes and clinical manifestations. A 29-year-old female patient complained of severe headache and presented at the emergency room with altered consciousness. Brain computed tomography and brain magnetic resonance image revealed the left sigmoid sinus thrombosis with venous hemorrhagic infarction (VHI) in the left temporal lobe. The patient had no past medical and family history of bleeding diathesis. The laboratory finding at the admission showed severe iron-deficiency anemia (IDA), and protein C and S activities were decreased. After the neurosurgery, iron replacement, and neurorehabilitation, the patient had a good recovery. There has been no known recurrence. We report our therapeutic intervention on a very rare case of CVST and VHI, with IDA as a probable cause of cerebral thrombosis. PMID:25379501

  17. Comparison of external jugular and peripheral venous administration of sodium bicarbonate in puppies.

    PubMed

    Fleisher, G; Caputo, G; Baskin, M

    1989-03-01

    We compared the administration of sodium bicarbonate via a catheter inserted in the external jugular and extending to the junction with the subclavian vein (group 1) and a peripheral hindpaw vein (group 2) in puppies. During spontaneous cardiac activity, the increases in pH (0.12 +/- 0.04 in group 1 vs. 0.08 +/- 0.04 in group 2) and PCO2 (11 +/- 2.8 torr in group 1 vs. 6 +/- 3.2 torr in group 2) in blood from the right atrium 10 sec after the injection of bicarbonate differed significantly. However, the increases in pH (0.31 +/- 0.07 in group 1 vs. 0.30 +/- 0.15 in group 2) and PCO2 (86 +/- 33 torr in group 1 vs. 72 +/- 35 torr in group 2) in blood from the right atrium during closed chest CPR were similar in the two groups. We found that the sodium bicarbonate reached the central circulation more rapidly when administered in the external jugular vein as compared to a peripheral site, but this difference was small and did not reach the level of significance during CPR. Our findings do not provide evidence of any advantage to obtaining central venous access (a potentially complicated procedure) in children with cardiac arrest in regard to the delivery of medications to the heart. PMID:2537708

  18. Implantable Subcutaneous Venous Access Devices: Is Port Fixation Necessary? A Review of 534 Cases

    SciTech Connect

    McNulty, Nancy J. Perrich, Kiley D.; Silas, Anne M.; Linville, Robert M.; Forauer, Andrew R.

    2010-08-15

    Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study. We performed a retrospective review of the remaining 534 ports, which were placed using standard surgical technique with the exception that none were sutured into the pocket. Mean duration of port use, total number of port days, indications for removal, and complications were recorded and compared with the literature. Mean duration of port use was 341 days (182,235 total port days, range 1-1279). One port inversion/flip occurred, which resulted in malfunction and necessitated port revision (0.2%). Other complications necessitating port removal included infection 26 (5%), thrombosis n = 2 (<1%), catheter fracture/pinch n = 1 (<1%), pain n = 2 (<1%), and skin erosion n = 3 (1%). There were two arrhythmias at the time of placement; neither required port removal. The overall complication rate was 7%. The 0.2% incidence of port inversion we report is concordant with that previously published, although many previous reports do not specify if suture fixation of the port was performed. Suture fixation of the port, in our experience, is not routinely necessary and may negatively impact port removal.

  19. Local Intravascular Drug Delivery: In Vitro Comparison of Three Catheter Systems

    SciTech Connect

    Alfke, Heiko; Wagner, Hans-Joachim; Calmer, Christian; Klose, Klaus Jochen

    1998-01-15

    Purpose: The aim of this in vitro study was to compare different catheter systems for local drug delivery with respect to the penetration depth of a biotin marker solution delivered into the vessel wall. Methods: Post-mortem carotid arteries from pigs were locally infused with a biotin solution using three different catheter systems. With all catheters (microporous balloon catheter, hydrogel-coated balloon catheter, and spiral balloon catheter) we used the same pressure of 405 kPa (4 atm) and infusion times of 60, 90, and 300 sec. After infusion the arteries were histologically prepared and stained using a biotin-specific method. With a light microscope an observer, blinded to the catheter type, scored the amount of biotin within the vessel wall, measured as staining intensity, and the penetration depth of the biotin. Results: Delivery with the hydrogel-coated balloon catheter was limited to the intima and the innermost parts of the media. The spiral balloon and microporous balloon catheter showed both a deeper penetration and a larger amount of delivered biotin compared with the hydrogel catheter, with a slightly deeper penetration using the microporous catheter. The penetration depth showed a correlation with infusion time for the spiral balloon and microporous catheters, but not for the hydrogel-coated catheter. Conclusion: Different catheter designs lead to different patterns of local drug delivery. The differences in penetration depth and amount of the substance delivered to the vessel wall should be known and might be useful for targeting specific areas within the vessel wall.

  20. Venous stasis, deep venous thrombosis and airline flight: can the seat be fixed?

    PubMed

    Abramowitz, Harry B; Gertz, S David

    2007-05-01

    Deep venous thrombosis (DVT) and pulmonary embolization (PE) associated with air travel are directly related to the duration of flight and seating in non-aisle seats. In this study, we assessed a modification of a standard airline seat (NewSit) designed to decrease the incidence of DVT on long flights. This seat raises the feet from the floor, facilitates mobility, and permits intermittent calf compression. Air plethysmography (APG) was used to measure the ejected venous volume of the calves of 25 volunteers before and after sitting for 5 hours on the conventional and modified seats. The mean percent (+/- standard deviation [SD]) increase in venous volume for the conventional seat after 5 hours of continuous sitting was significantly greater than that for the modified seat (26.6 +/- 18.5% vs 3.5 +/- 13.1%, P < 0.0001 by paired, two-tailed t-test). Improvement (any) was seen in 23 of 25 patients, with 15 of the 23 (65%) being better than 1 SD of the mean (P < 0.0001 by Chi-square analysis). This study suggests that the leg movement and calf compression associated with the modified airline seat (NewSit) may decrease the probability of DVT due to prolonged periods of sitting by reducing venous stasis as measured by APG. Further studies involving a larger randomized patient cohort, as well as analysis of the effect of this modification on specific coagulation markers such as tissue plasminogen activator and fibrin D-dimer, are planned. PMID:17484958

  1. Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis

    PubMed Central

    Lupascu, Cristian; Darius, Tom; Goffette, Pierre; Lerut, Jan

    2015-01-01

    Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental) portal hypertension. PMID:26539214

  2. Provisional Matrix Deposition in Hemostasis and Venous Insufficiency: Tissue Preconditioning for Nonhealing Venous Ulcers

    PubMed Central

    Parker, Tony J.; Broadbent, James A.; McGovern, Jacqui A.; Broszczak, Daniel A.; Parker, Christina N.; Upton, Zee

    2015-01-01

    Significance: Chronic wounds represent a major burden on global healthcare systems and reduce the quality of life of those affected. Significant advances have been made in our understanding of the biochemistry of wound healing progression. However, knowledge regarding the specific molecular processes influencing chronic wound formation and persistence remains limited. Recent Advances: Generally, healing of acute wounds begins with hemostasis and the deposition of a plasma-derived provisional matrix into the wound. The deposition of plasma matrix proteins is known to occur around the microvasculature of the lower limb as a result of venous insufficiency. This appears to alter limb cutaneous tissue physiology and consequently drives the tissue into a ‘preconditioned’ state that negatively influences the response to wounding. Critical Issues: Processes, such as oxygen and nutrient suppression, edema, inflammatory cell trapping/extravasation, diffuse inflammation, and tissue necrosis are thought to contribute to the advent of a chronic wound. Healing of the wound then becomes difficult in the context of an internally injured limb. Thus, interventions and therapies for promoting healing of the limb is a growing area of interest. For venous ulcers, treatment using compression bandaging encourages venous return and improves healing processes within the limb, critically however, once treatment concludes ulcers often reoccur. Future Directions: Improved understanding of the composition and role of pericapillary matrix deposits in facilitating internal limb injury and subsequent development of chronic wounds will be critical for informing and enhancing current best practice therapies and preventative action in the wound care field. PMID:25785239

  3. [Ambulatory treatment of deep venous thrombosis].

    PubMed

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  4. Venous thromboembolism: a public health concern.

    PubMed

    Beckman, Michele G; Hooper, W Craig; Critchley, Sara E; Ortel, Thomas L

    2010-04-01

    Venous thromboembolism (VTE), defined as deep vein thrombosis, pulmonary embolism, or both, affects an estimated 300,000-600,000 individuals in the U.S. each year, causing considerable morbidity and mortality. It is a disorder that can occur in all races and ethnicities, all age groups, and both genders. With many of the known risk factors-advanced age, immobility, surgery, obesity-increasing in society, VTE is an important and growing public health problem. Recently, a marked increase has occurred in federal and national efforts to raise awareness and acknowledge the need for VTE prevention. Yet, many basic public health functions-surveillance, research, and awareness-are still needed. Learning and understanding more about the burden and causes of VTE, and raising awareness among the public and healthcare providers through a comprehensive public health approach, has enormous potential to prevent and reduce death and morbidity from deep vein thrombosis and pulmonary embolism throughout the U.S. PMID:20331949

  5. Cardiovascular Pressures with Venous Gas Embolism and Decompression

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.

    1995-01-01

    Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

  6. Cryo-balloon catheter position planning using AFiT

    NASA Astrophysics Data System (ADS)

    Kleinoeder, Andreas; Brost, Alexander; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) is the most common heart arrhythmia. In certain situations, it can result in life-threatening complications such as stroke and heart failure. For paroxsysmal AFib, pulmonary vein isolation (PVI) by catheter ablation is the recommended choice of treatment if drug therapy fails. During minimally invasive procedures, electrically active tissue around the pulmonary veins is destroyed by either applying heat or cryothermal energy to the tissue. The procedure is usually performed in electrophysiology labs under fluoroscopic guidance. Besides radio-frequency catheter ablation devices, so-called single-shot devices, e.g., the cryothermal balloon catheters, are receiving more and more interest in the electrophysiology (EP) community. Single-shot devices may be advantageous for certain cases, since they can simplify the creation of contiguous (gapless) lesion sets around the pulmonary vein which is needed to achieve PVI. In many cases, a 3-D (CT, MRI, or C-arm CT) image of a patient's left atrium is available. This data can then be used for planning purposes and for supporting catheter navigation during the procedure. Cryo-thermal balloon catheters are commercially available in two different sizes. We propose the Atrial Fibrillation Planning Tool (AFiT), which visualizes the segmented left atrium as well as multiple cryo-balloon catheters within a virtual reality, to find out how well cryo-balloons fit to the anatomy of a patient's left atrium. First evaluations have shown that AFiT helps physicians in two ways. First, they can better assess whether cryoballoon ablation or RF ablation is the treatment of choice at all. Second, they can select the proper-size cryo-balloon catheter with more confidence.

  7. Balloon catheter injury and vein graft morphology and function.

    PubMed

    Davies, M G; Dalen, H; Svendsen, E; Hagen, P O

    1996-09-01

    Endovascular interventions to salvage failing vein bypass grafts are often associated with suboptimal outcomes. This study examines the effect of experimental vein graft catheter injury on vein graft morphology and vasomotor function. Thirty New Zealand white rabbits underwent a right common carotid interposition vein bypass graft. Ten grafts were harvested at 14 days, 10 were harvested at 28 days, and 10 had a balloon catheter injury induced at 14 days (4 F Fogarty catheter, 0.6 to 0.75 ml water inflation, 3 passes) and these 10 grafts were harvested after an additional 14 days. Morphologic and morphometric determinations (n = 5) or in vitro contractile studies (n = 5) were performed on segments of the vein grafts. Intimal thickness, without any intervention, increased by 84% from 14 to 28 days (p < 0.01), whereas catheter injury at 14 days induced a twofold increase (p < 0.001) in the formation of intimal hyperplasia by 28 days. Scanning electron microscopy demonstrated near-complete endothelial denudation after balloon catheter injury. In the 14- and 28-day control vein grafts, and in the balloon-injured vein grafts, the vascular surfaces had confluent endothelial linings. However, the ultrastructural features of the endothelial cells were group specific. Transmission electron microscopy of the same specimens confirmed this. There were no significant differences in contractility between the 28-day control and the catheter-injured vein grafts. This study demonstrates that balloon catheter injury doubles the rate at which intimal hyperplasia develops in vein grafts without significantly altering the physiologic phenotype of the smooth muscle cells as defined by their vasomotor function. PMID:8905062

  8. Relative Changes of Cerebral Arterial and Venous Blood Volumes During Increased Cerebral Blood Flow

    E-print Network

    Duong, Timothy Q.

    Relative Changes of Cerebral Arterial and Venous Blood Volumes During Increased Cerebral Blood Flow-Gi Kim1* Measurement of cerebral arterial and venous blood volumes during increased cerebral blood flow is dependent only on venous blood, not arterial blood. Thus, relative venous and arterial blood volume (r

  9. [Venous thromboembolic risk during repatriation for medical reasons].

    PubMed

    Stansal, A; Perrier, E; Coste, S; Bisconte, S; Manen, O; Lazareth, I; Conard, J; Priollet, P

    2015-12-01

    In France, approximately 3000 people are repatriated every year, either in a civil situation by insurers. Repatriation also concerns French army soldiers. The literature is scarce on the topic of venous thromboembolic risk and its prevention during repatriation for medical reasons, a common situation. Most studies have focused on the association between venous thrombosis and travel, a relationship recognized more than 60 years ago but still subject to debate. Examining the degree of venous thromboembolic risk during repatriation for medical reasons must take into account several parameters, related to the patient, to comorbid conditions and to repatriation modalities. Appropriate prevention must be determined on an individual basis. PMID:26548535

  10. Total Anomalous Pulmonary Venous Connection to the Portal Vein

    SciTech Connect

    Wyttenbach, Marina; Carrel, Thierry; Schuepbach, Peter; Tschaeppeler, Heinz; Triller, Juergen

    1996-03-15

    Anomalous pulmonary venous return represents a rare congenital anomaly with wide anatomic and physiologic variability. We report a case of a newborn with a rare form of total infracardiac anomalous pulmonary venous connection (TAPVC). The pulmonary veins draining both lungs formed two vertical veins, which joined to a common pulmonary trunk below the diaphragm. This venous channel connected to the portal vein through the esophageal hiatus. The diagnosis was suggested by color Doppler sonography and confirmed by intravenous digital subtraction angiography, which allowed definition of the anatomy.

  11. Venous return and clinical hemodynamics: how the body works during acute hemorrhage.

    PubMed

    Shen, Tao; Baker, Keith

    2015-12-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of unstressed blood volume into stressed blood volume. We show that mobilization of unstressed blood volume is the predominant and more effective mechanism in preserving venous pressure. Preservation of mean circulatory filling pressure helps sustain venous return and thus cardiac output during significant hemorrhage. PMID:26628647

  12. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

    PubMed

    Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature. PMID:26501916

  13. Catheter ablation of supraventricular arrhythmias and atrial fibrillation.

    PubMed

    Shapira, Adam R

    2009-11-15

    Supraventricular arrhythmias are relatively common, often persistent, and rarely life-threatening cardiac rhythm disturbances that arise from the sinus node, atrial tissue, or junctional sites between the atria and ventricles. The term "supraventricular arrhythmia" most often is used to refer to supraventricular tachycardias and atrial flutter. The term "supraventricular tachycardia" commonly refers to atrial tachycardia, atrioventricular nodal reentrant tachycardia, and atrioventricular reciprocating tachycardia, an entity that includes Wolff-Parkinson-White syndrome. Atrial fibrillation is a distinct entity classified separately. Depending on the arrhythmia, catheter ablation is a treatment option at initial diagnosis, when symptoms develop, or if medical therapy fails. Catheter ablation of supraventricular tachycardias, atrial flutter, and atrial fibrillation offers patients high effectiveness rates, durable (and often permanent) therapeutic end points, and low complication rates. Catheter ablation effectiveness rates exceed 88 percent for atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, and atrial flutter; are greater than 86 percent for atrial tachycardia; and range from 60 to 80 percent for atrial fibrillation. Complication rates for supraventricular tachycardias and atrial flutter ablation are 0 to 8 percent. The complication rates for atrial fibrillation ablation range from 6 to 10 percent. Complications associated with catheter ablation result from radiation exposure, vascular access (e.g., hematomas, cardiac perforation with tamponade), catheter manipulation (e.g., cardiac perforation with tamponade, thromboembolic events), or ablation energy delivery (e.g., atrioventricular nodal block). PMID:19904893

  14. Rat Indwelling Urinary Catheter Model of Candida albicans Biofilm Infection

    PubMed Central

    Nett, Jeniel E.; Brooks, Erin G.; Cabezas-Olcoz, Jonathan; Sanchez, Hiram; Zarnowski, Robert; Marchillo, Karen

    2014-01-01

    Indwelling urinary catheters are commonly used in the management of hospitalized patients. Candida can adhere to the device surface and propagate as a biofilm. These Candida biofilm communities differ from free-floating Candida, exhibiting high tolerance to antifungal therapy. The significance of catheter-associated candiduria is often unclear, and treatment may be problematic considering the biofilm drug-resistant phenotype. Here we describe a rodent model for the study of urinary catheter-associated Candida albicans biofilm infection that mimics this common process in patients. In the setting of a functioning, indwelling urinary catheter in a rat, Candida proliferated as a biofilm on the device surface. Characteristic biofilm architecture was observed, including adherent, filamentous cells embedded in an extracellular matrix. Similar to what occurs in human patients, animals with this infection developed candiduria and pyuria. Infection progressed to cystitis, and a biofilmlike covering was observed over the bladder surface. Furthermore, large numbers of C. albicans cells were dispersed into the urine from either the catheter or bladder wall biofilm over the infection period. We successfully utilized the model to test the efficacy of antifungals, analyze transcriptional patterns, and examine the phenotype of a genetic mutant. The model should be useful for future investigations involving the pathogenesis, diagnosis, therapy, prevention, and drug resistance of Candida biofilms in the urinary tract. PMID:25183731

  15. Foley Catheter versus Vaginal Misoprostol for Labour Induction

    PubMed Central

    Noor, Nasreen; Ansari, Mehkat; Ali, S. Manazir; Parveen, Shazia

    2015-01-01

    Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25??g of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p < 0.01). The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley's catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour. PMID:26557725

  16. In vitro cardiac catheter navigation via augmented reality surgical guidance

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Moore, John; Wiles, Andrew; Lo, Jennifer; Wedlake, Chris; Peters, Terry M.

    2009-02-01

    Catheter-driven cardiac interventions have emerged in response to the need of reducing invasiveness associated with the traditional cut-and-sew techniques. Catheter manipulation is traditionally performed under real-time fluoroscopy imaging, resulting in an overall trade-off of procedure invasiveness for radiation exposure of both the patient and clinical staff. Our approach to reducing and potentially eliminating the use of flouroscopy in the operating room entails the use of multi-modality imaging and magnetic tracking technologies, wrapped together into an augmented reality environment for enhanced intra-procedure visualization and guidance. Here we performed an in vitro study in which a catheter was guided to specific targets located on the endocardial atrial surface of a beating heart phantom. "Therapy delivery" was modeled in the context of a blinded procedure, mimicking a beating heart, intracardiac intervention. The users navigated the tip of a magnetically tracked Freezor 5 CRYOCATH catheter to the specified targets. Procedure accuracy was determined as the distance between the tracked catheter tip and the tracked surgical target at the time of contact, and it was assessed under three different guidance modalities: endoscopic, augmented reality, and ultrasound image guidance. The overall RMS targeting accuracy achieved under augmented reality guidance averaged to 1.1 mm. This guidance modality shows significant improvements in both procedure accuracy and duration over ultrasound image guidance alone, while maintianing an overall targeting accuracy comparable to that achieved under endoscopic guidance.

  17. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise.

    PubMed

    Yagel, S; Kivilevitch, Z; Cohen, S M; Valsky, D V; Messing, B; Shen, O; Achiron, R

    2010-07-01

    The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise. PMID:20205158

  18. Upper extremity impedance plethysmography in patients with venous access devices.

    PubMed

    Horne, M K; Mayo, D J; Alexander, H R; Steinhaus, E P; Chang, R C; Whitman, E; Gralnick, H R

    1994-10-01

    Central venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for Vo; P = 0.0036 for Vo/Vc). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations. PMID:7878628

  19. Incidence of Venous Thromboembolic Events Among Nursing Home Residents

    PubMed Central

    Gomes, Josephine P; Shaheen, Wassim H; Truong, Son V; Brown, Edward F; Beasley, Brent W; Gajewski, Byron J

    2003-01-01

    Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint—development of a venous thromboembolic event (VTE)—were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation. PMID:14687280

  20. Current challenges in diagnostic imaging of venous thromboembolism.

    PubMed

    Huisman, Menno V; Klok, Frederikus A

    2015-12-01

    Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. In this review, we present 3 evidence-based patient cases to underline recent developments in the imaging diagnosis of venous thromboembolism. PMID:26637722