Changing concepts in long-term central venous access: catheter selection and cost savings.

PubMed

Horattas, M C; Trupiano, J; Hopkins, S; Pasini, D; Martino, C; Murty, A

2001-02-01

Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed ports. Furthermore, in an effort to control costs, many traditionally inpatient therapies have moved to an outpatient setting. This raises many questions regarding catheter selection. Which catheter will result in the best outcome at the least cost? It has become apparent in our hospital that traditionally placed surgical catheters (ie, Hickmans and central venous ports) may no longer be the only options. The objective of this study was to explore the various modalities for establishing central venous access comparing indications, costs, and complications to guide the clinician in choosing the appropriate catheter with the best outcome at the least cost. We evaluated our institution's central venous catheter use during a 3-year period from 1995 through 1997. Data was obtained retrospectively through chart review. In addition to demographic data, specific information regarding catheter type, placement technique, indications, complications, and catheter history were recorded. Cost data were obtained from several departments including surgery, radiology, nursing, anesthesia, pharmacy, and the hospital purchasing department. During a 30-month period, 684 attempted central venous catheter insertions were identified, including 126 surgically placed central venous catheters, 264 peripherally inserted central catheters by the nursing service, and 294 radiologically inserted peripheral ports. Overall complications were rare but tended to be more severe in the surgical group. Relative cost differences between the groups were significant. Charges for peripherally inserted

Cross sectional survey of ultrasound use for central venous catheter insertion among resident physicians.

PubMed

Nomura, Jason T; Sierzenski, Paul R; Nace, Jason E; Bollinger, Melissa

2008-07-01

Use of ultrasound guidance for Central Venous Catheter insertion has been associated with decreased complications and increased success rates. Previous reports show low rates of use among physicians. Evaluation of the frequency of Ultrasound Guidance use for Central Venous Catheter insertion among residents at a teaching institution. A cross sectional electronic survey of resident physicians at a tertiary care teaching hospital was conducted to evaluate use of Ultrasound Guidance for Central Venous Catheterization. Assessment included self reported frequency of ultrasound guidance use, and volume of central venous catheter placement. Attitudes toward the use of ultrasound were assessed using Likert scales. There is a high rate. over 90%, of ultrasound guidance use for Internal Jugular central venous catheters among residents. The majority of residents use sterile real-time imaging with a single operator with a reported success rate greater then 80%. Resident use of ultrasound guidance for Internal Jugular central venous catheter insertion can be much higher than previously reported in the literature.

Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax.

PubMed

Amir, Rabia; Knio, Ziyad O; Mahmood, Feroze; Oren-Grinberg, Achikam; Leibowitz, Akiva; Bose, Ruma; Shaefi, Shahzad; Mitchell, John D; Ahmed, Muneeb; Bardia, Amit; Talmor, Daniel; Matyal, Robina

2017-07-01

Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. We hypothesize that a combination of transthoracic echocardiography and lung ultrasound is noninferior to chest radiograph when used to accurately assess central venous catheter positioning and screen for pneumothorax. All operating rooms and surgical and trauma ICUs at the institution. Single-center, prospective noninferiority study. Patients receiving ultrasound-guided subclavian or internal jugular central venous catheters. During ultrasound-guided central venous catheter placement, correct positioning of central venous catheter was accomplished by real-time visualization of the guide wire and positive right atrial swirl sign using the subcostal four-chamber view. After insertion, pneumothorax was ruled out by the presence of lung sliding and seashore sign on M-mode. Data analysis was done for 137 patients. Chest radiograph ruled out pneumothorax in 137 of 137 patients (100%). Lung ultrasound was performed in 123 of 137 patients and successfully screened for pneumothorax in 123 of 123 (100%). Chest radiograph approximated accurate catheter tip position in 136 of 137 patients (99.3%). Adequate subcostal four-chamber views could not be obtained in 13 patients. Accurate positioning of central venous catheter with ultrasound was then confirmed in 121 of 124 patients (97.6%) as described previously. Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound can reduce central venous catheter insertion to use time, exposure to radiation, and improve patient safety.

Central Venous Catheter-related Fungemia Caused by Rhodotorula glutinis.

PubMed

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

2015-01-01

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

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

PubMed Central

2013-01-01

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

Evaluation of a central venous catheter tip placement for superior vena cava–subclavian central venous catheterization using a premeasured length

PubMed Central

Kwon, Hyun-Jung; Jeong, Young-Il; Jun, In-Gu; Moon, Young-Jin; Lee, Yu-Mi

2018-01-01

Abstract Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system. To evaluate the placement of the tip of the CVC in subclavian central venous catheterizations using the C-length, we reviewed the medical records and chest radiographs of 122 adult patients in whom CVC catheterization was performed (from January 2012 to December 2014) via the right subclavian vein using the C-length. The tips of all subclavian CVCs were placed in the SVC using the C-length. No subclavian CVC entered the right atrium. Tip placement was not affected by demographic characteristics such as age, sex, height, weight, and body mass index. The evidence indicates that the C-length on chest radiographs can be used to determine the available insertion length and place the right subclavian CVC tip into the SVC. PMID:29480861

[Prophylaxis of thrombosis induced by chemotherapy or central venous catheters].

PubMed

Voog, Eric; Lazard, Eric; Juhel, Laurence

2007-02-01

Deep venous thrombosis and pulmonary embolism are well-recognized complications of cancer, especially in patients with a venous access device or receiving chemotherapy. The pathogenic mechanisms of thrombosis in cancer patients involve a complex interaction between the patient's tumor cells and hemostatic system. Chemotherapy and central venous catheters increase the risk of thromboembolism. Prophylactic treatment for these patients remains controversial. We conducted a systematic literature review using the Medline database and abstract books for meetings of the American Society of Clinical Oncology and the American Society of Hematology since 2000. Our search focused on clinical trials of primary prevention of venous catheter-related thrombosis or prevention of chemotherapy-related venous thromboembolism in cancer patients. Ten studies evaluating primary prevention of patients with central catheters were identified, and their results are contradictory. Currently only one study has examined prevention of chemotherapy-related venous thromboembolism, in women with metastatic breast cancer. Its results cannot be extrapolated to other tumors. Systematic prophylaxis cannot yet be recommended. In the near future we must improve our knowledge of the risk factors of these complications. Prophylaxis should be individualized for each patient. New anticoagulant drugs should be tested in cancer patients.

Risk factors for venous thrombosis associated with peripherally inserted central venous catheters

PubMed Central

Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

2014-01-01

To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ≥1 risk factor was 10.34% (12/116), in those with ≥2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis. PMID:25664112

Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.

PubMed

Pikwer, Andreas; Acosta, Stefan; Kölbel, Tilo; Åkeson, Jonas

2010-01-01

This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization. Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively. Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route. Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.

Central venous catheterization for parenteral nutrition.

PubMed Central

Padberg, F T; Ruggiero, J; Blackburn, G L; Bistrian, B R

1981-01-01

To define the risks associated with central venous catheterization for total parenteral nutrition (TPN) 3291 patient days of this therapy, delivered by an established nutrition support team, were evaluated. One hundred and seventy-five catheters placed in 104 patients were reviewed over an 18 month period. Positive cultures were reported on 11 cannulae for a 6.4% incidence of colonization; five catheters (2.8%) were considered septic. Pleural or mediastinal complications of subclavian or internal jugular venipuncture occurred in eight patients (4.8%). Misdirection of the catheter tip occurred in 11.5% of insertions. Five patients (4.8%) had clinically apparent thrombosis in the superior vena cava, innominate and/or subclavian veins during hospitalization; four others had evidence of thrombosis at autopsy examination, giving an incidence of 8.7% in the entire series. No death directly resulted from the use of this therapy. Compliance with a rigid protocol by an experienced team can allow safe and effective use of central venous catheters and parenteral nutrition therapy. PMID:6782956

A concise history of central venous access.

PubMed

Beheshti, Michael V

2011-12-01

Central venous access has become a mainstay of modern interventional radiology practice. Its history has paralleled and enabled many current medical therapies. This short overview provides an interesting historical perspective of these increasingly common interventional procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

Central line-associated venous late effects in children without prior history of thrombosis.

PubMed

Ruud, Ellen; Holmstrøm, Henrik; Hopp, Einar; Wesenberg, Finn

2006-09-01

The frequency of asymptomatic central line-associated thromboses is high and well recognized among children with cancer, while the long-term consequences are mainly unknown. In a cross-sectional study, we evaluated clinical and radiological venous outcome in children with previous long-standing intravascular catheters. The study enrolled 71 children previously treated for malignant or haematological diseases, 4-180 (median 37) mo after removal of their central lines. Inclusion criteria were a prior central line in a jugular vein for a minimum of 6 mo and no previous history of thrombosis. The children had clinical examination for post-thrombotic syndrome (PTS) and Doppler ultrasonography of the central neck veins. Twelve children had additional venous magnetic resonance imaging (MRI). But no kind of venography was performed in the remaining. We observed mild PTS with increased superficial collaterals in four children (6%), but no cases of more severe PTS. None complained of symptoms related to venous late effects. By ultrasonography, post-thrombotic venous alterations were detected in 17 children (24%), and five of these had complete occlusion of the veins. The sensitivity for pathologically increased collaterals to identify occlusive thrombosis was 0.6, while the specificity was 0.98. Occlusive venous thromboembolism was associated with the total number of central venous lines (CVLs; p=0.002), previous severe CVL-associated infections (p=0.001) and duration of central line in place (p=0.042). In spite of no prior history of thrombosis, children with previous long-term jugular lines frequently had local thrombotic sequelae, while clinical symptoms of PTS were rare.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Teichgraeber, Ulf Karl-Martin, E-mail: ulf.teichgraeber@charite.de; Streitparth, Florian, E-mail: florian.streitparth@charite.d; Gebauer, Bernhard, E-mail: bernhard.gebauer@charite.d

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 whenmore » 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.« less

Central Venous Catheter Insertion Site and Colonization in Pediatric Cardiac Surgery

ClinicalTrials.gov

2017-11-04

Central Line-associated Bloodstream Infection (CLABSI); Central Venous Catheter Associated Bloodstream Infection; Heart; Surgery, Heart, Functional Disturbance as Result; Congenital Heart Disease; Newborn; Infection

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

PubMed Central

2014-01-01

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

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

PubMed

Helder, Onno; Kornelisse, René; van der Starre, Cynthia; Tibboel, Dick; Looman, Caspar; Wijnen, René; Poley, Marten; Ista, Erwin

2013-10-14

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. 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. 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. Dutch trials registry (http://www.trialregister.nl), trial # 3635.

Central venous catheter-associated bloodstream infections in a pediatric intensive care unit: effect of the location of catheter insertion.

PubMed

Krishnaiah, Anil; Soothill, James; Wade, Angie; Mok, Quen Q; Ramnarayan, Padmanabhan

2012-05-01

To compare the rate of central venous catheter-associated bloodstream infections between pediatric intensive care unit admissions where central venous catheters were inserted within the same hospital (internal central venous catheters) and those where central venous catheters were inserted before transfer from other hospitals (external central venous catheters). Retrospective analysis of prospectively collected data. A tertiary care pediatric intensive care unit in London, UK. Consecutive pediatric intensive care unit admissions between May 2007 and March 2009. None. Catheter-associated bloodstream infections were identified using a widely accepted surveillance definition. The rate and time to occurrence of catheter-associated bloodstream infection were compared between internal and external nontunneled central venous catheters. A multilevel Cox-regression model was used to study the association between location of central venous catheter insertion and time to catheter-associated bloodstream infection. In total, 382 central venous catheters were studied (245 internal; 137 external) accounting for a total of 1,737 central venous catheter days. There was a higher catheter-associated bloodstream infection incidence density among external central venous catheters (23.1 [95% confidence interval 11.0-35.2] vs. 9.7 [95% confidence interval 3.9-15.5] per 1,000 catheter-days). Multivariable analyses demonstrated higher infection risk with external central venous catheters (hazard ratio 2.65 [95% confidence interval 1.18-5.96]) despite adjustment for confounding variables. The rate of catheter-associated bloodstream infections in the pediatric intensive care unit is significantly affected by external insertion of the central venous catheter. Future interventions to reduce nosocomial infections on pediatric intensive care units will need to be specifically targeted at this high-risk patient group.

[Delayed (tension) pneumothorax after placement of a central venous catheter].

PubMed

Tan, E C; van der Vliet, J A

1999-09-11

Laborious attempts at introducing a central venous catheter for parenteral nutrition in two women, aged 36 and 62 years, were followed by shortness of breath after 32 and 10 hours, respectively. This symptom was due to a (tension) pneumothorax not visible on earlier roentgenograms. Thoracic drainage led to recovery. In all patients with a central venous catheter an undetected delayed pneumothorax can be present. Urgent chest X-ray examination should be performed in all patients with acute respiratory symptoms. Patients undergoing elective intubation with positive pressure breathing should be examined carefully, since they are at risk of developing a late (tension) pneumothorax.

Central venous catheter infection-related glomerulonephritis under long-term parenteral nutrition: a report of two cases.

PubMed

Okada, Mari; Sato, Mai; Ogura, Masao; Kamei, Koichi; Matsuoka, Kentaro; Ito, Shuichi

2016-03-31

Advances in long-term parenteral nutrition via indwelling central venous catheter have improved the quality of life and mortality in patients with life-threatening gastrointestinal diseases complicated with severely impaired absorption. However, infection to central venous catheter is still a common and critical complication for such patients. We encountered two patients under long-term parenteral nutrition who developed glomerulonephritis associated with central venous catheter infection. Persistent bacterial infection in indwelling medical devices placed in the blood-stream such as a ventricular-atrial shunt is known to cause glomerulonephritis, a condition termed shunt nephritis. We reported the clinical manifestations, treatment and their pathological findings in the two patients with glomerulonephritis associated with central venous catheter infection. Both patients suffered from megacystis microcolon intestinal hypoperistalsis syndrome, a form of pseudo-Hirschsprung's disease. They had been receiving home parenteral nutrition via central venous catheter because of severe malabsorption. They presented proteinuria, hematuria, hypocomplementemia and positive PR3-antineutrophilic cytoplasmic antibody accompanied by Staphylococcus epidermidis infection in the central venous catheter. Their renal biopsy revealed membranoproliferative glomerulonephritis with positive C3 deposition. One of them recovered completely following the removal of catheter and administration of antibiotics, while another did not respond to the treatments. We then treated her with methylprednisolone pulse therapy followed by prednisolone. She responded well, and achieved complete remission. As central venous catheter infection-related glomerulonephritis has a similar etiology to shunt nephritis, removal of the catheter and administration of antibiotics is fundamental to the treatment. If a patient is resistant to such conventional therapy, additional steroid and/or immunosuppressive agent

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

NASA Technical Reports Server (NTRS)

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

1978-01-01

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

Characterization of central venous catheter-associated deep venous thrombosis in infants.

PubMed

Gray, Brian W; Gonzalez, Raquel; Warrier, Kavita S; Stephens, Lauren A; Drongowski, Robert A; Pipe, Steven W; Mychaliska, George B

2012-06-01

Deep venous thrombosis (DVT) is a frequent complication in infants with central venous catheters (CVCs). We performed this study to identify risk factors and risk-reduction strategies of CVC-associated DVT in infants. Infants younger than 1 year who had a CVC placed at our center from 2005 to 2009 were reviewed. Patients with ultrasonically diagnosed DVT were compared to those without radiographic evidence. Of 333 patients, 47% (155/333) had femoral, 33% (111/333) had jugular, and 19% (64/333) had subclavian CVCs. Deep venous thromboses occurred in 18% (60/333) of patients. Sixty percent (36/60) of DVTs were in femoral veins. Femoral CVCs were associated with greater DVT rates (27%; 42/155) than jugular (11%; 12/111) or subclavian CVCs (9%; 6/64; P < .01). There was a 16% DVT rate in those with saphenofemoral Broviac CVCs vs 83% (20/24) in those with percutaneous femoral lines (P < .01). Multilumen CVCs had higher DVT rates than did single-lumen CVCs (54% vs 6%, P < .01), and mean catheter days before DVT diagnosis was shorter for percutaneous lines than Broviacs (13 ± 17 days vs 30 ± 37 days, P = .02). Patients with +DVT had longer length of stay (86 ± 88 days vs 48 ± 48 days, P < .01) and higher percentage of intensive care unit admission (82% vs 70%, P = .02). Deep venous thrombosis reduction strategies in infants with CVCs include avoiding percutaneous femoral and multilumen CVCs, screening percutaneous lines, and early catheter removal. Copyright © 2012 Elsevier Inc. All rights reserved.

DKA, CVL and DVT. Increased risk of deep venous thrombosis in children with diabetic ketoacidosis and femoral central venous lines.

PubMed

Davis, J; Surendran, T; Thompson, S; Corkey, C

2007-01-01

Incidence of type 1 diabetes mellitus is continuing to rise in children. The presentation of diabetic ketoacidosis (DKA) in children with newly diagnosed diabetes is significantly higher in those less than 5 years old. Critically ill patients admitted to Paediatric Intensive Care Units (PICU), would have a central venous line (CVL) inserted as part of their ongoing management. There are associations linking with the development of deep venous thrombosis (DVT) in DKA/CVL patients. An 18-month-old boy presented with a short history of polydypsia, polyuria and weight loss. The initial blood sugar was 27.0 mmol/L and a venous blood gas showed severe metabolic acidosis. He was diagnosed and treated for DKA. He was transferred to the regional PICU for further management. There, a central venous line (CVL) was inserted in his left femoral vein. This was removed on Day 4. Subsequently, he developed a swelling on his left leg, with significant discrepancy in leg circumference. Doppler ultrasound confirmed a deep venous thrombosis. Conclusion Diabetes has a propensity for hypercoagulability and DKA promotes a prothrombotic state. Retrospective studies have shown younger patients with DKA and a femoral CVL are at higher risk of developing DVT. A central femoral line should avoided in such patients. DVT prophylaxis and Doppler follow up should also be considered.

Pinch-off syndrome: transection of implantable central venous access device.

PubMed

Sugimoto, Takuya; Nagata, Hiroshi; Hayashi, Ken; Kano, Nobuyasu

2012-11-30

As the population of people with cancer increases so does the number of patients who take chemotherapy. Majority of them are administered parentally continuously. Implantable central venous catheter device is a good choice for those patients; however, severe complication would occur concerning the devices. Pinch-off syndrome is one of the most severe complications. The authors report a severe case of pinch-off syndrome. The patient with the implantable central venous device could not take chemotherapy because the device occluded. Further examination revealed the transection of the catheter. The transected fragment of the catheter in the heart was successfully removed by using a loop snare placed through the right femoral vein.

Human cerebral venous outflow pathway depends on posture and central venous pressure

PubMed Central

Gisolf, J; van Lieshout, J J; van Heusden, K; Pott, F; Stok, W J; Karemaker, J M

2004-01-01

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R2 = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins. PMID:15284348

Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation.

PubMed

Lang, Elvira V; Reyes, Jorge; Faintuch, Salomao; Smith, Amy; Abu-Elmagd, Kareem

2005-09-01

To assess feasibility and success of venous recanalization in patients with short gut syndrome who have lost their traditional central venous access and required intestinal or multivisceral transplantation. Twelve patients between the ages of 7 and 55 years with short gut syndrome and long-standing total parenteral nutrition (TPN) dependency and/or hypercoagulability were treated. All had extensive chronic central venous occlusions and survival was dependent on restoration of access and planned transplantation. Central venous recanalizations were obtained via sharp needle recanalization techniques, venous reconstructions with stents, and/or extraanatomic access to the central venous system for placement of central venous tunneled catheters. Central venous access was restored in all patients without operative-related mortality. Three major hemodynamic perioperative technical complications were recorded and successfully treated. There were three self-limited early infectious complications. With a mean follow-up of 22 months, eight of the 12 patients were alive with successful small bowel or multivisceral transplantation; six of those became independent of TPN. The remaining four patients died of complications related to TPN (n = 3) or transplantation (n = 1). With a mean follow-up of 20 months, all but two of the recanalized venous accesses were maintained, for a success rate of 83%. Recanalizations of extensive chronic vein occlusions are feasible but associated with high risk. The technique is life-saving for TPN-dependent patients and can restore candidacy for intestinal and multivisceral transplantation. This approach is likely to be increasingly requested because of the current clinical availability of the transplant procedure.

Creating and evaluating a data-driven curriculum for central venous catheter placement.

PubMed

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

2010-09-01

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

Laser Recanalization of Central Venous Occlusion to Salvage a Threatened Arteriovenous Fistula.

PubMed

Rambhia, Sagar; Janko, Matthew; Hacker, Robert I

2018-07-01

Central venous occlusion is conventionally managed with balloon angioplasty, stent extension, or sharp recanalization. Here, we describe recanalization of a chronically occluded innominate vein using excimer laser after conventional techniques were unsuccessful. Patient clinical improvement and fistula patency have been sustained 2 years postintervention. This technique may provide new hemodialysis access options for patients who would not otherwise be candidates for hemodialysis access on the ipsilateral side of a central venous occlusion. Copyright © 2018 Elsevier Inc. All rights reserved.

Management of end-stage central venous access in children referred for possible small bowel transplantation.

PubMed

Rodrigues, A F; van Mourik, I D M; Sharif, K; Barron, D J; de Giovanni, J V; Bennett, J; Bromley, P; Protheroe, S; John, P; de Ville de Goyet, J; Beath, S V

2006-04-01

The 3-year survival after small bowel transplantation (SBTx) has improved to between 73% and 88%. Impaired venous access for parenteral nutrition can be an indication for SBTx in children with chronic intestinal failure. To report our experience in management of children with extreme end-stage venous access. The study consisted of 6 children (all boys), median age of assessment 27 months (range, 13-52 months), diagnosed with total intestinal aganglionosis (1), protracted diarrhea (1), and short bowel syndrome (4), of which gastroschisis (2) and malrotation with midgut volvulus (2) were the causes. All had a documented history of more than 10 central venous catheter insertions previously. All had venograms, and 1 child additionally had a magnetic resonance angiogram to evaluate venous access. Five of 6 presented with thrombosis of the superior vena cava (SVC) and/or inferior vena cava. Venous access was reestablished as follows: transhepatic venous catheters (5), direct intra-atrial catheter via midline sternotomy (4), azygous venous catheters (2), dilatation of left subclavian vein after passage of a guide wire and then placing a catheter to reach the right atrium (1), radiological recanalization of the SVC and placement of a central venous catheter in situ (1), and direct puncture of SVC stump(1). Complications included serous pleural effusion after direct intra-atrial line insertion, which resolved after chest drain insertion (1), displacement of transhepatic catheter needing repositioning (2), and SVC stent narrowing requiring repeated balloon dilatation. Four children with permanent intestinal failure on assessment were offered SBTx, 3 of which were transplanted and were established on full enteral nutrition; the family of 1 child declined the procedure. In the remaining 2 children in whom bowel adaptation was still a possibility, attempts were made to provide adequate central venous access as feeds and drug manipulations were undertaken. One of them received

Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography?

PubMed

Alonso-Quintela, Paula; Oulego-Erroz, Ignacio; Rodriguez-Blanco, Silvia; Muñiz-Fontan, Manoel; Lapeña-López-de Armentia, Santiago; Rodriguez-Nuñez, Antonio

2015-11-01

To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning. Prospective observational study. PICU of a university hospital. Patients aged 0-14 who required a central venous catheter. None. Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (κ coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (κ coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001). Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety.

[Port device central venous access in children with chronic renal disease--personal experience].

PubMed

Szczepańska, Maria; Szprynger, Krystyna; Stoksik, Piotr; Morawiec-Knysak, Aurelia; Adamczyk, Piotr; Ziora, Katarzyna; Oswiecimska, Joanna

2006-01-01

The application of central venous lines in children has been widely accepted in the case of pediatric cancer treatment. This is of particular importance when the treatment must be continued during the long period of time. The indication to long-term application of central venous lines became significantly frequent within last years. They are necessary in the treatment of chronic pediatric patients, in whom the central venous line allows continuous access for medication, parenteral rehydration, nutrition and frequent blood sampling. In the current study authors present their experience in subcutaneous port devices application in children with kidney disease. The case history data obtained from 8 children were retrospectively analysed. In these children subcutaneous port devices were applied for mean 26.7 months (totally 9 port devices). The mean age at the time of implantation was 2.2 years, and the mean body weight--10.6 kg. Peripheral venous access in all children was bad. In one child during the time of implantation the hematoma of coli and chest was present. Infectious complications connected with implanted port device were not detected. Thrombotic complications were present in 6 children with chronic renal failure--in 5 the lumen of port device has been successfully recanalysed, in 3 cases even several times. In 1 child the thrombus on the tip of central venous line was detected. In 2 children the removal of port device was necessary because of breakage of venous line and in the second case because of port device thrombosis. Two children died with functioning port device. The cause of death was not connected with implanted port device. The application of subcutaneous port devices definitely improved the comfort of treatment but was significantly associated with thrombotic complications. Infectious complications were not detected as compared to hematological group of patients.

Knowledge of nursing students about central venous catheters.

PubMed

Mlinar, Suzana; Malnarsić, Rosanda Rasković

2012-04-01

Central venous catheters (CVC) are at the crucial importance, particulary in the intensive therapy units. In order to handle a CVC safely, nursing students need to acquire theoretical and practical knowledge during the course of their studies. The aim of the study was to establish theoretical knowledge of nursing students about the procedures of nurses in placing and removing a central venous catheter (CVC), dressing the catheter entry point, the reasons for measuring central venous pressure (CVP), possible complications and risk factors for developing infections related to CVC. The questionnaire developed specifically for this cross-sectionl study was handed out to 87 full-time students and 57 part-time students. The results show that all the surveyed nursing students know why chest radiography is carried out when inserting a catheter, have relatively good knowledge of CVC insertion points, procedures carried out in case of a suspected catheter sepsis and complications and risk factors for the development of infections related to CVC. However, the study show that the majority of students have insufficient knowledge of the procedures accompanying insertion of a catheter, signs that indicate correct functioning of CVC, frequency of flushing a catheter when it is not in use and the reasons for introducing an implanted CVC. Based on the results of the study it can be concluded that the second-year nursing students have insufficient knowledge of CVC. In order to correctly and safely handle a CVC, good theoretical knowledge and relevant practical experience are needed. The authors therefore believe that, in future, the classes should be organized in smaller groups with step-by-step demonstrations of individual procedures in handling a CVC, and the students encouraged to learn as actively as possible.

[Femoral arteriovenous fistula: a late uncommon complication of central venous catheterization].

PubMed

Conz, P A; Malagoli, A; Normanno, M; Munaro, D

2007-01-01

A 77-year-old woman was admitted due to AV graft thrombosis; given the technical impossibility of performing other native AV fistulas, we chose to insert a tunnelled central venous catheter. Considering the vascular history of the patient, the central venous catheter could not be placed into the internal jugular vein; it was therefore put into the left femoral vein. Following a 3-month-period of the catheter working properly, the patient was hospitalized due to sudden acute pain in the left thigh. In a few days the patient developed an important haematoma with serious anemization in the left lower limb. Ultrasonography showed the presence of a fistula between the left common femoral artery and the femoral vein, leading to the subsequent successful positioning of a stent into the common femoral artery through right trans-femoral access. Angiography examination showed the femoral vein patency along the proximal stretch with respect to the function of the tunnelled venous catheter.

Assistive technology for ultrasound-guided central venous catheter placement.

PubMed

Ikhsan, Mohammad; Tan, Kok Kiong; Putra, Andi Sudjana

2018-01-01

This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

Risk factors for upper extremity venous thrombosis associated with peripherally inserted central venous catheters.

PubMed

Marnejon, Thomas; Angelo, Debra; Abu Abdou, Ahmed; Gemmel, David

2012-01-01

To identify clinically important risk factors associated with upper extremity venous thrombosis following peripherally inserted central venous catheters (PICC). A retrospective case control study of 400 consecutive patients with and without upper extremity venous thrombosis post-PICC insertion was performed. Patient data included demographics, body mass index (BMI), ethnicity, site of insertion, size and lumen of catheter, internal length, infusate, and co-morbidities, such as diabetes mellitus, congestive heart failure, and renal failure. Additional risk factors analyzed were active cancer, any history of cancer, recent trauma, smoking, a history of prior deep vein thrombosis, and recent surgery, defined as surgery within three months prior to PICC insertion. The prevalence of trauma, renal failure, and infusion with antibiotics and total parenteral nutrition (TPN) was higher among patients exhibiting upper extremity venous thrombosis (UEVT), when compared to controls. Patients developing UEVT were also more likely to have PICC line placement in a basilic vein and less likely to have brachial vein placement (P<.001). Left-sided PICC line sites also posed a greater risk (P=.026). The rate of standard DVT prophylaxis with low molecular weight heparin and unfractionated heparin and the use of warfarin was similar in both groups. Average length of hospital stay was almost double among patients developing UEVT, 19.5 days, when compared to patients undergoing PICC line insertion without thrombosis, 10.8 days (t=6.98, P<.001). In multivariate analysis, trauma, renal failure, left-sided catheters, basilic placement, TPN, and infusion with antibiotics, specifically vancomycin, were significant risk factors for UEVT associated with PICC insertion. Prophylaxis with low molecular weight heparin, unfractionated heparin or use of warfarin did not prevent the development of venous thrombosis in patients with PICCs. Length of hospital stay and cost are markedly increased in

Placement of Upper Extremity Arteriovenous Access in Patients with Central Venous Occlusions: A Novel Technique.

PubMed

Murga, Allen G; Chiriano, Jason T; Bianchi, Christian; Sheng, Neha; Patel, Sheela; Abou-Zamzam, Ahmed M; Teruya, Theodore H

2017-07-01

Central venous occlusion is a common occurrence in patients with end-stage renal disease. Placement of upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins is often not an option. Avoidance of lower extremity vascular access can decrease morbidity and infection. The central venous lesions were crossed centrally via femoral access. The wire was retrieved in the neck extravascularly. A Hemodialysis Reliable Outflow catheter was then placed in the right atrium and completed with an arterial anastomosis. We describe a novel technique for placing upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins. This technique was utilized in 3 patients. The technical success was 100%. The placement of upper extremity arteriovenous access in patients with central venous occlusions is technically feasible. Published by Elsevier Inc.

Endovascular treatment of central venous stenosis and obstruction in hemodialysis patients.

PubMed

Shi, Ya-xue; Ye, Meng; Liang, Wei; Zhang, Hao; Zhao, Yi-ping; Zhang, Ji-wei

2013-02-01

Central venous stenosis and obstruction (CVD) is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients. This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients. Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively. Eighteen males and six females with mean age of (66.4 ± 13.8) years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization. Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction. Interventional therapy was performed and the technique success rate was 83.3%. Percutaneous transluminal angioplasty (PTA) was performed in nine cases and stent was performed in 11 cases firstly. The symptoms of venous hypertension were resolved after intervention in all the cases. There was no major complication and death perioperatively. During follow-up, reintervention was done, the primary patency rates were (88.9 ± 10.5)%, (64.8 ± 10.5)% and (48.6 ± 18.7)% at 3 months, 6 months and 1 year after treatment in the PTA group; (90.0 ± 9.5)% and (77.1 ± 14.4)% at 6 months and 1 year after treatment in the stent group, respectively. The secondary patency rates were (48.6 ± 18.7)% in the PTA group and (83.3 ± 15.2)% in the stent group 1 year after treatment, respectively. There was no significant difference between the two groups (primary patency, P = 0.20; secondary patency, P = 0

Venous thrombosis and stenosis after peripherally inserted central catheter placement in children.

PubMed

Shin, H Stella; Towbin, Alexander J; Zhang, Bin; Johnson, Neil D; Goldstein, Stuart L

2017-11-01

Peripherally inserted central catheters (PICCs) can lead to development of venous thrombosis and/or stenosis. The presence of venous thrombosis and/or stenosis may preclude children with chronic medical conditions from receiving lifesaving therapies, from hemodialysis in end-stage renal disease to total parenteral nutrition in short bowel syndrome. Several adult studies have found an association between PICCs and venous thrombosis and/or stenosis, but none has evaluated for this association in children. To determine the incidence of venous thrombosis and/or stenosis after PICC placement and identify factors that increase the risk of venous thrombosis and/or stenosis after PICC placement in children. We conducted a retrospective review of children ages 1-18 years with a PICC placed between January 2010 and July 2013 at our center, and included those who had at least one vascular imaging study of the ipsilateral extremity (Doppler ultrasound, venogram or MR angiogram) after PICC placement. Logistic regression was applied to determine risk factors for development of venous thrombosis and/or stenosis. One thousand, one hundred and ten upper extremity PICCs were placed, with 703 PICCs in the right and 407 PICCs in the left. Eight hundred fifty-one imaging studies (609 Doppler ultrasounds, 193 contrast venograms and 49 MR angiograms) were performed in 376 patients. The incidence of venous thrombosis and/or stenosis in the imaged cohort was 26.3%. PICC laterality, insertion site, duration, patient height to PICC diameter ratio, and number of PICCs per patient were not associated with development of venous thrombosis and/or stenosis. Additionally, primary diagnosis and symptoms at the time of imaging did not predict findings of venous thrombosis and/or stenosis. However, patients exposed to non-PICC central venous catheters (CVC) were more likely to develop venous thrombosis and/or stenosis (odds ratio 1.95, 1.10-3.45). More than a quarter of the vascular imaging studies

Central venous access in children: indications, devices, and risks.

PubMed

Ares, Guillermo; Hunter, Catherine J

2017-06-01

Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation. Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs. Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.

Use of Nitinol Stents Following Recanalization of Central Venous Occlusions in Hemodialysis Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.on.ca; Saluja, Jasdeep S.

2007-07-15

Purpose. To retrospectively review the patency of endovascular interventions with nitinol stent placement for symptomatic central venous occlusions in hemodialysis patients. Methods. A retrospective review of all patients who underwent endovascular interventions for dysfunctional hemodialysis grafts and fistulas was performed from April 2004 to August 2006. A total of 6 patients presented with arm and/or neck and facial swelling and left brachiocephalic vein occlusion. The study group consisted of 3 men and 3 women with a mean age of 79.5 years (SD 11.2 years). Of these 6 patients, 1 had a graft and 5 had fistulas in the left arm.more » The primary indication for nitinol stent placement was technical failure of angioplasty following successful traversal of occluded central venous segments. Patency was assessed from repeat fistulograms and central venograms performed when patients redeveloped symptoms or were referred for access dysfunction determined by the ultrasound dilution technique. No patients were lost to follow-up. Results. Nitinol stent placement to obtain technically successful recanalization of occluded venous segments was initially successful in 5 of 6 patients (83%). In 1 patient, incorrect stent positioning resulted in partial migration to the superior vena cava requiring restenting to prevent further migration. Clinical success was observed in all patients (100%). Over the follow-up period, 2 patients underwent repeat intervention with angioplasty alone. Primary patency was 83.3% (95% CI 0.5-1.2) at 3 months, and 66.7% at 6 and 12 months (0.2-1.1, 0.1-1.2). Secondary patency was 100% at 12 months with 3 patients censored over that time period. Mean primary patency was 10.4 months with a mean follow-up of 12.4 months. No complications related to recanalization of the occluded central venous segments were observed. Conclusion. Our initial experience has demonstrated that use of nitinol stents for central venous occlusion in hemodialysis patients is

Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy

PubMed Central

Fang, Shirong; Yang, Jinhong; Song, Lei; Jiang, Yan; Liu, Yuxiu

2017-01-01

Background Central venous catheters (CVCs) have been an effective access for chemotherapy instead of peripherally intravenous catheters. There were limited studies on the choices and effects of different types of CVCs for chemotherapy. The aim of this study was to compare the complications, cost, and patients’ quality of life and satisfaction of three commonly used CVCs for chemotherapy, such as implanted venous port, peripherally inserted central catheters (PICCs), and external non-tunneled central venous catheters (NTCs). Methods A double-center prospective cohort study was carried out from March 2014 to December 2016. Catheterization situation, complications, catheter maintenance, cost, and patients’ quality of life and satisfaction were recorded, investigated, and analyzed. Forty-five ports, 60 PICCs and 40 NTCs were included. All the CVCs were followed up to catheter removal. Results There was no statistical difference in catheterization success rates between port and PICC. NTC had less success rate by one puncture compared with port. Ports had fewer complications compared with PICCs and NTCs. The complication rates of ports, PICCs and NTCs were 2.2%, 40%, and 27.5%, respectively. If the chemotherapy process was <12 months, NTCs cost least, and the cost of port was much higher than PICC and NTC. When the duration time was longer than 12 months, the cost of port had no difference with the cost of PICC. Quality of life and patients’ satisfaction of port group were significantly higher than the other two groups. Conclusion Although port catheterization costs more and needs professional medical staff and strict operational conditions, ports have fewer complications and higher quality of life and patients’ satisfaction than PICCs and NTCs. Therefore, not following consideration of the economic factor, we recommend port as a safe and an effective chemotherapy access for cancer patients, especially for whom needing long chemotherapy process. PMID:28744109

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.

Effect of hepatic venous sphincter contraction on transmission of central venous pressure to lobar and portal pressure.

PubMed

Lautt, W W; Legare, D J; Greenway, C V

1987-11-01

In dogs anesthetized with pentobarbital, central vena caval pressure (CVP), portal venous pressure (PVP), and intrahepatic lobar venous pressure (proximal to the hepatic venous sphincters) were measured. The objective was to determine some characteristics of the intrahepatic vascular resistance sites (proximal and distal to the hepatic venous sphincters) including testing predictions made using a recent mathematical model of distensible hepatic venous resistance. The stimulus used was a brief rise in CVP produced by transient occlusion of the thoracic vena cava in control state and when vascular resistance was elevated by infusions of norepinephrine or histamine, or by nerve stimulation. The percent transmission of the downstream pressure rise to upstream sites past areas of vascular resistance was elevated. Even small increments in CVP are partially transmitted upstream. The data are incompatible with the vascular waterfall phenomenon which predicts that venous pressure increments are not transmitted upstream until a critical pressure is overcome and then further increments would be 100% transmitted. The hepatic sphincters show the following characteristics. First, small rises in CVP are transmitted less than large elevations; as the CVP rises, the sphincters passively distend and allow a greater percent transmission upstream, thus a large rise in CVP is more fully transmitted than a small rise in CVP. Second, the amount of pressure transmission upstream is determined by the vascular resistance across which the pressure is transmitted. As nerves, norepinephrine, or histamine cause the hepatic sphincters to contract, the percent transmission becomes less and the distensibility of the sphincters is reduced. Similar characteristics are shown for the "presinusoidal" vascular resistance and the hepatic venous sphincter resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Injuries to blood vessels near the heart caused by central venous catheters].

PubMed

Abram, J; Klocker, J; Innerhofer-Pompernigg, N; Mittermayr, M; Freund, M C; Gravenstein, N; Wenzel, V

2016-11-01

Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible. The subclavian catheter is at a somewhat lower risk of catheter-associated sepsis and symptomatic venous thrombosis than approaches via the internal jugular and femoral veins. Indeed, access via the subclavian vein carries a substantial risk of pneumo- and hemothorax. Damage to the subclavian vein or artery can also occur during deliberate and inadvertent punctures and result in life-threatening complications. Therefore, careful consideration of the access route is required in relation to the patient and the clinical situation, to keep the incidence of complications as low as possible. For catheterization of the subclavian vein, puncture of the axillary vein in the infraclavicular fossa is a good alternative, because ultrasound imaging of the target vessel is easier than in the subclavian vein and the puncture can be performed much further from the lung.

Optoacoustic monitoring of central and peripheral venous oxygenation during simulated hemorrhage

NASA Astrophysics Data System (ADS)

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

2014-03-01

Circulatory shock may be fatal unless promptly recognized and treated. The most commonly used indicators of shock (hypotension and tachycardia) lack sensitivity and specificity. In the initial stages of shock, the body compensates by reducing blood flow to the peripheral (skin, muscle, etc.) circulation in order to preserve vital organ (brain, heart, liver) perfusion. Characteristically, this can be observed by a greater reduction in peripheral venous oxygenation (for instance, the axillary vein) compared to central venous oxygenation (the internal jugular vein). While invasive measurements of oxygenation are accurate, they lack practicality and are not without complications. We have developed a novel optoacoustic system that noninvasively determines oxygenation in specific veins. In order to test this application, we used lower body negative pressure (LBNP) system, which simulates hemorrhage by exerting a variable amount of suction on the lower body, thereby reducing the volume of blood available for central circulation. Restoration of normal blood flow occurs promptly upon cessation of LBNP. Using two optoacoustic probes, guided by ultrasound imaging, we simultaneously monitored oxygenation in the axillary and internal jugular veins (IJV). LBNP began at -20 mmHg, thereafter was reduced in a step-wise fashion (up to 30 min). The optoacoustically measured axillary oxygenation decreased with LBNP, whereas IJV oxygenation remained relatively constant. These results indicate that our optoacoustic system may provide safe and rapid measurement of peripheral and central venous oxygenation and diagnosis of shock with high specificity and sensitivity.

Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arabi, Mohammad, E-mail: marabi2004@hotmail.com; Ahmed, Ishtiaq; Mat’hami, Abdulaziz

PurposeWe report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.Materials and MethodsSince January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chibamore » needle was obtained.ResultsTechnical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.ConclusionSharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.« less

Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial.

PubMed

Schallom, Marilyn E; Prentice, Donna; Sona, Carrie; Micek, Scott T; Skrupky, Lee P

2012-06-01

To compare heparin (3 mL, 10 units/mL) and 0.9% sodium chloride (NaCl, 10 mL) flush solutions with respect to central venous catheter lumen patency. Single-center, randomized, open label trial. Medical intensive care unit and Surgical/Burn/Trauma intensive care unit at Barnes-Jewish Hospital, St. Louis, MO. Three hundred forty-one patients with multilumen central venous catheters. Patients with at least one lumen with a minimum of two flushes were included in the analysis. Patients were randomly assigned within 12 hrs of central venous catheter insertion to receive either heparin or 0.9% sodium chloride flush. The primary outcome was lumen nonpatency. Secondary outcomes included the rates of loss of blood return, inability to infuse or flush through the lumen (flush failure), heparin-induced thrombocytopenia, and catheter-related blood stream infection. Assessment for patency was performed every 8 hrs in lumens without continuous infusions for the duration of catheter placement or discharge from intensive care unit. Three hundred twenty-six central venous catheters were studied yielding 709 lumens for analysis. The nonpatency rate was 3.8% in the heparin group (n = 314) and 6.3% in the 0.9% sodium chloride group (n = 395) (relative risk 1.66, 95% confidence interval 0.86-3.22, p = .136). The Kaplan-Meier analysis for time to first patency loss was not significantly different (log rank = 0.093) between groups. The rates of loss of blood return and flush failure were similar between the heparin and 0.9% sodium chloride groups. Pressure-injectable central venous catheters had significantly greater rates of nonpatency (10.6% vs. 4.3%, p = .001) and loss of blood return (37.0% vs. 18.8%, p <.001) compared to nonpressure-injectable catheters. The frequencies of heparin-induced thrombocytopenia and catheter-related blood stream infection were similar between groups. 0.9% sodium chloride and heparin flushing solutions have similar rates of lumen nonpatency. Given potential

Incidence and risk factors for central venous access port-related infection in Chinese cancer patients.

PubMed

Wang, Ting-Yao; Lee, Kuan-Der; Chen, Ping-Tsung; Chen, Min-Chi; Chen, Yi-Yang; Huang, Cih-En; Kuan, Feng-Che; Chen, Chih-Cheng; Lu, Chang Hsien

2015-11-01

Cytotoxic chemotherapy via central venous access ports is an important part of the standard treatment for most cancers, but it is accompanied with the risk of infections. This study aimed to analyze the incidence and risk factors for central venous access port-related infection (CPI) among Chinese patients receiving cytotoxic chemotherapy. Between January 1, 2002 and December 31, 2005 a total of 1391 cancer patients with 1449 totally implantable central venous access ports were evaluated. The log-rank test and Cox proportional hazards model were used for the analyses of risk factors. The overall CPI incidence rate was 0.21 per 1000 catheter-days. Hematological malignancies and head and neck cancer were associated with an increased risk of CPI (hazard ratio 4.00 and 4.11, respectively, both p < 0.001) and less infection-free catheter longevity (p < 0.001) compared with other cancer types. Chemotherapy in an adjuvant setting was associated with a lower risk of infection than for patients in a nonadjuvant setting (p < 0.001). The most common pathogens isolated from CPI were Pseudomonas aeruginosa and Candida. Infection remains to be a challenging issue for totally implantable central venous ports. Implementation of an insertion bundle for the prevention of central line-associated bloodstream infections is warranted, especially for those patients with hematological and head and neck cancers, as well as for patients receiving chemotherapy in the metastatic settings. Copyright © 2015. Published by Elsevier B.V.

Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kundu, Sanjoy, E-mail: sanjoy_kundu40@hotmail.com; Modabber, Milad; You, John M.

2011-10-15

Purpose: To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions. Materials and Methods: Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50-83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14),more » and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria). Results: Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9-7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4-8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14). Conclusions: This PTFE encapsulated stent

[Disposable nursing applicator-pocket of indwelling central venous catheter].

PubMed

Wei, Congli; Ma, Chunyuan

2017-11-01

Catheter related infection is the most common complication of central venous catheter, which pathogen mainly originate from the pipe joint and the skin around puncture site. How to prevent catheter infection is an important issue in clinical nursing. The utility model disclosed a "disposable nursing applicator-pocket of indwelling central venous catheter", which is mainly used for the fixation and the protection. The main structure consists of two parts, one is medical applicator to protect the skin around puncture site, and the other is gauze pocket to protect the catheter external connector. When in use, the catheter connector is fitted into the pocket, and then the applicator is applied to cover the puncture point of the skin. Integrated design of medical applicator and gauze pocket was designed to realize double functions of fixation and protection. The disposable nursing applicator-pocket is made of medical absorbent gauze (outer layer) and non-woven fabric (inner layer), which has the characteristics of comfortable, breathable, dust filtered, bacteria filtered, waterproof, antiperspirant and anti-pollution. The utility model has the advantages of simple structure, low cost, simple operation, effective protection, easy realization and popularization.

Comparison of right atrial pressure and central venous pressures measured at various anatomical locations in children.

PubMed

Lin, Ming-Chih; Fu, Yun-Ching; Jan, Sheng-Ling; Chen, Ying-Tsung; Chi, Ching-Shiang

2005-01-01

To compare the right atrial pressure to the central venous pressures measured at different points in spontaneously breathing children and try to find a formula to estimate right atrial pressure by central venous pressure measurement. Fifty-one children, aged 5 +/- 4.7 years, who underwent right heart catheterization were studied. All patients were sedated and breathed naturally. The mean pressure was the electronic mean of nine heart beats calculated by Philips BC4000 digital angiographic system. Mean pressure of the right atrium was compared to those measured at the high superior vena cava (SVC), low SVC, high inferior vena cava (IVC) (T10-11), middle IVC (L1-2), low IVC (L3-4), and iliac vein (L5-S1). Mean pressures of central veins were significantly higher than that of the right atrium (all p<0.01). Adjusted central venous pressures of SVC-0.5, high IVC-1.5, middle IVC-2, low IVC-2.5, and iliac vein-3 (mmHg) had a good agreement with the right atrial pressure. Central venous pressures are significantly higher than the right atrial pressure in spontaneously breathing children. Adjusted pressures of SVC-0.5, high IVC-1.5, middle IVC-2, low IVC-2.5, and iliac vein-3 (mmHg) can accurately reflect the right atrial pressure.

Low values of central venous oxygen saturation (ScvO2) during surgery and anastomotic leak of abdominal trauma patients.

PubMed

Isaza-Restrepo, Andres; Moreno-Mejia, Jose F; Martin-Saavedra, Juan S; Ibañez-Pinilla, Milciades

2017-01-01

There is a well known relationship between hypoperfusion and postoperative complications like anastomotic leak. No studies have been done addressing this relationship in the context of abdominal trauma surgery. Central venous oxygen saturation is an important hypoperfusion marker of potential use in abdominal trauma surgery for identifying the risk of anastomotic leak development. The purpose of this study was to identify the relationship between low values of central venous oxygen saturation and anastomotic leak of gastrointestinal sutures in the postoperative period in abdominal trauma surgery. A cross-sectional prospective study was performed. Patients over 14 years old who required surgical gastrointestinal repair secondary to abdominal trauma were included. Anastomotic leak diagnosis was confirmed through clinical manifestations and diagnostic images or secondary surgery when needed. Central venous oxygen blood saturation was measured at the beginning of surgery through a central catheter. Demographic data, trauma mechanism, anatomic site of trauma, hemoglobin levels, abdominal trauma index, and comorbidities were assessed as secondary variables. Patients who developed anastomotic leak showed lower mean central venous oxygen saturation levels (60.0% ± 2.94%) than those who did not (69.89% ± 7.21%) ( p  = 0.010). Central venous oxygen saturation <65% was associated with the development of gastrointestinal leak during postoperative time of patients who underwent surgery secondary to abdominal trauma.

Instructional design affects the efficacy of simulation-based training in central venous catheterization.

PubMed

Craft, Christopher; Feldon, David F; Brown, Eric A

2014-05-01

Simulation-based learning is a common educational tool in health care training and frequently involves instructional designs based on Experiential Learning Theory (ELT). However, little research explores the effectiveness and efficiency of different instructional design methodologies appropriate for simulations. The aim of this study was to compare 2 instructional design models, ELT and Guided Experiential Learning (GEL), to determine which is more effective for training the central venous catheterization procedure. Using a quasi-experimental randomized block design, nurse anesthetists completed training under 1 of the 2 instructional design models. Performance was assessed using a checklist of central venous catheterization performance, pass rates, and critical action errors. Participants in the GEL condition performed significantly better than those in the ELT condition on the overall checklist score after controlling for individual practice time (F[1, 29] = 4.021, P = .027, Cohen's d = .71), had higher pass rates (P = .006, Cohen's d = 1.15), and had lower rates of failure due to critical action errors (P = .038, Cohen's d = .81). The GEL model of instructional design is significantly more effective than ELT for simulation-based learning of the central venous catheterization procedure, yielding large differences in effect size. Copyright © 2014 Elsevier Inc. All rights reserved.

Stroke Volume Variation-Guided Versus Central Venous Pressure-Guided Low Central Venous Pressure With Milrinone During Living Donor Hepatectomy: A Randomized Double-Blinded Clinical Trial.

PubMed

Lee, Jiwon; Kim, Won Ho; Ryu, Ho-Geol; Lee, Hyung-Chul; Chung, Eun-Jin; Yang, Seong-Mi; Jung, Chul-Woo

2017-08-01

We previously demonstrated the usefulness of milrinone for living donor hepatectomy. However, a less-invasive alternative to central venous catheterization and perioperative contributors to good surgical outcomes remain undetermined. The current study evaluated whether the stroke volume variation (SVV)-guided method can substitute central venous catheterization during milrinone-induced profound vasodilation. We randomly assigned 42 living liver donors to receive either SVV guidance or central venous pressure (CVP) guidance to obtain milrinone-induced low CVP. Target SVV of 9% was used as a substitute for CVP of 5 mm Hg. The surgical field grade evaluated by 2 attending surgeons on a 4-point scale was compared between the CVP- and SVV-guided groups (n = 19, total number of scores = 38 per group) as a primary outcome variable. Multivariable analysis was performed to identify independent factors associated with the best surgical field as a post hoc analysis. Surgical field grades, which were either 1 or 2, were not found to be different between the 2 groups via Mann-Whitney U test (P = .358). There was a very weak correlation between SVV and CVP during profound vasodilation such as CVP ≤ 5 mm Hg (R = -0.06; 95% confidence interval, -0.09 to -0.04; P < .001). Additional post hoc analysis suggested that younger age, lower baseline CVP, and longer duration of milrinone infusion might be helpful in providing the best surgical field. Milrinone-induced vasodilation resulted in favorable surgical environment regardless of guidance methods of low CVP during living donor hepatectomy. However, SVV was not a useful indicator of low CVP because of very weak correlation between SVV and CVP during profound vasodilation. In addition, factors contributing to the best surgical field such as donor age, proactive fasting, and proper dosing of milrinone need to be investigated further, ideally through prospective studies.

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

PubMed

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

2015-01-01

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

[Complications associated to central venous catheters in hematology patients].

PubMed

García-Gabás, Carmen; Castillo-Ayala, Ana; Hinojo-Marín, Begoña; Muriel-Abajo, M Ángeles; Gómez-Gutiérrez, Isabel; de Mena-Arenas, Ana M; Rodríguez-Gonzalo, Ana; Chao-Lozano, Cristina; García-Menéndez, Carmen; Madroñero-Agreda, M Antonia

2015-01-01

To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. Major complications in the tunnellized were infections (13.7% in HURYC vs. 6.8% in HUGM - p<0.001) and occlusions (at least once in 3.8% vs. 21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs. 1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Central venous stenosis in haemodialysis patients without a previous history of catheter placement.

PubMed

Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

2005-08-01

To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

Results of surgery in symptomatic non-hydrocephalic pineal cysts: role of magnetic resonance imaging biomarkers indicative of central venous hypertension.

PubMed

Eide, Per Kristian; Ringstad, Geir

2017-02-01

We have previously proposed that pineal cysts (PCs) may result in crowding of the pineal recess, causing symptoms due to compression of the internal cerebral veins and central venous hypertension. In the present study, we compared clinical outcome of different treatment modalities in symptomatic individuals with non-hydrocephalic PCs. The study included all patients managed surgically for non-hydrocephalic PCs in our Department of Neurosurgery over a 10-year period. We applied a questionnaire to determine occurrence of symptoms before and after surgery, which allowed the use of a grading scale for symptom severity. Magnetic resonance imaging (MRI) biomarkers indicative of central venous hypertension were assessed before and after surgery. Relief of symptoms after surgery was most efficiently obtained by complete microsurgical cyst removal [n = 15; no (0/15), some (1/15) or marked (14/15) improvement], and to a lesser extent by microsurgical cyst fenestration [n = 6; no (2/6), some (4/6) or marked (0/6) improvement]. Shunt surgery was not successful [n = 6; no (5/6), some (1/6) or marked (0/6) improvement]. In all patients, the proposed MRI biomarkers gave evidence of central venous hypertension (PC grades 2-4). Microsurgical cyst removal provided marked symptom relief in symptomatic individuals with non-hydrocephalic PCs and MRI biomarkers of central venous hypertension. The hypothesis that PC-induced crowding of the pineal recess may compromise venous run-off and induce a central venous hypertension syndrome deserves further study.

Simulation improves procedural protocol adherence during central venous catheter placement: a randomized-controlled trial

PubMed Central

Peltan, Ithan D.; Shiga, Takashi; Gordon, James A.; Currier, Paul F.

2015-01-01

Background Simulation training may improve proficiency at and reduces complications from central venous catheter (CVC) placement, but the scope of simulation’s effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. Methods Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns’ performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees. Results We observed 52 interns place 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (p=0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores or complication rates. Conclusions Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety. PMID:26154250

Variability in alignment of central venous pressure transducer to physiologic reference point in the intensive care unit-A descriptive and correlational study.

PubMed

Sjödin, Carl; Sondergaard, Soren; Johansson, Lotta

2018-06-01

The phlebostatic axis is the most commonly used anatomical external reference point for central venous pressure measurements. Deviation in the central venous pressure transducer alignment from the phlebostatic axis causes inadequate pressure readings, which may affect treatment decisions for critically ill patients in intensive care units. The primary aim of the study was to assess the variability in central venous pressure transducer levelling in the intensive care unit. We also assessed whether patient characteristics impacted on central venous pressure transducer alignment deviation. A sample of 61 critical care nurses was recruited and asked to place a transducer at the appropriate level for central venous pressure measurement. The measurements were performed in the intensive care unit on critically ill patients in supine and Fowler's positions. The variability among the participants using eyeball levelling and a laser levelling device was calculated in both sessions and adjusted for patient characteristics. A significant variation was found among critical care nurses in the horizontal levelling of the pressure transducer placement when measuring central venous pressure in the intensive care unit. Using a laser levelling device did not reduce the deviation from the phlebostatic axis. Patient characteristics had little impact on the deviation in the measurements. The anatomical external landmark for the phlebostatic axis varied between critical care nurses, as the variation in the central venous pressure transducer placement was not reduced with a laser levelling device. Standardisation of a zero-level for vascular pressures should be considered to reduce the variability in vascular pressure readings in the intensive care unit to improve patient treatment decisions. Further studies are needed to evaluate critical care nurses' knowledge and use of central venous pressure monitoring and whether assistive tools and/or routines can improve the accuracy in vascular

Part versus Whole: A Randomized Trial of Central Venous Catheterization Education

ERIC Educational Resources Information Center

Chan, Angela; Singh, Sunita; Dubrowski, Adam; Pratt, Daniel D.; Zalunardo, Nadia; Nair, Parvarthy; McLaughlin, Kevin; Ma, Irene W. Y.

2015-01-01

Central venous catheterization (CVC) is a complex but commonly performed procedure. How best to teach this complex skill has not been clearly delineated. We conducted a randomized trial of the effects of two types of teaching of CVC on skill acquisition and retention. We randomly assigned novice internal medicine residents to learning CVC in-part…

Central venous catheter-related thrombosis in senile male patients: New risk factors and predictors.

PubMed

Liu, Gao; Fu, Zhi-Qing; Zhu, Ping; Li, Shi-Jun

2015-06-01

Central venous catheterization (CVC)-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases (6.17%) of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization (P<0.01) and that in internal jugular vein catheterization (P<0.05). No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization (P<0.05). Previous venous thrombosis history (P<0.01), high lactate dehydrogenase level (P<0.01), low high-density lipoprotein (HDL) level (P<0.05), and low albumin level (P<0.05) were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

[Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition].

PubMed

Santos-Martínez, Luis Efren; Guevara-Carrasco, Marlene; Naranjo-Ricoy, Guillermo; Baranda-Tovar, Francisco Martín; Moreno-Ruíz, Luis Antonio; Herrera-Velázquez, Marco Antonio; Magaña-Serrano, José Antonio; Valencia-Sánchez, Jesús Salvador; Calderón-Abbo, Moisés Cutiel

2014-01-01

The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P<.05. Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029±0.048 (-0018, 0.077) and -0.12±0.22 (-0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86±6.08 (15.9, 39.8) and oxygen saturation 33.02±6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. The best matching parameters between arterial and central venous blood samples were pH and lactate. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study

PubMed Central

Jose Amo-Setién, Francisco; Herrero-Montes, Manuel; Olavarría-Beivíde, Encarnación; Rodríguez-Rodríguez, Mercedes; Torres-Manrique, Blanca; Rodríguez-de la Vega, Carlos; Caso-Álvarez, Vanesa; González-Parralo, Laura

2016-01-01

Background and Aim The use of venous catheters is a widespread practice, especially in oncological and oncohematological units. The objective of this study was to evaluate the complications associated with peripherally inserted central catheters (PICCs) in a cohort of patients. Materials and Methods In this retrospective cohort study, we included all patient carrying PICCs (n = 603) inserted at our institute between October 2010 and December 2013. The main variables collected were medical diagnosis, catheter care, location, duration of catheterization, reasons for catheter removal, complications, and nursing care. Complications were classified as infection, thrombosis, phlebitis, migration, edema, and/or ecchymosis. Results All patients were treated according to the same “nursing care” protocol. The incidence rate of complications was two cases per 1000 days of catheter duration. The most relevant complications were infection and thrombosis, both with an incidence of 0.17 cases per 1000 days of the total catheterization period. The total average duration of catheterization was 170 days [SD 6.06]. Additionally to “end of treatment” (48.42%) and “exitus”, (22.53%) the most frequent cause of removal was migration (displacement towards the exterior) of the catheter (5.80%). Conclusions PICCs are safe devices that allow the administration of long-term treatment and preserve the integrity of the venous system of the patient. Proper care of the catheter is very important to improve the quality life of patients with oncologic and hematologic conditions. Therefore, correct training of professionals and patients as well as following the latest scientific recommendations are particularly relevant. PMID:27588946

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

PubMed Central

Chen, Kenneth P.; Cavender, Susan; Lee, Joon; Feng, Mengling; Mark, Roger G.; Celi, Leo Anthony; Mukamal, Kenneth J.

2016-01-01

Background and objectives Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated. Design, setting, participants, & measurements Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria. Results Of the 18% (n=2338) of patients with peripheral edema on admission, 27% (n=631) developed AKI, compared with 16% (n=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; P<0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; P<0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H2O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; P=0.02). Conclusions Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require

A central venous catheter coated with benzalkonium chloride for the prevention of catheter-related microbial colonization.

PubMed

Moss, H A; Tebbs, S E; Faroqui, M H; Herbst, T; Isaac, J L; Brown, J; Elliott, T S

2000-11-01

In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined. The benzalkonium chloride resulted in a significant reduction of the incidence of microbial colonization on both the internal and external catheter surfaces. The reduction in colonization was detected at both the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P = 0.0016) and distal segments of the antiseptic-coated catheters. Following catheter removal retained activity was demonstrated in benzalkonium chloride catheters which had been in place for up to 12 days. No patients developed adverse reactions to the benzalkonium chloride catheters. The findings demonstrate that the benzalkonium chloride catheter significantly reduced the incidence of catheter-associated colonization.

Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock.

PubMed

Du, Wei; Liu, Da-Wei; Wang, Xiao-Ting; Long, Yun; Chai, Wen-Zhao; Zhou, Xiang; Rui, Xi

2013-12-01

Central venous oxygen saturation (Scvo2) is a useful therapeutic target when treating septic shock. We hypothesized that combining Scvo2 and central venous-to-arterial partial pressure of carbon dioxide difference (△Pco2) may provide additional information about survival. We performed a retrospective analysis of 172 patients treated for septic shock. All patients were treated using goal-directed therapy to achieve Scvo2 ≥ 70%. After 6 hours of treatment, we divided patients into 4 groups based on Scvo2 (<70% or ≥ 70%) and △Pco2 (<6 mm Hg or ≥ 6 mm Hg). Overall, 28-day mortality was 35.5%. For patients in whom the Scvo2 target was not achieved at 6 hours, mortality was 50.0%, compared with 29.5% in those in whom Scvo2 exceeded 70% (P = .009). In patients with Scvo2 ≥ 70%, mortality was lower if △Pco2 was <6 mm Hg than if △Pco2 was ≥ 6 mm Hg (56.1% vs 16.1%, respectively; P < .001) and 6-hour lactate clearance was superior (0.01 ± 0.61 vs 0.21 ± 0.31, respectively; P = .016). The combination of Scvo2 and △Pco2 appears to predict outcome in critically ill patients resuscitated from septic shock better than Scvo2 alone. Patients who meet both targets appear to clear lactate more efficiently. © 2013.

[Doctor-nurse delegation of the insertion of central venous lines].

PubMed

Cellupica, Mary

2015-01-01

The Léon Bérard Cancer Centre treats the disease in all its complexity with numerous disciplines such as surgery, medicine, radiotherapy, palliative care, home care, etc. The insertion of a central venous line is an essential part of cancer care and the nursing profession. It enables patients to have their treatment administered in the best possible conditions and without risk. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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

PubMed

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

2016-07-01

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

Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: A systematic review and meta-analysis

PubMed Central

Ablordeppey, Enyo A.; Drewry, Anne M.; Beyer, Alexander B.; Theodoro, Daniel L.; Fowler, Susan A.; Fuller, Brian M.; Carpenter, Christopher R.

2016-01-01

Objective We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared to chest radiography. Data Sources PubMed, EMBASE, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov Study Selection Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2×2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, inter-rater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Data Extraction Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Data Synthesis 15 studies with 1553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 [0.77, 0.86] and 0.98 [0.97, 0.99] respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 [14.72, 65.78] and 0.25 [0.13, 0.47]. The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Conclusions Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition

Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis.

PubMed

Ablordeppey, Enyo A; Drewry, Anne M; Beyer, Alexander B; Theodoro, Daniel L; Fowler, Susan A; Fuller, Brian M; Carpenter, Christopher R

2017-04-01

We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than

Long-term central venous access device selection.

PubMed

Gabriel, Janice

Infusion therapy is often viewed as a means to an end - a way to administer medications and fluids. It is one of the few specialties that affect almost all areas of healthcare. Safe, effective and reliable vascular access should be the goal of every health professional who is starting a patient on a prescribed course of intravenous therapy, especially if that patient is undergoing a prolonged course. This article aims to refresh and update nurses' clinical knowledge of the detailed patient assessment required before choosing a central venous access device, as well as supporting a reduction in complications and earlier recognition of potential problems. It discusses clinical indications for devices, the range of long-term intravenous therapies that can be used, and patient assessment.

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

PubMed Central

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

2015-01-01

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

Iatrogenic vertebral artery pseudoaneurysm due to central venous catheterization

PubMed Central

Vasquez, Jay

2011-01-01

Central venous lines have become an integral part of patient care, but they are not without complications. Vertebral artery pseudoaneurysm formation is one of the rarer complications of central line placement. Presented is a rare case of two pseudoaneurysms of the vertebral and subclavian artery after an attempted internal jugular vein catheterization. These were successfully treated with open surgical repair and bypass. Open surgical repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudoaneurysms has been described with promising outcomes, but long-term results are lacking. Ultimately, the best treatment of these iatrogenic injuries should start with prevention. Well-documented techniques to minimize mechanical complications, including inadvertent arterial puncture, should be practiced and taught in training programs to avoid the potentially devastating consequences. PMID:21566753

[Near-infrared spectroscopy in sepsis therapy : predictor of a low central venous oxygen saturation].

PubMed

Lichtenstern, C; Koch, C; Röhrig, R; Rosengarten, B; Henrich, M; Weigand, M A

2012-10-01

Early goal-directed hemodynamic optimization has become a cornerstone of sepsis therapy. One major defined goal is to achieve adequate central venous oxygen saturation (SO(2)). This study aimed to investigate the correlation between central venous SO(2) and frontal cerebral near-infrared spectroscopy (NIRS) measurement in patients with severe sepsis and septic shock. The NIRS method provides non-invasive measurement of regional oxygen saturation (rSO(2)) in tissues approximately 2 cm below the optical NIRS sensors which depends on arterial, capillary and venous blood. Thus this system gives site-specific real-time data about the balance of oxygen supply and demand. This was a secondary analysis from a prospective study of surgical intensive care (ICU) patients in the early phase of severe sepsis or septic shock. Bilateral cerebral rSO(2), central venous SO(2), arterial oxygen saturation (S(a)O(2)) and other surrogate parameters of oxygen supply, such as hemoglobin, partial pressure of oxygen and oxygen content in arterial blood were recorded. A total of 16 ICU patients (4 women, median age 65.5 years) were included in the study. As sepsis focus an intra-abdominal infection was detected in 62.5 % of patients, severe pneumonia was determined in 31.3 % and skin and soft tissue infections were recognized in 12.5 %. At study inclusion 50 % of patients had septic shock, the median sequential organ failure assessment (SOFA) score was 10.2 (interquartile range 5.25-8.75) and the median acute physiology and chronic health evaluation II (APACHE II) score was 26 (range 23.25-29.75). Mortality at day 28 was 37.5 %. Minimum rSO(2) (median 58) and right-sided rSO(2) (median 58) values showed a significant correlation in the analysis of receiver operating characteristics (area under the curve 0.844, p= 0.045). A central venous SO(2)< 70 % was indicated by rSO(2)< 56.5 with sensitivity and specificity of 75 % and 100 %, respectively. Cerebral NIRS could provide a fast and easily

Central venous catheter integrity during mechanical power injection of iodinated contrast medium.

PubMed

Macha, Douglas B; Nelson, Rendon C; Howle, Laurens E; Hollingsworth, John W; Schindera, Sebastian T

2009-12-01

To evaluate a widely used nontunneled triple-lumen central venous catheter in order to determine whether the largest of the three lumina (16 gauge) can tolerate high flow rates, such as those required for computed tomographic angiography. Forty-two catheters were tested in vitro, including 10 new and 32 used catheters (median indwelling time, 5 days). Injection pressures were continuously monitored at the site of the 16-gauge central venous catheter hub. Catheters were injected with 300 and 370 mg of iodine per milliliter of iopamidol by using a mechanical injector at increasing flow rates until the catheter failed. The infusion rate, hub pressure, and location were documented for each failure event. The catheter pressures generated during hand injection by five operators were also analyzed. Mean flow rates and pressures at failure were compared by means of two-tailed Student t test, with differences considered significant at P < .05. Injections of iopamidol with 370 mg of iodine per milliliter generate more pressure than injections of iopamidol with 300 mg of iodine per milliliter at the same injection rate. All catheters failed in the tubing external to the patient. The lowest flow rate at which catheter failure occurred was 9 mL/sec. The lowest hub pressure at failure was 262 pounds per square inch gauge (psig) for new and 213 psig for used catheters. Hand injection of iopamidol with 300 mg of iodine per milliliter generated peak hub pressures ranging from 35 to 72 psig, corresponding to flow rates ranging from 2.5 to 5.0 mL/sec. Indwelling use has an effect on catheter material property, but even for used catheters there is a substantial safety margin for power injection with the particular triple-lumen central venous catheter tested in this study, as the manufacturer's recommendation for maximum pressure is 15 psig.

Does the preference of peripheral versus central venous access in peripheral blood stem cell collection/yield change stem cell kinetics in autologous stem cell transplantation?

PubMed

Dogu, Mehmet Hilmi; Kaya, Ali Hakan; Berber, Ilhami; Sari, İsmail; Tekgündüz, Emre; Erkurt, Mehmet Ali; Iskender, Dicle; Kayıkçı, Ömur; Kuku, Irfan; Kaya, Emin; Keskin, Ali; Altuntaş, Fevzi

2016-02-01

Central venous access is often used during apheresis procedure in stem cell collection. The aim of the present study was to evaluate whether central or peripheral venous access has an effect on stem cell yield and the kinetics of the procedure and the product in patients undergoing ASCT after high dose therapy. A total of 327 patients were retrospectively reviewed. The use of peripheral venous access for stem cell yield was significantly more frequent in males compared to females (p = 0.005). Total volume of the product was significantly lower in central venous access group (p = 0.046). As being a less invasive procedure, peripheral venous access can be used for stem cell yield in eligible selected patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bilateral Pneumothoraces Following Central Venous Cannulation

PubMed Central

Pazos, F.; Masterson, K.; Inan, C.; Robert, J.; Walder, B.

2009-01-01

We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax. PMID:19901997

Air embolism after central venous catheterization.

PubMed

Kashuk, J L; Penn, I

1984-09-01

Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.

[Central venous catheter-related infections in critically ill patients].

PubMed

Diener, J R; Coutinho, M S; Zoccoli, C M

1996-01-01

To determine incidence rate, etiology and risk factors for central venous catheter (CVC)-related infections in critically-ill patients, a prospective cohort study was conducted in the general Intensive Care Unit (ICU) of a 212 bed Hospital in Florianópolis, Brazil. Patients admitted to ICU between May 1993 and February 1994, exposed to short-term CVC, were included in the study. Quantitative skin culture at CVC insertion site, semi-quantitative CVC tip culture, quantitative hub culture, and peripheral blood-culture were done. Results were submitted to univariate and multivariate analysis. Fifty-seven catheterization periods were analysed in 51 patients. The incidence rate was 21.1% (33.1 per 1,000 catheter-days) for local infection, and 8.7% (14.1 per 1,000 catheter-days) for catheter-associated bacteremia. The skin at the insertion site was colonized in 32.7% and the hub in 29.1% of the patients respectively. Potential sources of infection were the skin in 41.2% of the cases, the hub in 29.4%, remote site in 5.9% and unknown in 23.5%. The hub was implicated in 60% of the catheter-associated bacteremias. Coagulase-negative staphylococci were the main isolates. Another intravascular device and purulence at the insertion site were independently associated with local infection. Insertion at internal jugular site and hub colonization were independently associated with bacteremia. Catheter-associated bacteremia is a major complication of central venous catheterization in critically-ill patients. Internal jugular insertion and CVC hub colonization are important risk factors for significant catheter-related infections.

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

PubMed Central

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

2015-01-01

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

Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tercan, Fahri; Oguzkurt, Levent; Ozkan, Ugur

2008-05-15

The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, andmore » rate of single wall puncture were 99.4%, 1.04 (range, 1-3), and 83% for adults and 90.3%, 1.25 (range, 1-5), and 49% for children, respectively. All the differences were statistically significant (p < 0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p > 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.« less

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

PubMed

Linnemann, Birgit; Lindhoff-Last, Edelgard

2012-09-01

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

Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses.

PubMed

Labeau, Sonia O; Vandijck, Dominique M; Rello, Jordi; Adam, Sheila; Rosa, Ana; Wenisch, Christoph; Bäckman, Carl; Agbaht, Kemal; Csomos, Akos; Seha, Myriam; Dimopoulos, George; Vandewoude, Koenraad H; Blot, Stijn I

2009-01-01

To determine European intensive care unit (ICU) nurses' knowledge of guidelines for preventing central venous catheter-related infection from the Centers for Disease Control and Prevention. Multicountry survey (October 2006-March 2007). Twenty-two European countries. ICU nurses. Using a validated multiple-choice test, knowledge of ten recommendations for central venous catheter-related infection prevention was evaluated (one point per question) and assessed in relation to participants' gender, ICU experience, number of ICU beds, and acquisition of a specialized ICU qualification. We collected 3405 questionnaires (70.9% response rate); mean test score was 44.4%. Fifty-six percent knew that central venous catheters should be replaced on indication only, and 74% knew this also concerns replacement over a guidewire. Replacing pressure transducers and tubing every 4 days, and using coated devices in patients requiring a central venous catheter >5 days in settings with high infection rates only were recognized as recommended by 53% and 31%, respectively. Central venous catheters dressings in general are known to be changed on indication and at least once weekly by 43%, and 26% recognized that both polyurethane and gauze dressings are recommended. Only 14% checked 2% aqueous chlorhexidine as the recommended disinfection solution; 30% knew antibiotic ointments are not recommended because they trigger resistance. Replacing administration sets within 24 hrs after administering lipid emulsions was recognized as recommended by 90%, but only 26% knew sets should be replaced every 96 hrs when administering neither lipid emulsions nor blood products. Professional seniority and number of ICU beds showed to be independently associated with better test scores. Opportunities exist to optimize knowledge of central venous catheter-related infection prevention among European ICU nurses. We recommend including central venous catheter-related infection prevention guidelines in educational

Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC).

PubMed

Abdullah, B J J; Mohammad, N; Sangkar, J V; Abd Aziz, Y F; Gan, G G; Goh, K Y; Benedict, I

2005-07-01

The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).

Comparison of catheter-related large vein thrombosis in centrally inserted versus peripherally inserted central venous lines in the neurological intensive care unit.

PubMed

Wilson, Thomas J; Stetler, William R; Fletcher, Jeffrey J

2013-07-01

To compare cumulative complication rates of peripherally (PICC) and centrally (CICVC) inserted central venous catheters, including catheter-related large vein thrombosis (CRLVT), central line-associated bloodstream infection (CLABSI), and line insertion-related complications in neurological intensive care patients. Retrospective cohort study and detailed chart review for 431 consecutive PICCs and 141 CICVCs placed in patients under neurological intensive care from March 2008 through February 2010. Cumulative incidence of CRLVT, CLABSI, and line insertion-related complications were compared between PICC and CICVC groups. Risk factors for CRLVT including mannitol therapy during dwell time, previous history of venous thromboembolism, surgery longer than 1h during dwell time, and line placement in a paretic arm were also compared between groups. During the study period, 431 unique PICCs were placed with cumulative incidence of symptomatic thrombosis of 8.4%, CLABSI 2.8%, and line insertion-related complications 0.0%. During the same period, 141 unique CICVCs were placed with cumulative incidence of symptomatic thrombosis of 1.4%, CLABSI 1.4%, and line insertion-related complications 0.7%. There was a statistically significant difference in CRLVT with no difference in CLABSI or line insertion-related complications. In neurological critical care patients, CICVCs appear to have a better risk profile compared to PICCs, with a decreased risk of CRLVT. As use of PICCs in critical care patients increases, a prospective randomized trial comparing PICCs and CICVCs in neurological critical care patients is necessary to assist in choosing the appropriate catheter and to minimize risks of morbidity and mortality associated with central venous access. Copyright © 2012 Elsevier B.V. All rights reserved.

A prospective study of central venous catheters placed in a tertiary care Emergency Department: indications for use, infectious complications, and natural history.

PubMed

Diaz, Katrina; Kelly, Sean G; Smith, Barbara; Malani, Preeti N; Younger, John G

2012-02-01

Despite successful efforts to improve overall central line-associated bloodstream infections (CLABSI) rates, little is known about CLABSI rates or even central venous catheter insertion practices in the Emergency Department. We sought to determine the baseline CLABSI rate for Emergency Department-inserted central venous catheters and to describe indications for placement, duration of use, and the natural history of these devices. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation.

PubMed

Kumar, Dharmendra; Ahmed, Syed Moied; Ali, Shahna; Ray, Utpal; Varshney, Ankur; Doley, Kashmiri

2015-11-01

Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP. To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation. Prospective observational study in Intensive Care Unit. Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°. Pearson's correlation and Bland-Altman's analysis. This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH2O. However, the correlation was good when the CVP was >10 cmH2O. Bland-Altman analysis showed 95% limits of agreement to be -2.912-9.472. PVP can replace CVP for guiding fluid therapy in critically ill patients.

[Venous access in oncology].

PubMed

Lesimple, T; Béguec, J F; Levêque, J M

1998-10-31

Many treatments administered to cancer patients require venous access either via a peripheral vein or a larger central vein at the risk of local or systemic infection, thrombus formation or venous occlusion and dysfunction. Insertion of a central catheter is an invasive procedure which must be conducted under conditions of rigorous asepsia. Strict rules based on well-defined protocols must be applied throughout its use. Local or systemic infectious complications account for 18 to 25% of all nosocomial infections and are often related to colonisation of the puncture site by a Gram positive germ. In case of infection, ablation of the central catheter is not mandatory for diagnosis or antibiotic treatment. Reported at varying frequencies in the literature from 4 to 42%, thrombus formation is unpredictable and often difficult to diagnose. Anticoagulants or fibrolytic agents are indicated but it may also be necessary to withdraw the catheter. Displacement, rupture, obstruction and extravasation are frequent complications. Back flow must be checked in all venous accesses and free flow carefully verified. The access must remain patent throughout the period of use, guaranteed by a standard heparinization and rinsing protocol. This complications must not mask the important progress achieved with the use of central venous access for specific and symptomatic treatment in cancer patients.

Detection of an embolized central venous catheter fragment with endobronchial ultrasound.

PubMed

Dhillon, Samjot Singh; Harris, Kassem; Alraiyes, Abdul H; Picone, Anthony L

2018-01-01

An 84-year-old woman underwent Convex-probe Endobronchial Ultrasound (CP-EBUS) for 18 F-fluorodeoxyglucose avid subcarinal lymphadenopathy on Positron Emission Tomogram (PET) scan. Endobronchial ultrasound-guided transbronchial needle aspiration of the subcarinal lymph node revealed squamous cell lung carcinoma. A small hyperechoic rounded density was noted inside the lumen of the azygous vein. Based on chest computed tomography findings and her clinical history, this was felt to be a broken fragment of a peripherally inserted central catheter, which was placed for intravenous antibiotics, a few months prior to this presentation. To the best of our knowledge, this is the first ever CP-EBUS description of a broken fragment of central venous catheter. © 2016 John Wiley & Sons Ltd.

Evaluation of the monitor cursor-line method for measuring pulmonary artery and central venous pressures.

PubMed

Pasion, Editha; Good, Levell; Tizon, Jisebelle; Krieger, Staci; O'Kier, Catherine; Taylor, Nicole; Johnson, Jennifer; Horton, Carrie M; Peterson, Mary

2010-11-01

To determine if the monitor cursor-line feature on bedside monitors is accurate for measuring central venous and pulmonary artery pressures in cardiac surgery patients. Central venous and pulmonary artery pressures were measured via 3 methods (end-expiratory graphic recording, monitor cursor-line display, and monitor digital display) in a convenience sample of postoperative cardiac surgery patients. Pressures were measured twice during both mechanical ventilation and spontaneous breathing. Analysis of variance was used to determine differences between measurement methods and the percentage of monitor pressures that differed by 4 mm Hg or more from the measurement obtained from the graphic recording. Significance level was set at P less than .05. Twenty-five patients were studied during mechanical ventilation (50 measurements) and 21 patients during spontaneous breathing (42 measurements). Measurements obtained via the 3 methods did not differ significantly for either type of pressure (P > .05). Graphically recorded pressures and measurements obtained via the monitor cursor-line or digital display methods differed by 4 mm Hg or more in 4% and 6% of measurements, respectively, during mechanical ventilation and 4% and 11%, respectively, during spontaneous breathing. The monitor cursor-line method for measuring central venous and pulmonary artery pressures may be a reasonable alternative to the end-expiratory graphic recording method in hemodynamically stable, postoperative cardiac surgery patients. Use of the digital display on the bedside monitor may result in larger discrepancies from the graphically recorded pressures than when the cursor-line method is used, particularly in spontaneously breathing patients.

Central venous catheter-related bloodstream infections in the intensive care unit

PubMed Central

Patil, Harsha V.; Patil, Virendra C.; Ramteerthkar, M. N.; Kulkarni, R. D.

2011-01-01

Context: Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed

A Rare Vascular Anomaly during Central Venous Catheterization: A Persistent Left-Sided Superior Vena Cava.

PubMed

Aydın, Kutlay; Tokur, Murat Emre; Ergan, Begüm

2018-01-01

A persistent left-sided superior vena cava (PLSVC) is the most frequent abnormality of the venous system; however, it is not a very well-known variation among physicians. Herein we report the case of a patient with a PLSVC who was diagnosed after central venous catheterization (CVC). An 80-year-old man was admitted to the emergency room with cardiopulmonary arrest. After the return of spontaneous circulation, CVC was blindly performed from the left jugular vein without any complications. However, routine chest X-ray after catheterization revealed that the catheter was moving down directly to the left heart. Thoracic computed tomography showed the right brachiocephalic vein draining into the left brachiocephalic vein and forming the left superior vena cava in front of the aortic arch. The left superior vena cava merged into the right atrium after crossing the left pulmonary artery. CVC is widely used in clinical practice, and therefore clinicians should be aware of possible variations in central veins, particularly during blind catheterization.

Single-stick tunneled central venous access using the jugular veins in infants weighing less than 5 kg.

PubMed

Lindquester, Will S; Hawkins, C Matthew; Monroe, Eric J; Gill, Anne E; Shivaram, Giridhar M; Seidel, F Glen; Lungren, Matthew P

2017-11-01

Despite the demonstrated feasibility of the single-stick technique in the femoral vein, its use in neonates and infants for placing central lines in internal and external jugular veins has not been reported. Describe and assess the safety and efficacy of tunneled jugular central venous catheter placement performed under ultrasound (US) and fluoroscopic guidance in neonates and infants weighing <5 kg using the single-stick technique at three tertiary pediatric hospitals. Thirty-three children weighing less than 5 kg received tunneled central venous access in either internal or external jugular veins using the single-stick technique. Patient history, procedural records and clinical follow-up documents were retrospectively reviewed. Complication rates were compared to those of 41 patients receiving single-stick femoral central lines. Technical complications occurred during one (3.0%) jugular placement with the patient having a failed right-side attempt with subsequent successful left-side placement. The catheters did not last the entire course of treatment in three (9.1%) patients with jugular lines. One patient had the catheter removed due to concern for infection, one catheter was accidentally removed during dressing changes, and one catheter was displaced and subsequently exchanged. Of patients receiving femoral central lines, 1 (2.4%) had a technical complication and 5 catheters (12.2%) did not last the entire course of treatment. The placement of tunneled central venous catheters in neonates/infants <5 kg is safe and technically feasible using the internal/external jugular vein via the single-stick technique. By theoretically reducing the risks of catheter infection by avoiding the diaper area and thrombosis by using larger veins, it may be preferable in certain patient populations.

Central venous catheterization training: current perspectives on the role of simulation.

PubMed

Soffler, Morgan I; Hayes, Margaret M; Smith, C Christopher

2018-01-01

Simulation is a popular and effective training modality in medical education across a variety of domains. Central venous catheterization (CVC) is commonly undertaken by trainees, and carries significant risk for patient harm when carried out incorrectly. Multiple studies have evaluated the efficacy of simulation-based training programs, in comparison with traditional training modalities, on learner and patient outcomes. In this review, we discuss relevant adult learning principles that support simulation-based CVC training, review the literature on simulation-based CVC training, and highlight the use of simulation-based CVC training programs at various institutions.

The role of central venous oxygen saturation, blood lactate, and central venous-to-arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment.

PubMed

Wittayachamnankul, Borwon; Chentanakij, Boriboon; Sruamsiri, Kamphee; Chattipakorn, Nipon

2016-12-01

The current practice in treatment of severe sepsis and septic shock is to ensure adequate oxygenation and perfusion in patients, along with prompt administration of antibiotics, within 6 hours from diagnosis, which is considered the "golden hour" for the patients. One of the goals of treatment is to restore normal tissue perfusion. With this goal in mind, some parameters have been used to determine the success of treatment and mortality rate; however, none has been proven to be the best predictor of mortality rate in sepsis patients. Despite growing evidence regarding the prognostic indicators for mortality in sepsis patients, inconsistent reports exist. This review comprehensively summarizes the reports regarding the frequently used parameters in sepsis including central venous oxygen saturation, blood lactate, and central venous-to-arterial carbon dioxide partial pressure difference, as prognostic indicators for clinical outcomes in sepsis patients. Moreover, consistent findings and inconsistent reports for their pathophysiology and the potential mechanisms for their use as well as their limitations in sepsis patients are presented and discussed. Finally, a schematic strategy for potential management and benefits in sepsis patients is proposed based upon these current available data. There is currently no ideal biomarker that can indicate prognosis, predict progression of the disease, and guide treatment in sepsis. Further studies are needed to be carried out to identify the ideal biomarker that has all the desired properties. Copyright © 2016 Elsevier Inc. All rights reserved.

[The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC)].

PubMed

Emoli, Alessandro; Cappuccio, Serena; Marche, Bruno; Musarò, Andrea; Scoppettuolo, Giancarlo; Pittiruti, Mauro

2014-01-01

The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). The insertion of a peripherally inserted central venous catheter (PICC) is not without risks. The Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) has developed a protocol (SIP: Safe Implantation of PICCs) with the aim of minimizing the risks which may be associated with the placement of PICCs. The protocol is based on recommendations available in the literature and on the main clinical practice guidelines. The SIP protocol, a bundle of evidence-based recommendations, it is is easy to use, inexpensive, and cost-effective. If routinely used and carefully inplemented, it greatly reduces complications such as failure of venipuncture, accidental arterial puncture, damage of median nerve, infection and catheter related venous thrombosis.

An analysis of leukapheresis and central venous catheter use in the randomized, placebo controlled, phase 3 IMPACT trial of Sipuleucel-T for metastatic castrate resistant prostate cancer.

PubMed

Flanigan, Robert C; Polcari, Anthony J; Shore, Neil D; Price, Thomas H; Sims, Robert B; Maher, Johnathan C; Whitmore, James B; Corman, John M

2013-02-01

Sipuleucel-T is an autologous cellular immunotherapy. We review the safety of the leukapheresis procedure required for sipuleucel-T preparation and complications related to venous catheter use in the randomized, placebo controlled phase 3 IMPACT (IMmunotherapy for ProstAte Cancer Trial) study (NCT 00065442). A total of 512 patients with asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer were enrolled in the study. All patients were scheduled to undergo 3 standard 1.5 to 2.0 blood volume leukapheresis procedures at 2-week intervals. Leukapheresis related adverse events and those related to venous catheter use were reviewed. Immune cell counts were examined throughout the treatment course. Of 512 enrolled patients 506 underwent 1 or more leukapheresis procedures and were included in this analysis. Adverse events were comparable between the sipuleucel-T and control arms. Leukapheresis related adverse events were primarily associated with transient hypocalcemia (39.3%). Most leukapheresis related adverse events (97%) were of mild/moderate intensity. Median white blood cell count and absolute monocyte and lymphocyte counts were stable and within normal ranges throughout the treatment course. Of all patients 23.3% had a central venous catheter placed primarily for leukapheresis. Patients with vs without a central venous catheter had a higher risk of infection potentially related to catheter use (11.9% vs 1.3%, p <0.0001) and a trend toward a higher incidence of venous vascular events potentially related to catheter use, excluding the central nervous system (5.9% vs 2.1%, p = 0.06). Adverse events related to leukapheresis are manageable and quickly reversible. The majority of patients can undergo leukapheresis without a central venous catheter. Central venous catheters are associated with an increased risk of infections and venous vascular events. Peripheral intravenous access should be used when feasible. Copyright © 2013 American

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

PubMed

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

2014-03-01

To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12.45 ± 6.17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality

Superior vena cava syndrome with central venous catheter for chemotherapy treated successfully with fibrinolysis.

PubMed

Guijarro Escribano, J F; Antón, R F; Colmenarejo Rubio, A; Sáenz Cascos, L; Sainz González, F; Alguacil Rodríguez, R

2007-03-01

Recently, there has been an increase in the number of cases of superior vena cava (SVC) syndrome associated with chronic indwelling central venous catheters. Fibrinolytic therapy and endovascular treatment are currently achieving good results. We present a case history of a patient with SVC with a catheter used for chemotherapy, which was successfully treated with catheter-directed (intraclot) infusion thrombolytic therapy with urokinase.

Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial.

PubMed

Habib, Ashraf S; Moul, Judd W; Polascik, Thomas J; Robertson, Cary N; Roche, Anthony M; White, William D; Hill, Stephen E; Nosnick, Israel; Gan, Tong J

2014-05-01

To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5 mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Ninety-two patients completed the study. Estimated blood loss (mean ± SD) was significantly lower with low central venous pressure (706 ± 362 ml) compared to acute normovolemic hemodilution (1103 ± 635 ml) and conventional (1051 ± 714 ml) groups (p = 0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p = 0.0028) and prostate size (p = 0.0323), accounting for surgeon (p = 0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p = 0.0037), the treatment effect depended on prostate size (p = 0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Maintaining low central venous

Percutaneous Treatment of Central Venous Stenosis in Hemodialysis Patients: Long-Term Outcomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Young Chul; Won, Jong Yun, E-mail: jywon@yumc.yonsei.ac.kr; Choi, Sun Young

2009-03-15

The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and 15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months. Each patient was followed for 14 to 60 months.more » Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%, respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion, endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference in patency between PTAs and stent placement.« less

Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings.

PubMed

Catalano, Orlando; de Lutio di Castelguidone, Elisabetta; Sandomenico, Claudia; Petrillo, Mario; Aprea, Pasquale; Granata, Vincenza; D'Errico, Adolfo Gallipoli

2011-03-01

Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter-related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi.

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

PubMed

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

2010-05-01

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

Cardiac veins: collateral venous drainage pathways in chronic hemodialysis patients.

PubMed

Ozmen, Evrim; Algin, Oktay

2016-07-12

Venous anomalies are diagnostic and therapeutic challenges. Subclavian or superior vena cava stenosis can be developed and venous return can be achieved via cardiac veins and coronary sinus in patients with central venous catheter for long-term hemodialysis. These types of abnormalities are not extremely rare especially in patients with a history of central venous catheter placement. Detection of these anomalies and subclavian vein stenosis before the surgical creation of hemodialysis fistulae or tunneled central venous catheter placement may prevent unnecessary interventions in those patients. Multidetector computed tomography (MDCT) technique can give further information when compared with fluoroscopy or digital subtraction angiography in the management of these patients. This case report describes interesting aspects of central vein complications in hemodialysis patients. As a conclusion, there are limited data about thoracic venous return, and further prospective studies with large patient number are required. MDCT with 3D reconstruction is particularly useful for the accurate evaluation of venous patency, variations, and collateral circulation. Also it is an excellent tool for choosing and planning treatment.

Central venous catheterization training: current perspectives on the role of simulation

PubMed Central

Soffler, Morgan I; Hayes, Margaret M; Smith, C Christopher

2018-01-01

Simulation is a popular and effective training modality in medical education across a variety of domains. Central venous catheterization (CVC) is commonly undertaken by trainees, and carries significant risk for patient harm when carried out incorrectly. Multiple studies have evaluated the efficacy of simulation-based training programs, in comparison with traditional training modalities, on learner and patient outcomes. In this review, we discuss relevant adult learning principles that support simulation-based CVC training, review the literature on simulation-based CVC training, and highlight the use of simulation-based CVC training programs at various institutions. PMID:29872360

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

PubMed

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

2016-01-01

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

Measurement of central venous pressure and determination of hormones in blood serum during weightlessness

NASA Technical Reports Server (NTRS)

Kirsch, K.

1981-01-01

A Spacelab experiment is described which proposes to obtain data on the degree of engorgement of the cephalad circulation during weightlessness by recording central venous pressure. Of practical importance is the question of how close the astronauts are to pulmonary edema and whether the pressure falls toward normal during the time of the mission. Another experiment to investigate deviations from normal fluid and mineral metabolism, possibly initiated by the central engorgement of the low pressure system, is discussed. Hormones responsible for the control of water and mineral balance (vasopressin, catecholamines, renin, aldosterone, corticosteroids, and prostaglandin E1) will be analyzed from blood samples.

[Superior vena cava syndrome unrelated to central venous catheter in a patient on chronic hemodialysis].

PubMed

Veronesi, Marco; Mancini, Elena; Salvati, Filippo; Santoro, Antonio

2011-01-01

A 67-year-old woman with end-stage renal disease (polycystic kidney disease) who had been on dialysis for 10 years came to our department for a second opinion about upper left arm edema homolateral to the arteriovenous fistula (AVF). Because of the suspicion of venous stenosis she had already been submitted to angiographic examination of the AVF which, however, did not show any occlusive process. In addition to the kidney problem, the clinical history included dilated cardiomyopathy, and 2 years earlier a biventricular implantable cardioverter defibrillator (ICD) had been placed. The patient had never had a central venous catheter (CVC). She presented a typical superior vena cava syndrome picture with arm, neck and hemifacial edema and superficial cutaneous venous reticulum. The venous pressure during extracoroporeal circulation was high and blood recirculation was documented. Angio-CT was performed to look for a compressive process in the chest, but this was excluded. We then performed a new trans-AVF angiography to study extensively the axillary-subclavian-superior vena cava district. At first, no stenosis or thrombosis was observed, but the presence of ICD and its leads (left-sided implanted) in the anonymous vein created obstacles to diagnosis. Repeated injections of contrast medium and focusing imaging on the leads route allowed us to highlight a venous stenosis in the anonymous vein. Transluminal angioplasty was successfully carried out during the same procedure. 1) In hemodialysis patients the appearance of signs of intrathoracic vein drainage obstacles is not always associated with previous CVC implantation; 2) in the hemodialysis patient, any device (PM, ICD) should be implanted contralaterally to the fistula arm in order to avoid the risk that a venous stenosis may cause AVF dysfunction.

Locating the optimal internal jugular target site for central venous line placement.

PubMed

Giordano, Chris R; Murtagh, Kevin R; Mills, Jaime; Deitte, Lori A; Rice, Mark J; Tighe, Patrick J

2016-09-01

Historically, the placement of internal jugular central venous lines has been accomplished by using external landmarks to help identify target-rich locations in order to steer clear of dangerous structures. This paradigm is largely being displaced, as ultrasound has become routine practice, raising new considerations regarding target locations and risk mitigation. Most human anatomy texts depict the internal jugular vein as a straight columnar structure that exits the cranial vault the same size that it enters the thoracic cavity. We dispute the notion that the internal jugulars are cylindrical columns that symmetrically descend into the thoracic cavity, and purport that they are asymmetric conical structures. The primary aim of this study was to evaluate 100 consecutive adult chest and neck computed tomography exams that were imaged at an inpatient hospital. We measured the internal jugular on the left and right sides at three different levels to look for differences in size as the internal jugular descends into the thoracic cavity. We revealed that as the internal jugular descends into the thorax, the area of the vessel increases and geometrically resembles a conical structure. We also reconfirmed that the left internal jugular is smaller than the right internal jugular. Understanding that the largest target area for central venous line placement is the lower portion of the right internal jugular vein will help to better target vascular access for central line placement. This is the first study the authors are aware of that depicts the internal jugular as a conical structure as opposed to the commonly depicted symmetrical columnar structure frequently illustrated in anatomy textbooks. This target area does come with additional risk, as the closer you get to the thoracic cavity, the greater the chances for lung injury. Copyright © 2016 Elsevier Inc. All rights reserved.

Central venous pressure and mean circulatory filling pressure in the dogfish Squalus acanthias: adrenergic control and role of the pericardium.

PubMed

Sandblom, Erik; Axelsson, Michael; Farrell, Anthony P

2006-11-01

Subambient central venous pressure (Pven) and modulation of venous return through cardiac suction (vis a fronte) characterizes the venous circulation in sharks. Venous capacitance was estimated in the dogfish Squalus acanthias by measuring the mean circulatory filling pressure (MCFP) during transient occlusion of cardiac outflow. We tested the hypothesis that venous return and cardiac preload can be altered additionally through adrenergic changes of venous capacitance. The experiments involved the surgical opening of the pericardium to place a perivascular occluder around the conus arteriosus. Another control group was identically instrumented, but lacked the occluder, and was subjected to the same pharmacological protocol to evaluate how pericardioectomy affected cardiovascular status. Routine Pven was negative (-0.08+/-0.02 kPa) in control fish but positive (0.09+/-0.01 kPa) in the pericardioectomized group. Injections of 5 microg/kg body mass (Mb) of epinephrine and phenylephrine (100 microg/kg Mb) increased Pven and MCFP, whereas isoproterenol (1 microg/kg Mb) decreased both variables. Thus, constriction and relaxation of the venous vasculature were mediated through the respective stimulation of alpha- and beta-adrenergic receptors. Alpha-adrenergic blockade with prazosin (1 mg/kg Mb) attenuated the responses to phenylephrine and decreased resting Pven in pericardioectomized animals. Our results provide convincing evidence for adrenergic control of the venous vasculature in elasmobranchs, although the pericardium is clearly an important component in the modulation of venous function. Thus active changes in venous capacitance have previously been underestimated as an important means of modulating venous return and cardiac performance in this group.

Use of peripherally inserted central venous catheters (PICCs) in children receiving autologous or allogeneic stem-cell transplantation.

PubMed

Benvenuti, Stefano; Ceresoli, Rosanna; Boroni, Giovanni; Parolini, Filippo; Porta, Fulvio; Alberti, Daniele

2018-03-01

The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure. From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children's Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit. No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation. Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.

Strategies for prevention of iatrogenic inferior vena cava filter entrapment and dislodgement during central venous catheter placement.

PubMed

Wu, Alex; Helo, Naseem; Moon, Eunice; Tam, Matthew; Kapoor, Baljendra; Wang, Weiping

2014-01-01

Iatrogenic migration of inferior vena cava (IVC) filters is a potentially life-threatening complication that can arise during blind insertion of central venous catheters when the guide wire becomes entangled with the filter. In this study, we reviewed the occurrence of iatrogenic migration of IVC filters in the literature and assessed methods for preventing this complication. A literature search was conducted to identify reports of filter/wire entrapment and subsequent IVC filter migration. Clinical outcomes and complications were identified. A total of 38 cases of filter/wire entrapment were identified. All of these cases involved J-tip guide wires. Filters included 23 Greenfield filters, 14 VenaTech filters, and one TrapEase filter. In 18 cases of filter/wire entrapment, there was migration of the filter to the heart and other central venous structures. Retrieval of the migrated filter was successful in only four of the 18 cases, and all of these cases were complicated by strut fracture and distant embolization of fragments. One patient required resuscitation during retrieval. Successful disengagement was possible in 20 cases without filter migration. Iatrogenic migration of an IVC filter is an uncommon complication related to wire/filter entrapment. This complication can be prevented with knowledge of the patient's history, use of proper techniques when placing a central venous catheter, identification of wire entrapment at an early stage, and use of an appropriate technique to disengage an entrapped wire. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Intracardiac electrocardiography via a "saline-filled central venous catheter electrocardiographic lead": a historical perspective.

PubMed

Madias, John E

2004-04-01

The author describes his experience with a "saline-filled central venous catheter electrocardiographic lead" for the recording of intracardiac electrocardiograms provides a brief description of the methodology, refers to this modality's clinical usefulness, furnishes 2 examples illustrating the contribution of the method to clinical diagnosis, and outlines his literature search to find the discoverer/originator of the employment of a saline-filled intracardiac catheter as an electrocardiogram recording lead.

Open heart surgery for management of right auricular thrombus related to central venous catheterization.

PubMed

Ribeiro, A F; Neto, I S; Maia, I; Dias, C

2018-04-19

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

A Randomized Controlled Comparison of the Internal Jugular Vein and the Subclavian Vein as Access Sites for Central Venous Catheterization in Pediatric Cardiac Surgery.

PubMed

Camkiran Firat, Aynur; Zeyneloglu, Pinar; Ozkan, Murat; Pirat, Arash

2016-09-01

To compare internal jugular vein and subclavian vein access for central venous catheterization in terms of success rate and complications. A 1:1 randomized controlled trial. Baskent University Medical Center. Pediatric patients scheduled for cardiac surgery. Two hundred and eighty children undergoing central venous catheterization were randomly allocated to the internal jugular vein or subclavian vein group during a period of 18 months. The primary outcome was the first-attempt success rate of central venous catheterization through either approach. The secondary outcomes were the rates of infectious and mechanical complications. The central venous catheterization success rate at the first attempt was not significantly different between the subclavian vein (69%) and internal jugular vein (64%) groups (p = 0.448). However, the overall success rate was significantly higher through the subclavian vein (91%) than the internal jugular vein (82%) (p = 0.037). The overall frequency of mechanical complications was not significantly different between the internal jugular vein (25%) and subclavian vein (31%) (p = 0.456). However, the rate of arterial puncture was significantly higher with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter malposition was significantly higher with subclavian vein (17% vs 1%; p < 0.001). The rates per 1,000 catheter days for both positive catheter-tip cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection (6.9 vs 0; p < 0.001) were significantly higher with internal jugular vein. There were no significant differences between the groups in the length of ICU and hospital stays or in-hospital mortality rates (p > 0.05 for all). Central venous catheterization through the internal jugular vein and subclavian vein was not significantly different in terms of success at the first attempt. Although the types of mechanical complications were different, the overall rate was similar between internal jugular vein and

Assessment of central venous catheter colonization using surveillance culture of withdrawn connectors and insertion site skin.

PubMed

Pérez-Granda, María Jesús; Guembe, María; Cruces, Raquel; Barrio, José María; Bouza, Emilio

2016-02-02

Culture of catheter hubs and skin surrounding the catheter entry site has a negative predictive value for catheter tip colonization. However, manipulation of the hub for culture requires the hubs to be swabbed, introducing potential dislodging of biofilm and subsequent migration of microorganisms. Hubs are usually closed with needleless connectors (NCs), which are replaced regularly. Our objective was to evaluate whether culture of flushed withdrawn NCs is an alternative to hub culture when investigating central venous catheter colonization. The study population comprised 49 intensive care unit patients whose central venous catheters had been in place for at least 7 days. Cultures of NCs and skin were obtained weekly. We included 82 catheters with more than 7 days' indwelling time. The catheter tip colonization rate was 18.3% (15/82). Analysis of skin and NC cultures revealed a 92.5% negative predictive value for catheter colonization. Three episodes of catheter-related bloodstream infection (C-RBSI) occurred in patients with colonized catheters. Surveillance of NC and skin cultures could help to identify patients at risk for C-RBSI.

Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

NASA Technical Reports Server (NTRS)

Watenpaugh, Donald E.

1996-01-01

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.

Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve.

PubMed

Rotzinger, Roman; Gebauer, Bernhard; Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Grieser, Christian; Freyhardt, Patrick; Hamm, Bernd; Maurer, Martin H

2017-12-01

Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions' durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.

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

PubMed Central

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

2016-01-01

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

Occult central venous stenosis leading to airway obstruction after subtotal parathyroidectomy.

PubMed

Meiklejohn, Duncan A; Chan, Dylan K; Lalakea, M Lauren

2016-07-01

Subtotal parathyroidectomy may be indicated in patients with chronic renal failure and tertiary hyperparathyroidism, a population at increased risk for central venous stenosis (CVS) due to repeated vascular access. Here we report a case of complete upper airway obstruction precipitated by subtotal parathyroidectomy with ligation of anterior jugular vein collaterals in a patient with occult CVS. This case demonstrates a previously unreported risk of anterior neck surgery in patients with chronic renal failure. We present a review of the literature and discuss elements of the history and physical examination suggestive of occult CVS, with additional workup proposed for appropriate cases. Recommendations are discussed for perioperative and postoperative care in patients at increased risk for CVS.

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

PubMed

Freer, M; Noble, S

2012-08-01

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

Anti-fouling strategies for central venous catheters

PubMed Central

Albadawi, Hassan; Patel, Nikasha; Khademhosseini, Ali; Zhang, Yu Shrike; Naidu, Sailendra; Knuttinen, Grace; Oklu, Rahmi

2017-01-01

Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs. PMID:29399528

Anti-fouling strategies for central venous catheters.

PubMed

Wallace, Alex; Albadawi, Hassan; Patel, Nikasha; Khademhosseini, Ali; Zhang, Yu Shrike; Naidu, Sailendra; Knuttinen, Grace; Oklu, Rahmi

2017-12-01

Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.

Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience.

PubMed

Fadoo, Zehra; Nisar, Muhammad I; Iftikhar, Raza; Ali, Sajida; Mushtaq, Naureen; Sayani, Raza

2015-10-01

Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.

Elevated central venous pressure: a consequence of exercise training-induced hypervolemia?

NASA Technical Reports Server (NTRS)

Convertino, V. A.; Mack, G. W.; Nadel, E. R.

1991-01-01

Resting blood volumes and arterial and central venous pressures (CVP) were measured in 14 men before and after exercise training to determine whether training-induced hypervolemia is accompanied by a change in total vascular capacitance. In addition, resting levels of plasma arginine vasopressin (AVP), atrial natriuretic peptide (ANP), aldosterone (Ald), and norepinephrine (NE) were measured. The same measurements were conducted in seven subjects who did not undergo exercise and acted as controls. Exercise training consisted of 10 wk of controlled cycle exercise for 30 min/day, 4 days/wk at 75-80% of maximal O2 uptake (VO2max). A training effect was verified by a 20% increase in VO2max, a resting bradycardia, and a 9% increase in blood volume. Mean arterial blood pressure was unaltered by exercise training, but resting CVP increased by 16% (P less than 0.05). The percent change in blood volume from before to after training was linearly related to the percent change in CVP (r = 0.903, P less than 0.05). As a consequence of elevations in both blood volume and CVP, the volume-to-pressure ratio was unchanged after exercise training. Plasma AVP, ANP, Ald, and NE were unaltered. Our results indicate that elevated CVP is a consequence of training-induced hypervolemia without alteration in total effective venous capacitance.

Central venous catheters: legal issues.

PubMed

Gallieni, Maurizio; Martina, Valentina; Rizzo, Maria Antonietta; Gravellone, Luciana; Mobilia, Francesca; Giordano, Antonino; Cusi, Daniele; Genovese, Umberto

2011-01-01

In dialysis patients, both central venous catheter (CVC) insertion and CVC use during the dialysis procedure pose important legal issues, because of potentially severe, even fatal, complications. The first issue is the decision of the kind of vascular access that should be proposed to patients: an arteriovenous (AV) fistula, a graft, or a CVC. The second issue, when choosing the CVC option, is the choice of CVC: nontunneled versus tunneled. Leaving a temporary nontunneled CVC for a prolonged time increases the risk of complications and could raise a liability issue. Even when choosing a long-term tunneled CVC, nephrologists should systematically explain its potential harms, presenting them as "unsafe for long-term use" unless there is a clear contraindication to an AV native or prosthetic access. Another critical issue is the preparation of a complete, informative, and easy-to-understand consent form. The CVC insertion procedure has many aspects of legal interest, including the choice of CVC, the use of ECG monitoring, the use of ultrasound guidance for cannulation, and the use of fluoroscopy for checking the position of the metal guidewire during the procedure as well as the CVC tip before the end of the procedure. Use of insertion devices and techniques that can prevent complications should obviously be encouraged. Complications of CVC use are mainly thrombosis and infection. These are theoretically expected as pure complications (and not as malpractice effects), but legal issues might relate to inappropriate catheter care (in both the inpatient and outpatient settings) rather than to the event per se. Thus, in the individual case it is indeed very difficult to establish malpractice and liability with a catheter-related infection or thrombosis. In conclusion, we cannot avoid complications completely when using CVCs, but reducing them to a minimum and adopting safe approaches to their insertion and use will reduce legal liability.

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

PubMed Central

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

2014-01-01

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

A New Technique for Femoral Venous Access in Infants Using Arterial Injection Venous Return Guidance

PubMed Central

Ebishima, Hironori; Kitano, Masataka; Kurosaki, Kenichi; Shiraishi, Isao

2017-01-01

Objectives: Although venography guidance is helpful for central venous catheter placement, it is sometimes difficult to place a peripheral intravenous cannula for enhancement. We designed a new technique for establishing femoral venous access using venography guidance in the return phase of peripheral arteriography. This new technique was named arterial injection venous return guidance. Here we assessed the efficacy and safety of arterial injection venous return guidance. Methods: We reviewed data of 29 infants less than 6 months old undergoing catheter intervention at our institute in 2014. Of the 29 patients, femoral venous cannulation was performed using arterial injection venous return guidance in 5 patients, venography in 20 patients, and the landmark method in 4 patients. The technical success rates and incidence of complications were compared. Results: The overall success rates were 100% in the arterial injection venous return-guided and venography-guided groups. The mean procedure duration and mean contrast material injection time were similar between the groups. The contrast effect on the femoral vein in the arterial injection venous return-guided group was lower than that in the venography-guided group, but adequate for surgery. The overall complication rate was 17%, and obstruction of previously placed intravenous catheters was the most common complication. Conclusions: Therefore, the arterial injection venous return guidance technique was as safe and efficient as venography for establishing venous access. PMID:29034015

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

PubMed Central

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

2012-01-01

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

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

PubMed Central

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

2015-01-01

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

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

2015-01-01

To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections. 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. 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). 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.

Risk factors for venous port migration in a single institute in Taiwan

PubMed Central

2014-01-01

Background An implantable port device provides an easily accessible central route for long-term chemotherapy. Venous catheter migration is one of the rare complications of venous port implantation. It can lead to side effects such as pain in the neck, shoulder, or ear, venous thrombosis, and even life-threatening neurologic problems. To date, there are few published studies that discuss such complications. Methods This retrospective study of venous port implantation in a single center, a Taiwan hospital, was conducted from January 2011 to March 2013. Venous port migration was recorded along with demographic and characteristics of the patients. Results Of 298 patients with an implantable import device, venous port migration had occurred in seven, an incidence rate of 2.3%. All seven were male and had received the Bard port Fr 6.6 which had smaller size than TYCO port Fr 7.5 and is made of silicon. Significantly, migration occurred in male patients (P = 0.0006) and in those with lung cancer (P = 0.004). Multivariable logistic regression analysis revealed that lung cancer was a significant risk factor for port migration (odds ratio: 11.59; P = 0.0059). The migration rate of the Bard port Fr 6.6 was 6.7%. The median time between initial venous port implantation and port migration was 35.4 days (range, 7 to 135 days) and 71.4% (5/7) of patients had port migration within 30 days after initial port implantation. Conclusions Male sex and lung cancer are risk factors for venous port migration. The type of venous port is also an important risk factor. PMID:24423026

Elevated central venous pressure: A consequence of exercise training-induced hypervolemia

NASA Technical Reports Server (NTRS)

Convertino, Victor A.; Mack, Gary W.; Nadel, Ethan R.

1990-01-01

Resting plasma volumes, and arterial and central venous pressures (CVP) were measured in 16 men before and after exercise training to determine if training-induced hypervolemia could be explained by a change in total vascular capacitance. In addition, resting levels of plasma vasopressin (AVP), atrial natriuretic peptide (ANP), aldosterone (ALD), and norepinephrine (NE) were measured before and after training. The same measurements of vacular volume, pressures, and plasma hormones were measured in 8 subjects who did not undergo exercise and acted as controls. The exercise training program consisted of 10 weeks of controlled cycle exercise for 30 min/d, 4 d/wk at 75 to 80 percent of maximal oxygen uptake (VO2max). A training effect was verified by a 20 percent increase in VO2max, a resting bradycardia, and a 370 ml (9 percent) increase in blood volume. Mean arterial blood pressure was unaltered by exercise training, but resting CVP increased. The percent change in blood volume from before to after training was linearly related to the percent change in CVP. As a consequence of elevations in both blood volume and CVP, the volume-to-pressure ratio was essentially unchanged following exercise training. Plasma AVP, ANP, ALD, and NE were unaltered. Results indicate that elevated CVP is a consequence of training-induced hypervolemia without alteration in total effective venous capacitance. This may represent a resetting of the pressure-volume stimulus-response relation for regulation of blood volume.

Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure.

PubMed

Ormsby, Jennifer A; Bukoye, Bola; Lajoie, Debra; Shermont, Herminia; Martin, Lisa; Leger, Kierrah; Mahoney, Judy; Potter-Bynoe, Gail; Carpenter, Jane; Ozonoff, Al; Lee, Grace M

2018-05-16

Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and increase antimicrobial use and length of stay among hospitalized children in the United States. CLABSI occurs more frequently among high-risk pediatric patients, such as those with intestinal failure (IF) who are parenteral nutrition (PN) dependent. Following an increase in CLABSI rates, a quality improvement (QI) initiative was implemented. Using QI methodology, an enhanced central venous catheter (CVC) maintenance bundle was developed and implemented on 2 units for pediatric PN-dependent patients with IF. CLABSI rates were prospectively monitored pre- and postimplementation, and bundle element adherence was monitored. Enhanced bundle elements included chlorhexidine-impregnated patch, daily bathing, ethanol locks, 2 nurses for CVC care in a distraction-free zone, peripheral laboratory draws, bundling routine laboratory tests, and PN administration set changes every 24 hours. Adherence to enhanced bundle elements increased to >90% over 3 months. CLABSI rates averaged 1.41 per 1,000 central line days preimplementation compared with 0.40 per 1,000 device days postimplementation (P = .003), an 85% absolute reduction in CLABSI rates over 12 months. Patients with IF are at an increased risk for CLABSI. Enhanced CVC maintenance bundles that specifically target prevention practices in this population may be beneficial. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Cost-Effectiveness of a Central Venous Catheter Care Bundle

PubMed Central

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

2010-01-01

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

Central venous catheter infection caused by Moraxella osloensis in a patient receiving home parenteral nutrition.

PubMed

Buchman, A L; Pickett, M J; Mann, L; Ament, M E

1993-01-01

We report the first case of a central venous catheter infection caused by Moraxella osloensis, which was successfully treated without catheter removal. The isolation, identification, and pathogenesis of this species are discussed. It is recommended that Moraxella isolates be identified to species in order to determine the relative pathogenic and opportunistic roles of the various Moraxella species. Our case also demonstrates that catheter sepsis caused by some Gram-negative organisms may be amenable to systemic antibiotic therapy without the necessity of catheter removal.

Thromboelastometry versus standard coagulation tests versus restrictive protocol to guide blood transfusion prior to central venous catheterization in cirrhosis: study protocol for a randomized controlled trial.

PubMed

Rocha, Leonardo Lima; Pessoa, Camila Menezes Souza; Neto, Ary Serpa; do Prado, Rogerio Ruscitto; Silva, Eliezer; de Almeida, Marcio Dias; Correa, Thiago Domingos

2017-02-27

Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far. The aim of this study is to compare three transfusion strategies (routine coagulation test-guided - ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis. Design and setting: a double-blinded, parallel-group, single-center, randomized controlled clinical trial in a tertiary private hospital in São Paulo, Brazil. adults (aged 18 years or older) admitted to the intensive care unit with cirrhosis and an indication for central venous line insertion. Patients will be randomly assigned to three groups for blood transfusion strategy prior to central venous catheterization: standard coagulation tests-based, thromboelastometry-based, or restrictive. The primary efficacy endpoint will be the proportion of patients transfused with any blood product prior to central venous catheterization. The primary safety endpoint will be the incidence of major bleeding. Secondary endpoints will be the proportion of transfusion of fresh frozen plasma, platelets and cryoprecipitate; infused volume of blood products; hemoglobin and hematocrit before and after the procedure; intensive care unit and hospital length of stay; 28-day and hospital mortality; incidence of minor bleeding; transfusion-related adverse reactions; and cost analysis. This study will evaluate three strategies to guide blood transfusion prior to central venous line placement in severely ill patients with cirrhosis. We hypothesized that thromboelastometry-based and/or restrictive protocols are safe and would significantly

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.

Use of peripherally inserted central catheters as an alternative to central catheters in neurocritical care units.

PubMed

DeLemos, Christi; Abi-Nader, Judy; Akins, Paul T

2011-04-01

Patients in neurological critical care units often have lengthy stays that require extended vascular access and invasive hemodynamic monitoring. The traditional approach for these patients has relied heavily on central venous and pulmonary artery catheters. The aim of this study was to evaluate peripherally inserted central catheters as an alternative to central venous catheters in neurocritical care settings. Data on 35 patients who had peripherally inserted central catheters rather than central venous or pulmonary artery catheters for intravascular access and monitoring were collected from a prospective registry of neurological critical care admissions. These data were cross-referenced with information from hospital-based data registries for peripherally inserted central catheters and subarachnoid hemorrhage. Complete data were available on 33 patients with Hunt-Hess grade IV-V aneurysmal subarachnoid hemorrhage. Catheters remained in place a total of 649 days (mean, 19 days; range, 4-64 days). One patient (3%) had deep vein thrombosis in an upper extremity. In 2 patients, central venous pressure measured with a peripherally inserted catheter was higher than pressure measured concurrently with a central venous catheter. None of the 33 patients had a central catheter bloodstream infection or persistent insertion-related complications. CONCLUSIONS Use of peripherally inserted central catheters rather than central venous catheters or pulmonary artery catheters in the neurocritical care unit reduced procedural and infection risk without compromising patient management.

Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects.

PubMed

Menegueti, Mayra Gonçalves; Betoni, Natália Cristina; Bellissimo-Rodrigues, Fernando; Romão, Elen Almeida

2017-01-01

Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profiles of the primary microorganisms isolated during one year of follow-up. A prospective cohort study was conducted in 2014 in a hemodialysis referral center. We included 200 outpatients with acute kidney injury who had no permanent venous access. A nurse assessed the patients for signs of infection three times per week during dressing changes. The clinicopathologic characteristics of patients with and without local or systemic infection were compared. Fifty-five episodes of catheter-related infections occurred in 43 (22%) patients; 38 (69%) were bloodstream infections and 17 (31%) were local infections. Thirty-two (75%) patients with infection had femoral vein catheter placement. In total, 6,240 hemodialysis sessions were performed; the rates of primary bloodstream and local infection were 6.1 and 2.7 episodes per 1,000 patients on daily dialysis, respectively. In the univariate analysis, diabetes was significantly associated with the development of infection, while level of education, ethnicity, age, and sex were not. Gram-negative bacteria were primarily isolated from blood culture specimens (55% of samples). Of the Gram-negative isolates, 56% were resistant to the carbapenems. We identified a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters.

Moraxella osloensis: an unusual cause of central venous catheter infection in a cancer patient

PubMed Central

Hadano, Yoshiro; Ito, Kenta; Suzuki, Jun; Kawamura, Ichiro; Kurai, Hanako; Ohkusu, Kiyofumi

2012-01-01

Moraxella osloensis is a rare causative organism of infections in humans, with most cases reported in cancer patients. We report the case of a 67-year-old Japanese man with advanced cancer of the pancreatic head and multiple liver metastases who developed fever with chills. Blood culture was found to be positive for Gram-negative bacilli that were aerobic, oxidase-positive, and catalase-positive. M. osloensis was identified by 16 rRNA gene sequencing. Prompt control of the infection was achieved by treatment with cefepime for 14 days, without the need for removal of the central venous catheter. PMID:23109812

Moraxella osloensis: an unusual cause of central venous catheter infection in a cancer patient.

PubMed

Hadano, Yoshiro; Ito, Kenta; Suzuki, Jun; Kawamura, Ichiro; Kurai, Hanako; Ohkusu, Kiyofumi

2012-01-01

Moraxella osloensis is a rare causative organism of infections in humans, with most cases reported in cancer patients. We report the case of a 67-year-old Japanese man with advanced cancer of the pancreatic head and multiple liver metastases who developed fever with chills. Blood culture was found to be positive for Gram-negative bacilli that were aerobic, oxidase-positive, and catalase-positive. M. osloensis was identified by 16 rRNA gene sequencing. Prompt control of the infection was achieved by treatment with cefepime for 14 days, without the need for removal of the central venous catheter.

Cerebral venous circulatory system evaluation by ultrasonography.

PubMed

Zavoreo, Iris; Basić-Kes, Vanja; Zadro-Matovina, Lucija; Lisak, Marijana; Corić, Lejla; Cvjeticanin, Timon; Ciliga, Dubravka; Bobić, Tatjana Trost

2013-06-01

Venous system can be classified as pulmonary veins, systemic veins and venous sinuses that are present only within the skull. Cerebral venous system is divided into two main parts, the superficial and the deep system. The main assignment of veins is to carry away deoxygenated blood and other maleficient materials from the tissues towards the heart. Veins have thinner walls and larger lumina than arteries. Between 60% and 70% of the total blood volume is found in veins. The major factors that influence venous function are the respiratory cycle, venous tone, the function of the right heart, gravity, and the muscle pump. Venous system, in general, can be presented by selective venography, Doppler sonography, computed tomography (CT) venography and magnetic resonance (MR) venography, and cerebral venous system can be displayed by selective venography, cerebral CT venography, cerebral MR venography, and specialized extracranial and transcranial Doppler sonography. The aim of this paper is to show the possibilities of intracranial and extracranial ultrasound evaluation of the head and neck venous circulation and chronic cerebrospinal venous insufficiency as one of the most common pathologies evaluated as part of neurodegenerative processes in the central nervous system.

Comparing the Use of Global Rating Scale with Checklists for the Assessment of Central Venous Catheterization Skills Using Simulation

ERIC Educational Resources Information Center

Ma, Irene W. Y.; Zalunardo, Nadia; Pachev, George; Beran, Tanya; Brown, Melanie; Hatala, Rose; McLaughlin, Kevin

2012-01-01

The use of checklists is recommended for the assessment of competency in central venous catheterization (CVC) insertion. To explore the use of a global rating scale in the assessment of CVC skills, this study seeks to compare its use with two checklists, within the context of a formative examination using simulation. Video-recorded performances of…

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

PubMed

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

2010-04-01

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

Elucidating the mechanism of posterior reversible encephalopathy syndrome: a case of transient blindness after central venous catheterization.

PubMed

Rao, Neal M; Raychev, Radoslav; Kim, Doojin; Liebeskind, David S

2012-11-01

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by reversible symptoms including headache, visual disturbances, focal neurological deficits, altered mentation, and seizures. It has been associated with circumstances that may affect the cerebrovascular system, such as hypertension, eclampsia, and immunosuppression with calcineurin inhibitors. The underlying etiology of PRES has remained unclear; however, cerebrovascular autoregulatory dysfunction, hyperperfusion, and endothelial activation have been implicated. We describe a case of a young patient with lung transplant, who presented with headache, acute binocular blindness, and seizure immediately after infusion of saline through a peripherally inserted central catheter line, which inadvertently terminated cephalad in the left internal jugular vein, near the jugular foramen. Subsequent brain magnetic resonance imaging revealed vasogenic edematous lesions in a pattern consistent with PRES--a diagnosis supported by his constellation of symptoms, history of lung transplantation on tacrolimus immunosuppression, and relative hypertension. This is the first reported case describing the development of PRES after the insertion of a peripherally inserted central catheter line. The development of PRES in a typical high-risk patient immediately after cerebral venous outflow obstruction implicates the role of the cerebral venous system and provides potential insight into the mechanism of this disorder that remains of unclear pathogenesis.

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.

It all unraveled from there: case report of a central venous catheter guidewire unraveling.

PubMed

Zerkle, Samuel; Emdadi, Vanessa; Mancinelli, Marc

2014-12-01

Inferior vena cava (IVC) filters can present challenges to emergency physicians in the process of central venous catheter (CVC) placement. A 68-year-old woman presented to the emergency department with severe shortness of breath and was intubated. A central line was placed after the intubation to facilitate peripheral access. A CVC guidewire unraveled during placement after getting caught on an IVC filter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of the complications that IVC filters can cause in the placement of CVCs. Imaging and identification of IVC filters beforehand will allow for proper planning of how to manage the case in which a filter catches on the guidewire. Simple anecdotal techniques, such as advancing the guidewire and spinning the guidewire between the fingers, can facilitate the removal of the guide wire from the IVC filter. Copyright © 2014 Elsevier Inc. All rights reserved.

Vascular Access Tracking System: a Web-Based Clinical Tracking Tool for Identifying Catheter Related Blood Stream Infections in Interventional Radiology Placed Central Venous Catheters.

PubMed

Morrison, James; Kaufman, John

2016-12-01

Vascular access is invaluable in the treatment of hospitalized patients. Central venous catheters provide a durable and long-term solution while saving patients from repeated needle sticks for peripheral IVs and blood draws. The initial catheter placement procedure and long-term catheter usage place patients at risk for infection. The goal of this project was to develop a system to track and evaluate central line-associated blood stream infections related to interventional radiology placement of central venous catheters. A customized web-based clinical database was developed via open-source tools to provide a dashboard for data mining and analysis of the catheter placement and infection information. Preliminary results were gathered over a 4-month period confirming the utility of the system. The tools and methodology employed to develop the vascular access tracking system could be easily tailored to other clinical scenarios to assist in quality control and improvement programs.

Central load reduces peripheral processing: Evidence from incidental memory of background speech.

PubMed

Halin, Niklas; Marsh, John E; Sörqvist, Patrik

2015-12-01

Is there a trade-off between central (working memory) load and peripheral (perceptual) processing? To address this question, participants were requested to undertake an n-back task in one of two levels of central/cognitive load (i.e., 1-back or 2-back) in the presence of a to-be-ignored story presented via headphones. Participants were told to ignore the background story, but they were given a surprise memory test of what had been said in the background story, immediately after the n-back task was completed. Memory was poorer in the high central load (2-back) condition in comparison with the low central load (1-back) condition. Hence, when people compensate for higher central load, by increasing attentional engagement, peripheral processing is constrained. Moreover, participants with high working memory capacity (WMC) - with a superior ability for attentional engagement - remembered less of the background story, but only in the low central load condition. Taken together, peripheral processing - as indexed by incidental memory of background speech - is constrained when task engagement is high. © 2015 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.

The Relationship Between Intrinsic and Extrinsic Factors and Central Venous Catheter Infections in the Acutely Ill Patient

DTIC Science & Technology

1991-01-01

central venous catheter is inserted into the bloodstream, a fibrin sheath forms around the cannula which attracts bacteria . Bacteria can either migrate from...to the fibrin sheath. After colonization of the fibrin sheath, the bacteria replicate and are released into the bloodstream when symptoms may develop...culture." Rose et al. (1988, p. 511) defined catheter site infection as occurring when "cultures at the exit site are identical to bacteria found on

Ultrasonography-guided central venous catheterisation in haematological patients with severe thrombocytopenia

PubMed Central

Napolitano, Mariasanta; Malato, Alessandra; Raffaele, Francesco; Palazzolo, Manuela; Iacono, Giorgio Lo; Pinna, Roberto; Geraci, Girolamo; Modica, Giuseppe; Saccullo, Giorgia; Siragusa, Sergio; Cajozzo, Massimo

2013-01-01

Background Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia. Materials and methods We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×109/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded. Results All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group. Discussion US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion. PMID:23399356

Prevalence and Risk Factors of Central Venous Stenosis among Prevalent Hemodialysis Patients, a Single Center Experience.

PubMed

Osman, Osama O; El-Magzoub, Abdul-Rahman A; Elamin, Sarra

2014-01-01

Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. In this study we evaluated the prevalence and risk factors of CVS among hemodialysis (HD) patients in a single center in Sudan, using Doppler ultrasound as a screening tool. The study included 106 prevalent HD patients. For every patient, we performed Duplex Doppler for the right and left jugular, subclavian and femoral veins. A patient was considered to have hemodynamically significant stenosis if the pre-stenosis to the post-stenosis velocities ratio was ≥ 2.5 or they had complete vein occlusion. Overall, 28.3% of patients had Doppler detected CVS, including 25.5% with hemodynamically significant stenosis and 2.8% with compromised flow. The prevalence of CVS was 68.4% among symptomatic patients compared to 19.5% in asymptomatic patients. The prevalence of CVS among patients with history of 0-1, 2-3 and ≥ 4 central venous catheters was 3.4%, 29.4% and 53.8% respectively (p=0.00). CVS was not more common in patients with history of previous/current jugular or femoral vein catheterization compared to no catheter placement in these veins (28.3% vs 28.6% and 35% vs 26.7% respectively; p >0.1). However, CVS was significantly more common in patients with previous/ current subclavian vein catheterization compared to no catheter placement in this vein (47.8% vs 22.9%, p = 0.02). CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS.

Central Venous Catheter Placement in the Left Internal Jugular Vein Complicated by Perforation of the Left Brachiocephalic Vein and Massive Hemothorax: A Case Report.

PubMed

Wetzel, Lindsay R; Patel, Priyesh R; Pesa, Nicholas L

2017-07-01

An elderly male presented for emergent repair of a ruptured abdominal aortic aneurysm. For anticipated volume resuscitation, vasopressor administration, and hemodynamic monitoring, a large-bore central venous catheter was placed in the left internal jugular vein under ultrasound guidance before surgical incision. Initially, there were no readily apparent signs of venous perforation. However, a massive left hemothorax developed because of perforation of the brachiocephalic vein and violation of the pleural space. This case report discusses both prevention and management of such a complication.

Central venous access and handwashing: variability in policies and practices.

PubMed

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

2003-12-01

This study examined variability in handwashing policy between hospitals, variability in handwashing practices in nurses and how practice differed from policy in tertiary paediatric hospitals in Australia and New Zealand. Eight of the possible nine major paediatric hospitals provided a copy of their handwashing and/or central venous access device (CVAD) policies, and 67 nurses completed a survey on their handwashing practices associated with CVAD management. A high degree of variability was found in relation to all the questions posed in the study. There was little consistency between policies and little agreement between policies and clinical practice, with many nurses washing for longer than required by policy. Rigour of handwashing also varied according to the procedure undertaken and the type of CVAD with activities undertaken farther from the insertion site of the device more likely to be performed using a clean rather than an aseptic handwashing technique. As both patients and nursing staff move within and between hospitals, a uniform and evidence-based approach to handwashing is highly desirable.

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education

PubMed Central

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J.A.; Dandorf, Stewart J.; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-01-01

Introduction Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. Methods This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Results Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). Conclusion The use of this novel cadaver

Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education.

PubMed

Miller, Ryan; Ho, Hang; Ng, Vivienne; Tran, Melissa; Rappaport, Douglas; Rappaport, William J A; Dandorf, Stewart J; Dunleavy, James; Viscusi, Rebecca; Amini, Richard

2016-05-01

Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). The use of this novel cadaver model prevented extravasation of fluid

Central nervous system infection after Onyx embolisation of arterio-venous malformations in two paediatric patients.

PubMed

Pulhorn, H; Hartley, J C; Shanmuganathan, M; Lee, C H; Harkness, W; Thompson, D N P

2014-09-01

Increasingly, Onyx is used for endovascular embolization of aneurysms and arterio-venous malformations. Although reports in the literature on the use of Onyx are favourable, there have been so far no reports on the central nervous system (CNS) infection rate after embolisation with Onyx and no recommendations as to the management of these infections. We present two cases of paediatric patients who acquired CNS infection with Pseudomonas aeruginosa after Onyx embolisation of AVMs and describe their subsequent management. Presence of established infection after Onyx embolisation should be dealt with by removal of infected material, administration of appropriate antibiotic therapy and supportive treatment.

Managing central venous obstruction in cystic fibrosis recipients--lung transplant considerations.

PubMed

Otani, Shinji; Westall, Glen P; Levvey, Bronwyn J; Marasco, Silvana; Lyon, Stuart; Snell, Gregory I

2015-03-01

The superior vena cava (SVC) syndrome in cystic fibrosis (CF) patients is rare, but presents unique challenges in the peri-transplant period. We reviewed our experience of SVC syndrome in CF recipients undergoing lung transplantation. This is a retrospective case series from a single center chart-review. SVC obstruction is defined by clinically significant stenosis or obstruction of the SVC as detected by contrast studies. We identified SVC obstruction in seven post-transplant cases and one pre-transplant case. All eight patients had previous or current history of indwelling central venous catheters. Three recipients experienced operative complications. Five of the seven recipients suffered at least one episode of post-operative SVC obstruction or bleeding despite prophylactic anticoagulation. At a median follow-up of 29 months, six of the seven patients transplanted are well. Strategies are available to minimize the risks of intra/peri-operative acute life-threatening SVC obstruction in CF patients. Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

[Central venous-arterial carbon dioxide tension to arterial-central venous oxygen content ratio combined with lactate clearance rate as early resuscitation goals of septic shock].

PubMed

Gao, X H; Li, P J; Cao, W

2018-02-13

Objective: To investigate the prognostic significance of central venous-arterial carbon dioxide tension to arterial-venous oxygen content ratio (Pcv-aCO(2)/Ca-cvO(2)) combined with lactate clearance rate (LCR) as early resuscitation goals of septic shock. Methods: One hundred and forty-five septic shock patients admitted to Second Department of Critical Care Medicine of Lanzhou University Second Hospital from March 2013 to May 2017 were enrolled in this study.All septic shock patients received an initial resuscitation therapy according to early goal-directed therapy.The arterial and central venous blood gases were measured simultaneously at baseline (T0) and 6 hours after resuscitation (T6). Pcv-aCO(2)/Ca-cvO(2) and LCR were calculated.Patients were classified into four groups according to Pcv-aCO(2)/Ca-cvO(2) and LCR at T6: group A, Pcv-aCO(2)/Ca-cvO(2)>1.8 and LCR<30%; group B, Pcv-aCO(2)/Ca-cvO(2)>1.8 and LCR≥30%; group C, Pcv-aCO(2)/Ca-cvO(2)≤1.8 and LCR<30%; group D, Pcv-aCO(2)/Ca-cvO(2)≤1.8 and LCR≥30%.General demographics, hemodynamic parameters, oxygen metabolism parameters, acute physiology and chronic health evaluation (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores, length of intensive care unit (ICU) stay, and 28-day mortality rate were compared among the 4 groups.A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test for multiple comparisons.Parameters were introduced into a Cox's proportional hazards regression model to analyze the prediction of 28-day mortality.Receiver operating characteristics (ROC) curves were constructed to evaluate the ability of Pcv-aCO(2)/Ca-cvO(2), LCR, Pcv-aCO(2)/Ca-cvO(2) combined with LCR at T6 to predict 28-day mortality. Results: Compared with patients in group A, patients from group D had the lower APACHE Ⅱ and SOFA score at day 3 ( t =-2.909, -3.630, both P <0.05), shorter ICU stay ( t =-2.575, P =0.011), and lower mortality rate at day 28 (χ(2)=3.124, P

Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

NASA Astrophysics Data System (ADS)

Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

2016-05-01

To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P <0.05). Compared with gelatin sponge and alginate dressing hemostatic effect, The difference was not statistically significant. (2) Tube maintenance cost: Puncture point using gelatin sponge, The local maintenance costs of the catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (P<0.05). Conclusion: The choice of compression hemostasis material for the puncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

Retained embolized fragment of totally implantable central venous catheter in right ventricle: it is really necessary to remove?

PubMed

Tazzioli, Giovanni; Gargaglia, Eleonora; Vecchioni, Ilaria; Papi, Simona; Di Blasio, Petronilla; Rossi, Rosario

2015-01-01

Central venous catheters are often required in oncologic patients for long-term safe administration of chemotherapeutic agents, antibiotics, and parenteral nutrition. Rupture of these devices and intracardiac migration is a rare complication. We report one spontaneous rupture and embolization of a totally implantable vascular access device (TIVAD) in an asymptomatic patient. A 50-year-old woman received a TIVAD silicone catheter 8 FR for adjuvant chemotherapy. After 3 years of port time in situ, during a follow-up control, a catheter malfunction was found and radiologic investigations showed a rupture and migration of the catheter to the right ventricle. The attempt to remove the fragment under fluoroscopic control using the femoral route was unsuccessful. We did not try a surgical approach because of the complete absence of symptomatology and hemodynamic impairment. The catheter rupture and intracardiac embolization is a rare complication associated with totally implantable or tunneled central venous catheters. When such an event happens, the patient should be managed by expert hemodynamists or interventional radiologists making an effort to remove the fragment without surgical measures. When the intravascular percutaneous route fails, the possibility to leave the fragmented catheter in heart chambers should be evaluated, being surgery questionable in asymptomatic patients.

Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.

PubMed

Gambardella, Ivancarmine; Gaudino, Mario; Ronco, Claudio; Lau, Christopher; Ivascu, Natalia; Girardi, Leonard N

2016-11-01

Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1.99, 95% confidence interval (95% CI) of 1.16-3.40. In cardiac surgery subsets where venous hypertension is a hallmark feature, the incidence of AKI is higher (tricuspid disease 30%, carcinoid valve disease 22%). Even in the non-chronically congested coronary artery bypass population, CVP measured 6 h postoperatively showed significant association to renal failure: risk-adjusted OR for AKI was 5.5 (95% CI 1.93-15.5; P = 0.001) with every 5 mmHg rise in CVP for patients with CVP <9 mmHg; for CVP increments of 5 mmHg above the threshold of 9 mmHg, the risk-adjusted OR for AKI was 1.3 (95% CI 1.01-1.65; P = 0.045). This and other clinical evidence are discussed along with the underlying pathophysiological mechanisms, involving the supremacy of volume receptors in regulating the autonomic output in hypervolaemia, and the regional effect of venous congestion on the nephron. The effect of CVP on renal function was found to be modulated by ventricular function class, aetiology and acuity of venous congestion. Evidence suggests that acute increases of CVP should be actively treated to avoid a deterioration of the renal function, particularly in patients with poor ventricular fraction. Besides, the practice of treating right heart failure with fluid loading should be avoided in favour of other ways to optimize haemodynamics in this setting, because of the detrimental effects on the kidney function. © The Author 2016. Published by Oxford

An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Desai, Shamit S., E-mail: shamit.desai@northwestern.edu; Konanur, Meghana; Foltz, Gretchen

PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared andmore » externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.« less

Primary Stenting Is Not Necessary in Benign Central Venous Stenosis.

PubMed

Rangel, Lynsey E; Lyden, Sean P; Clair, Daniel G

2018-01-01

The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone

[Risk factors of deep venous thrombosis associated with peripherally inserted central venous catheter in upper extremity in ICU].

PubMed

Zhao, Ning; Zhang, Jiale; Jiang, Ting; Chen, Xia; Wang, Jianning; Ding, Chengzhi; Liu, Fen; Qian, Kejian; Jiang, Rong

2017-02-01

To analyze the incidence and its risk factors of peripherally inserted central venous catheter related upper extremity deep venous thrombosis (PICC-UEDVT) in intensive care unit (ICU). Clinical data of the patients received PICCs in ICU of the First Affiliated Hospital of Nanchang University from August 2013 to August 2016 were retrospectively analysed. The inclusion criteria in the study included: the age > 18 years old, catheter indwelling time > 1 week and the complete relevant information. The gender, age, history of deep venous thrombosis (DVT) and PICC; number of illness involved organs; complicated with hypertension, diabetes, infection or not; and acute physiology and chronic health evaluation II (APACHE II), duration of mechanical ventilation; D-dimer, platelet count (PLT), and activated partial thromboplastin time (APTT) were recorded. According to the occurrence of PICC-UEDVT, univariate analysis was performed to identify the risk factors of PICC-UEDVT and variables with statistical difference were selected to do multivariate binary logistic regression analysis for the confirmable independence risk factors. Six patients of the 61 cases occurred PICC-UEDVT with the occurrence rate of 9.8%. Time of occurrence was 9 days, 14 days (2 cases), 22 days, 28 days, 62 days after inserted catheter respectively. Univariate analysis demonstrated that previous DVT, D-dimer and big diameter PICC were risk factors associated with PICC-UEDVT [the previous DVT: 50.00% vs. 7.27%, P = 0.017; D-dimer > 5 mg/L: 66.67% vs. 18.18%, P = 0.021; 5F catheter: 83.33% vs. 29.09%, P = 0.016]. It was shown by multivariate logistic regression analysis that the previous DVT [odds ratio (OR) = 20.539, 95% confidence interval (95%CI) = 1.733-243.875, P = 0.017] and increasing size of catheter (OR = 18.070, 95%CI = 1.317-247.875, P = 0.030) were independent risk factors associated with the development of PICC-UEDVT. For critical patients with a history of DVT and D-dimer > 5 mg

Between the lines: The 50th anniversary of long-term central venous catheters.

PubMed

Gow, Kenneth W; Tapper, David; Hickman, Robert O

2017-05-01

Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion. Copyright © 2017 Elsevier Inc. All rights reserved.

Central venous access by trainees: a systematic review and meta-analysis of the use of simulation to improve success rate on patients.

PubMed

Madenci, Arin L; Solis, Carolina V; de Moya, Marc A

2014-02-01

Simulation training for invasive procedures may improve patient safety by enabling efficient training. This study is a meta-analysis with rigorous inclusion and exclusion criteria designed to assess the real patient procedural success of simulation training for central venous access. Published randomized controlled trials and prospective 2-group cohort studies that used simulation for the training of procedures involving central venous access were identified. The quality of each study was assessed. The primary outcome was the proportion of trainees who demonstrated the ability to successfully complete the procedure. Secondary outcomes included the mean number of attempts to procedural success and periprocedural adverse events. Proportions were compared between groups using risk ratios (RRs), whereas continuous variables were compared using weighted mean differences. Random-effects analysis was used to determine pooled effect sizes. We identified 550 studies, of which 5 (3 randomized controlled trials, 2 prospective 2-group cohort studies) studies of central venous catheter (CVC) insertion were included in the meta-analysis, composed of 407 medical trainees. The simulation group had a significantly larger proportion of trainees who successfully placed CVCs (RR, 1.09; 95% confidence interval [CI], 1.03-1.16, P<0.01). In addition, the simulation group had significantly fewer mean attempts to CVC insertion (weighted mean difference, -1.42; 95% CI, -2.34 to -0.49, P<0.01). There was no significant difference in the rate of adverse events between the groups (RR, 0.50; 95% CI, 0.19-1.29; P=0.15). Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.

Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study.

PubMed

Viana Taveira, Michelle Ribeiro; Lima, Luciana Santana; de Araújo, Cláudia Corrêa; de Mello, Maria Júlia Gonçalves

2017-02-01

Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysis was performed to determine CLABSI-free catheter survival. Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated, Gram-negative microorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm -3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment. © 2016 Wiley Periodicals, Inc.

Integrated studies on the use of cognitive task analysis to capture surgical expertise for central venous catheter placement and open cricothyrotomy.

PubMed

Yates, Kenneth; Sullivan, Maura; Clark, Richard

2012-01-01

Cognitive task analysis (CTA) methods were used for 2 surgical procedures to determine (1) the extent that experts omitted critical information, (2) the number of experts required to capture the optimalamount of information, and (3) the effectiveness of a CTA-informed curriculum. Six expert physicians for both the central venous catheter placement and open cricothyrotomy were interviewed. The transcripts were coded, corrected, and aggregated as a "gold standard." The information captured for each surgeon was then analyzed against the gold standard. Experts omitted an average of 34% of the decisions for the central venous catheter and 77% of the decisions for the Cric. Three to 4 experts were required to capture the optimal amount of information. A significant positive effect on performance (t([21]) = 2.08, P = .050), and self-efficacy ratings (t([18]) = 2.38, P = .029) were found for the CTA-informed curriculum for cricothyrotomy. CTA is an effective method to capture expertise in surgery and a valuable component to improve surgical training. Copyright © 2012 Elsevier Inc. All rights reserved.

Low central venous pressure with milrinone during living donor hepatectomy.

PubMed

Ryu, H-G; Nahm, F S; Sohn, H-M; Jeong, E-J; Jung, C-W

2010-04-01

Maintaining a low central venous pressure (CVP) has been frequently used in liver resections to reduce blood loss. However, decreased preload carries potential risks such as hemodynamic instability. We hypothesized that a low CVP with milrinone would provide a better surgical environment and hemodynamic stability during living donor hepatectomy. Thirty-eight healthy adult liver donors were randomized to receive either milrinone (milrinone group, n = 19) or normal saline (control group, n = 19) infusion during liver resection. The surgical field was assessed using a four-point scale. Intraoperative vital signs, blood loss, the use of vasopressors and diuretics and postoperative laboratory data were compared between groups. The milrinone group showed a superior surgical field (p < 0.001) and less blood loss (142 +/- 129 mL vs. 378 +/- 167 mL, p < 0.001). Vital signs were well maintained in both groups but the milrinone group required smaller amounts of vasopressors and less-frequent diuretics to maintain a low CVP. The milrinone group also showed a more rapid recovery pattern after surgery. Milrinone-induced low CVP improves the surgical field with less blood loss during living donor hepatectomy and also has favorable effects on intraoperative hemodynamics and postoperative recovery.

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

PubMed

Horberry, Tim; Teng, Yi-Chun; Ward, James; Patil, Vishal; Clarkson, P John

2014-01-01

Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection.

PubMed

Sand, L; Rizell, M; Houltz, E; Karlsen, K; Wiklund, J; Odenstedt Hergès, H; Stenqvist, O; Lundin, S

2011-10-01

It has been suggested that blood loss during liver resection may be reduced if central venous pressure (CVP) is kept at a low level. This can be achieved by changing patient position but it is not known how position changes affect portal (PVP) and hepatic (HVP) venous pressures. The aim of the study was to assess if changes in body position result in clinically significant changes in these pressures. We studied 10 patients undergoing liver resection. Mean arterial pressure (MAP) and CVP were measured using fluid-filled catheters, PVP and HVP with tip manometers. Measurements were performed in the horizontal, head up and head down tilt position with two positive end expiratory pressure (PEEP) levels. A 10° head down tilt at PEEP 5 cm H(2) O significantly increased CVP (11 ± 3 to 15 ± 3 mmHg) and MAP (72 ± 8 to 76 ± 8 mmHg) while head up tilt at PEEP 5 cm H(2) O decreased CVP (11 ± 3 to 6 ± 4 mmHg) and MAP (72 ± 8 to 63 ± 7 mmHg) with minimal changes in transhepatic venous pressures. Increasing PEEP from 5 to 10 resulted in small increases, around 1 mmHg in CVP, PVP and HVP. There was no significant correlation between changes in CVP vs. PVP and HVP during head up tilt and only a weak correlation between CVP and HVP by head down tilt. Changes of body position resulted in marked changes in CVP but not in HVPs. Head down or head up tilt to reduce venous pressures in the liver may therefore not be effective measures to reduce blood loss during liver surgery. 2011 The Authors Acta Anaesthesiologica Scandinavica, 2011 The Acta Anaesthesiologica Scandinavica Foundation.

Use of percutaneous closure devices in the removal of central venous catheters from inadvertent arterial catheterizations.

PubMed

Guimaraes, M; Uflacker, R; Schonholz, C; Hannegan, C; Selby, B

2008-06-01

Although rare, misplacement of central venous catheters in supra-aortic arteries is potentially fatal. Five patients had safe catheters removal using percutaneous closure devices. Three patients were coagulopathic, 3 under intensive care and 1 in immediate postoperative limb amputation. Patients were treated successfully, with immediate hemostasis and without complications in a mean follow-up of 12.5 months. Although the number of patients is small, the closure devices proved to be safe. This is a minimally invasive alternative technique in the management of large bore catheters removed from non-compressible puncture sites such as subclavian and brachiocephalic arteries.

Central line infections - hospitals

MedlinePlus

... infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired infection - central line infection; Patient safety - central ...

Pentoxifylline for treating venous leg ulcers.

PubMed

Jull, Andrew B; Arroll, Bruce; Parag, Varsha; Waters, Jill

2012-12-12

Healing of venous leg ulcers is improved by the use of compression bandaging but some venous ulcers remain unhealed, and some people are unsuitable for compression therapy. Pentoxifylline, a drug which helps blood flow, has been used to treat venous leg ulcers. To assess the effects of pentoxifylline (oxpentifylline or Trental 400) for treating venous leg ulcers, compared with a placebo or other therapies, in the presence or absence of compression therapy. For this fifth update we searched the Cochrane Wounds Group Specialised Register (searched 20 July 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (2010 to July Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 19, 2012); Ovid EMBASE (2010 to 2012 Week 28); and EBSCO CINAHL (2010 to July 13 2012). Randomised trials comparing pentoxifylline with placebo or other therapy in the presence or absence of compression, in people with venous leg ulcers. One review author extracted and summarised details from eligible trials using a coding sheet. One other review author independently verified data extraction. No new trials were identified for this update. We included twelve trials involving 864 participants. The quality of trials was variable. Eleven trials compared pentoxifylline with placebo or no treatment. Pentoxifylline is more effective than placebo in terms of complete ulcer healing or significant improvement (RR 1.70, 95% CI 1.30 to 2.24). Pentoxifylline plus compression is more effective than placebo plus compression (RR 1.56, 95% CI 1.14 to 2.13). Pentoxifylline in the absence of compression appears to be more effective than placebo or no treatment (RR 2.25, 95% CI 1.49 to 3.39).More adverse effects were reported in people receiving pentoxifylline (RR 1.56, 95% CI 1.10 to 2.22). Nearly three-quarters (72%) of the reported adverse effects were gastrointestinal. Pentoxifylline is an effective adjunct to compression

Central venous access devices: an investigation of oncology nurses' troubleshooting techniques.

PubMed

Mason, Tina M; Ferrall, Sheila M; Boyington, Alice R; Reich, Richard R

2014-08-01

Experienced oncology nurses use different troubleshooting techniques for clearing occluded central venous access devices (CVADs) with varying degrees of success. The purpose of this study was to explore troubleshooting techniques used for clearing occluded CVADs by experienced oncology RNs and identify the perceived effectiveness of each technique. An invitation for a web-based survey was sent to select RN members of the Oncology Nursing Society. All nurses (N = 224) reported asking patients to raise and/or move their arm. Most nurses asked patients to lie down, cough, and take deep breaths. Respondents considered instilling a thrombolytic agent to be the most effective technique. No associations were found between techniques and respondents' years in oncology nursing, work setting, certification, or academic degree. The findings contribute to knowledge about care of patients with occluded devices and will help formulate direction for additional investigation of CVADs. Establishing the appropriateness of practice-related troubleshooting techniques may eliminate unnecessary steps and save nursing time. Educating nurses on the topic will also help reduce techniques that are not expected to yield results or are contraindicated.

Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients

PubMed Central

Keller, Sara C.; Williams, Deborah; Gavgani, Mitra; Hirsch, David; Adamovich, John; Hohl, Dawn; Krosche, Amanda; Cosgrove, Sara; Perl, Trish M.

2017-01-01

BACKGROUND Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy. OBJECTIVE To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications. DESIGN Prospective cohort study between March and December 2015. SETTING Home infusion therapy after discharge from academic medical centers. PARTICIPANTS Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal. METHODS Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications. RESULTS Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications. CONCLUSIONS complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients. PMID:27697084

Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients.

PubMed

Keller, Sara C; Williams, Deborah; Gavgani, Mitra; Hirsch, David; Adamovich, John; Hohl, Dawn; Krosche, Amanda; Cosgrove, Sara; Perl, Trish M

2017-01-01

BACKGROUND Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy. OBJECTIVE To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications. DESIGN Prospective cohort study between March and December 2015. SETTING Home infusion therapy after discharge from academic medical centers. PARTICIPANTS Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal. METHODS Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications. RESULTS Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51-15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09-5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01-0.74]). Other environmental exposures were not associated with CVC complications. CONCLUSIONS complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients. Infect Control Hosp Epidemiol 2016;1-8.

Congestive renal failure: the pathophysiology and treatment of renal venous hypertension.

PubMed

Ross, Edward A

2012-12-01

Longstanding experimental evidence supports the role of renal venous hypertension in causing kidney dysfunction and "congestive renal failure." A focus has been heart failure, in which the cardiorenal syndrome may partly be due to high venous pressure, rather than traditional mechanisms involving low cardiac output. Analogous diseases are intra-abdominal hypertension and renal vein thrombosis. Proposed pathophysiologic mechanisms include reduced transglomerular pressure, elevated renal interstitial pressure, myogenic and neural reflexes, baroreceptor stimulation, activation of sympathetic nervous and renin angiotensin aldosterone systems, and enhanced proinflammatory pathways. Most clinical trials have addressed the underlying condition rather than venous hypertension per se. Interpreting the effects of therapeutic interventions on renal venous congestion are therefore problematic because of such confounders as changes in left ventricular function, cardiac output, and blood pressure. Nevertheless, there is preliminary evidence from small studies of intense medical therapy or extracorporeal ultrafiltration for heart failure that there can be changes to central venous pressure that correlate inversely with renal function, independently from the cardiac index. Larger more rigorous trials are needed to definitively establish under what circumstances conventional pharmacologic or ultrafiltration goals might best be directed toward central venous pressures rather than left ventricular or cardiac output parameters. Copyright © 2012 Elsevier Inc. All rights reserved.

A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.

PubMed

Loubani, Osama M; Green, Robert S

2015-06-01

The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. A systematic search of Medline, Embase, and Cochrane databases was performed from inception through January 2014 for reports of adults who received vasopressor intravenously via peripheral IV or central venous catheter for a therapeutic purpose. We included primary studies or case reports of vasopressor administration that resulted in local tissue injury or extravasation of vasopressor solution. Eighty-five articles with 270 patients met all inclusion criteria. A total of 325 separate local tissue injury and extravasation events were identified, with 318 events resulting from peripheral vasopressor administration and 7 events resulting from central administration. There were 204 local tissue injury events from peripheral administration of vasopressors, with an average duration of infusion of 55.9 hours (±68.1), median time of 24 hours, and range of 0.08 to 528 hours. In most of these events (174/204, 85.3%), the infusion site was located distal to the antecubital or popliteal fossae. Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs. Copyright © 2015 Elsevier Inc. All rights reserved.

Maximal venous outflow velocity: an index for iliac vein obstruction.

PubMed

Jones, T Matthew; Cassada, David C; Heidel, R Eric; Grandas, Oscar G; Stevens, Scott L; Freeman, Michael B; Edmondson, James D; Goldman, Mitchell H

2012-11-01

Leg swelling is a common cause for vascular surgical evaluation, and iliocaval obstruction due to May-Thurner syndrome (MTS) can be difficult to diagnose. Physical examination and planar radiographic imaging give anatomic information but may miss the fundamental pathophysiology of MTS. Similarly, duplex ultrasonographic examination of the legs gives little information about central impedance of venous return above the inguinal ligament. We have modified the technique of duplex ultrasonography to evaluate the flow characteristics of the leg after tourniquet-induced venous engorgement, with the objective of revealing iliocaval obstruction characteristic of MTS. Twelve patients with signs and symptoms of MTS were compared with healthy control subjects for duplex-derived maximal venous outflow velocity (MVOV) after tourniquet-induced venous engorgement of the leg. The data for healthy control subjects were obtained from a previous study of asymptomatic volunteers using the same MVOV maneuvers. The tourniquet-induced venous engorgement mimics that caused during vigorous exercise. A right-to-left ratio of MVOV was generated for patient comparisons. Patients with clinical evidence of MTS had a mean right-to-left MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTS patients who had undergone endovascular treatment had a poststent mean ratio of 1.2 (P = 0.011). Interestingly, computed tomography and magnetic resonance imaging results, when available, were interpreted as positive in only 53% of the patients with MTS according to both our MVOV criteria and confirmatory venography. After intervention, the right-to-left MVOV ratio in the MTS patients was found to be reduced similar to asymptomatic control subjects, indicating a relief of central venous obstruction by stenting the compressive MTS anatomy. Duplex-derived MVOV measurements are helpful for detection of iliocaval venous obstruction, such as MTS. Right-to-left MVOV ratios and

Total anomalous systemic venous drainage in left heterotaxy syndrome.

PubMed

Khandenahally, Ravindranath S; Deora, Surender; Math, Ravi S

2013-04-01

Total anomalous systemic venous drainage is an extremely rare congenital heart defect. In this study we describe an 11-year-old girl who presented with a history of fatigue and central cyanosis that she had had since early childhood with unremarkable precordial examination results. Investigations revealed left heterotaxy with all systemic venous drainage to the left-sided atrium with non-compaction of the left ventricle.

Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein.

PubMed

Ansari, Md Abu Masud; Kumar, Naveen; Kumar, Shailesh; Kumari, Sarita

2016-10-01

Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.

[Multidimensional Strategy Regarding the Reduction of Central-Line Associated Infection in Pediatric Intensive Care].

PubMed

Rodrigues, Jorge; Dias, Andrea; Oliveira, Guiomar; Farela Neves, José

2016-06-01

To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. After multidimensional strategy implementation there was no reported

Long-term venous access using a subcutaneous implantable drug delivery system.

PubMed Central

Soo, K. C.; Davidson, T. I.; Selby, P.; Westbury, G.

1985-01-01

To facilitate long-term venous access in patients receiving chemotherapy, a subcutaneous totally implantable system (Port-a-Cath, Phamacia) has been used in 14 patients. The method of implantation and the advantages over conventional central venous catheters are discussed. The expense of the system necessitates careful patient selection. PMID:4037644

Correlation of Blood Gas Parameters with Central Venous Pressure in Patients with Septic Shock; a Pilot Study

PubMed Central

Baratloo, Alireza; Rahmati, Farhad; Rouhipour, Alaleh; Motamedi, Maryam; Gheytanchi, Elmira; Amini, Fariba; Safari, Saeed

2014-01-01

Objective: To determine the correlation between blood gas parameters and central venous pressure (CVP) in patients suffering from septic shock. Methods: Forty adult patients with diagnosis of septic shock who were admitted to the emergency department (ED) of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were. Results: A significant direct correlation between CVP with anion gap (AG) and inversely with base deficit (BD) and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/ AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index (SI) and mean arterial pressure (MAP). Conclusion: It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock. PMID:27162870

[Venous thrombosis of atypical location in patients with cancer].

PubMed

Campos Balea, Begoña; Sáenz de Miera Rodríguez, Andrea; Antolín Novoa, Silvia; Quindós Varela, María; Barón Duarte, Francisco; López López, Rafael

2015-01-01

Venous thromboembolism (VTE) is a complication that frequently occurs in patients with neoplastic diseases. Several models have therefore been developed to identify patient subgroups diagnosed with cancer who are at increased risk of developing VTE. The most common forms of thromboembolic episodes are deep vein thrombosis in the lower limbs and pulmonary thromboembolism. However, venous thrombosis is also diagnosed in atypical locations. There are few revisions of unusual cases of venous thrombosis. In most cases, VTE occurs in the upper limbs and in the presence of central venous catheters, pacemakers and defibrillators. We present the case of a patient diagnosed with breast cancer and treated with surgery, chemotherapy and radiation therapy who developed a thrombosis in the upper limbs (brachial and axillary). Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

[Subcutaneous implantation type central venous port management in patients with malignant tumors effect of different antiseptic agents on central venous port-related infection].

PubMed

Sato, Junya; Kumagai, Masumi; Kato, Kenichi; Akahane, Akio; Suzuki, Michiko; Kashiwaba, Masahiro; Sone, Miyuki; Kudo, Kenzo

2014-08-01

Subcutaneous implantation type central venous ports(CV ports)are used in chemotherapy. Here, we prospectively examined the frequency of CV port-related infections when the disinfectant was changed from 10% povidone iodine to 1% chlorhexidine ethanol or 70% ethanol. The subjects were patients with malignant tumors, who had newly been implanted with CV ports. We examined CV port-related infections at 1 week after CV port implantation and every 2 weeks thereafter, following sterilization upon insertion of a Huber needle to the CV port. CV port evulsion due to CV port-related infection was noted in 3 patients(4.8%)in whom 15%chlorhexidine ethanol was used(n=62)and in 2 patients(3.3%)in whom 70% ethanol was used(n=60). Infection rates per 1,000 days of CV port use were 1.48% and 1.01%, respectively. Thus, the outcomes of sterilization using 1% chlorhexidine ethanol and 70% ethanol did not differ significantly from those on using 10% povidone iodine for sterilization, based on preliminary results at our institution(3 of 59 patients[5.1%]had port evulsion due to CV port-related infection and the infection rate per 1,000 days of CV port use was 1.47%, Akahane et al, 2012). Chlorhexidine ethanol and ethanol are very convenient to use because they dry quickly and do not need discoloration. Accordingly, chlorhexidine ethanol and ethanol might be useful in CV port management.

Substantial harm associated with failure of chronic paediatric central venous access devices.

PubMed

Ullman, Amanda J; Kleidon, Tricia; Cooke, Marie; Rickard, Claire M

2017-07-06

Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.Over 2½ years, a child requiring parenteral nutrition and associated vascular access dependency due to 'short gut syndrome' (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Prospective comparison of two management strategies of central venous catheters in burn patients.

PubMed

Kealey, G P; Chang, P; Heinle, J; Rosenquist, M D; Lewis, R W

1995-03-01

Central venous catheters (CVCs) are associated with sepsis in burn patients. This study was undertaken to compare two strategies of CVC management in patients with major burn injuries. Forty-two burn patients with major burn injuries were randomly assigned to undergo site change every 48 hours of the CVC or to undergo wire guide exchange of the CVC every 48 hours at the same site. Catheter insertion site, distance from the burn wound, cultures of catheter tips, and blood cultures were obtained from all patients in a prospective manner. There was no difference in the incidence of CVC sepsis between the two groups studied. CVCs inserted less than 5 cm from the burn wound developed bacterial contamination at an earlier time than CVCs inserted more than 5 cm from the burn wound. There was no advantage to changing the CVC insertion site every 48 hours. Changing the CVC using the wire guide technique did not prevent, nor predict, CVC bacterial contamination.

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

PubMed

Dumantepe, Mert; Tarhan, Arif; Ozler, Azmi

2013-06-01

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

Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery.

PubMed

Sand, L; Lundin, S; Rizell, M; Wiklund, J; Stenqvist, O; Houltz, E

2014-09-01

To reduce blood loss during liver surgery, a low central venous pressure (CVP) is recommended. Nitroglycerine (NG) with its rapid onset and offset can be used to reduce CVP. In this study, the effect of NG on portal and hepatic venous pressures (PVP and HVP) in different body positions was assessed. Thirteen patients undergoing liver resection were studied. Cardiac output (CO), mean arterial pressure (MAP) and CVP were measured. PVP and HVP were measured using tip manometer catheters at baseline (BL) in horizontal position; during NG infusion, targeting a MAP of 60 mmHg, with NG infusion and the patient placed in 10 head-down position. NG infusion reduced HVP from 9.7 ± 2.4 to 7.2 ± 2.4, PVP from 12.3 ± 2.2 to 9.7 ± 3.0 and CVP from 9.8 ± 1.9 to 7.2 ± 2.1 mmHg at BL. Head-down tilt during ongoing NG resulted in increases in HVP to 8.2 ± 2.1, PVP to 10.7 ± 3 and CVP to 11 ± 1.9 mmHg. CO at BL was 6.3 ± 1.1, which was reduced by NG to 5.8 ± 1.2. Head-down tilt together with NG infusion restored CO to 6.3 ± 1.0 l/min. NG infusion leads to parallel reductions in CVP, HVP and PVP at horizontal body position. Thus, CVP can be used to guide NG dosage and fluid administration at horizontal position. NG infusion can be used to reduce HVP. Head-down tilt can be used during NG infusion to improve both blood pressure and CO without substantial increase in liver venous pressure. In head-down tilt, CVP dissociates from HVP and PVP. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Thrombosis-related complications and mortality in cancer patients with central venous devices: an observational study on the effect of antithrombotic prophylaxis.

PubMed

Fagnani, D; Franchi, R; Porta, C; Pugliese, P; Borgonovo, K; Bertolini, A; Duro, M; Ardizzoia, A; Filipazzi, V; Isa, L; Vergani, C; Milani, M; Cimminiello, C

2007-03-01

Recent guidelines do not recommend antithrombotic prophylaxis (AP) to prevent catheter-related thrombosis in cancer patients with a central line. This study assessed the management of central lines in cancer patients, current attitude towards AP, catheter-related and systemic venous thromboses, and survival. Of 1410 patients enrolled, 1390 were seen at least once in the 6-month median follow-up. Continuous AP, mainly low-dose warfarin, was given to 451 (32.4%); they were older, with a more frequent history of venous thromboembolism (VTE), and more advanced cancer. There was no difference in catheter-related thrombosis in patients given AP or not (2.8% and 2.2%, odds ratio 1.29, 95% confidence interval 0.64-2.6). The median time to first catheter-related complication was 120 days. Systemic VTE including deep and superficial thromboses and pulmonary embolism, were less frequent with AP (4% versus 8.2%, P = 0.005). Mortality was also lower (25% versus 44%, P = 0.0001). Multiple logistic regression analysis found only advanced cancer and no AP significantly associated with mortality. No major bleeding was recorded with AP. Current AP schedules do not appear to prevent catheter-related thrombosis. Systemic VTE and mortality, however, appeared lower after prophylaxis.

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

PubMed

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

2014-05-01

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

Epidemiology and natural history of central venous access device use and infusion pump function in the NO16966 trial.

PubMed

Chu, E; Haller, D; Cartwright, T; Twelves, C; Cassidy, J; Sun, W; Saif, M W; McKenna, E; Lee, S; Schmoll, H-J

2014-03-18

Central venous access devices in fluoropyrimidine therapy are associated with complications; however, reliable data are lacking regarding their natural history, associated complications and infusion pump performance in patients with metastatic colorectal cancer. We assessed device placement, use during treatment, associated clinical outcomes and infusion pump performance in the NO16966 trial. Device replacement was more common with FOLFOX-4 (5-fluorouracil (5-FU)+oxaliplatin) than XELOX (capecitabine+oxaliplatin) (14.1% vs 5.1%). Baseline device-associated events and post-baseline removal-/placement-related events occurred more frequently with FOLFOX-4 than XELOX (11.5% vs 2.4% and 8.5% vs 2.1%). Pump malfunctions, primarily infusion accelerations in 16% of patients, occurred within 1.6-4.3% of cycles. Fluoropyrimidine-associated grade 3/4 toxicity was increased in FOLFOX-4-treated patients experiencing a malfunction compared with those who did not (97 out of 155 vs 452 out of 825 patients), predominantly with increased grade 3/4 neutropenia (53.5% vs 39.8%). Febrile neutropenia rates were comparable between patient cohorts±malfunction. Efficacy outcomes were similar in patient cohorts±malfunction. Central venous access device removal or replacement was common and more frequent in patients receiving FOLFOX-4. Pump malfunctions were also common and were associated with increased rates of grade 3/4 haematological adverse events. Oral fluoropyrimidine-based regimens may be preferable to infusional 5-FU based on these findings.

Neonatal venous cerebral hemorrhage. Report of two cases.

PubMed

Misra, Sanjay N; Misra, Ashish K

2003-10-15

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

Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study.

PubMed

Paglialonga, Fabio; Artoni, Andrea; Braham, Simon; Consolo, Silvia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Martinelli, Ida; Montini, Giovanni; Edefonti, Alberto

2016-05-01

To date, no study has investigated the use of vitamin K antagonists (VKA) in children undergoing chronic haemodialysis (HD) with a central venous catheter (CVC). Consecutive patients aged <18 years with a newly placed tunnelled CVC for chronic HD were enrolled over a 3-year period. Children with active nephrotic syndrome or a history of venous thrombosis received warfarin (VKA group) with therapeutic target international normalised ratios of between 2.0 and 3.0. Patients at standard risk of CVC malfunction were not treated with VKA (standard group). The primary end-point was overall CVC survival. The VKA group consisted of nine patients (median age 10.6 years; range 1.2-15.3 years) with 11 CVC, and the standard group comprised eight patients (11.8 years; 6.1-17.3 years) with ten CVC. The 6- and 12-month CVC survival was significantly longer in the VKA group than in the standard group (100 vs. 60 % and 83.3 vs. 16.7 %, respectively; p < 0.05), with a median survival of 369 and 195 days, respectively (p < 0.05). None of the CVC in the VKA group required removal due to malfunction, as compared to four in the standard group. No major bleeding episodes occurred in either group. Therapy with VKA would appear to be safe in children on chronic HD and may improve CVC survival in patients at increased risk of CVC thrombosis.

Is there resetting of central venous pressure in microgravity?

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

Upper Arm Central Venous Port Implantation: A 6-Year Single Institutional Retrospective Analysis and Pictorial Essay of Procedures for Insertion

PubMed Central

Shiono, Masatoshi; Takahashi, Shin; Kakudo, Yuichi; Takahashi, Masanobu; Shimodaira, Hideki; Kato, Shunsuke; Ishioka, Chikashi

2014-01-01

Background The requirement of central venous (CV) port implantation is increasing with the increase in the number of cancer patients and advancement in chemotherapy. In our division, medical oncologists have implanted all CV ports to save time and consultation costs to other departments. Recently, upper arm implantation has become the first choice as a safe and comfortable method in our unit. Here we report our experience and discuss the procedure and its potential advantages. Methods All CV port implantations (n = 599) performed in our unit from January 2006 to December 2011 were analyzed. Procedural success and complication rates between subclavian and upper arm groups were compared. Results Both groups had similar patient characteristics. Upper arm CV port and subclavian implantations were equivalently successful and safe. Although we only retrospectively analyzed data from a single center, the upper arm group had a significantly lower overall postprocedural complication rate than the subclavian group. No pneumothorax risk, less risk of arterial puncture by ultrasound, feasibility of stopping potential arterial bleeding, and prevention of accidental arterial cannulation by targeting the characteristic solitary basilic vein were the identified advantages of upper arm CV port implantation. In addition to the aforementioned advantages, there is no risk of “pinch-off syndrome,” possibly less patient fear of manipulation, no scars on the neck and chest, easier accessibility, and compatibility with the “peripherally inserted central catheter” technique. Conclusions Upper arm implantation may benefit clinicians and patients with respect to safety and comfort. We also introduce our methods for upper arm CV port implantation with the videos. PMID:24614412

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

A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection.

PubMed

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

2014-07-01

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. 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. 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). 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.

Cardiac tamponade due to umbilical venous catheter in the new born

PubMed Central

Abdellatif, Mohamed; Ahmed, Ashfag; Alsenaidi, Khalfan

2012-01-01

With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate, an uncommon, yet potentially fatal complication. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving. PMID:22802560

Central venous pulse pressure analysis using an R-synchronized pressure measurement system.

PubMed

Fujita, Yoshihisa; Hayashi, Daisuke; Wada, Shinya; Yoshioka, Naoki; Yasukawa, Takeshi; Pestel, Gunther

2006-12-01

The information derived from central venous catheters is underused. We developed an EKG-R synchronization and averaging system to obtained distinct CVP waveforms and analyzed components of these. Twenty-five paralyzed surgical patients undergoing CVP monitoring under mechanical ventilation were studied. CVP and EKG signals were analyzed employing our system, the mean CVP and CVP at end-diastole during expiration were compared, and CVP waveform components were measured using this system. CVP waveforms were clearly visualized in all patients. They showed the a peak to be 1.8+/- 0.7 mmHg, which was the highest of three peaks, and the x trough to be lower than the y trough (-1.6+/- 0.7 mmHg and -0.9+/- 0.5 mmHg, respectively), with a mean pulse pressure of 3.4 mmHg. The difference between the mean CVP and CVP at end-diastole during expiration was 0.58+/- 0.81 mmHg. The mean CVP can be used as an index of right ventricular preload in patients under mechanical ventilation with regular sinus rhythm. Our newly developed system is useful for clinical monitoring and for education in circulatory physiology.

"Targeting to zero" in pediatric oncology: a review of central venous catheter-related bloodstream infections.

PubMed

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

2012-01-01

Reducing or eliminating hospital acquired infections is a national quality of care priority. The majority of the 12,400 children diagnosed with cancer each year require long-term intravenous access to receive intensive and complex therapies. These children are at high risk for infection by nature of their disease and treatment, which often involves use of a central venous catheter (CVC). Throughout the nation, nurses assume frontline responsibility for safe, quality CVC care to minimize the risk of potentially life-threatening infections. Substantial financial and human costs are associated with CVC-related bloodstream infections, including prolonged hospital lengths of stay and increased care required to treat these infections. The purpose of this review of the literature is to summarize existing adult and pediatric data on CVC-related bloodstream infections and explore nursing models of CVC care that may improve pediatric oncology patient outcomes.

Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension.

PubMed

Matloob, Samir A; Toma, Ahmed K; Thompson, Simon D; Gan, Chee L; Robertson, Fergus; Thorne, Lewis; Watkins, Laurence D

2017-08-01

Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH. Venous sinus stenting has emerged as a possible interventional option. Evidence for venous sinus stenting is based on elimination of the venous pressure gradient and clinical response. There have been no studies demonstrating the immediate effect of venous stenting on ICP. Patients with a potential or already known diagnosis of IIH were investigated according to departmental protocol. ICP monitoring was performed for 24 h. When high pressures were confirmed, CT venogram and catheter venography were performed to look for venous stenosis to demonstrate a pressure gradient. If positive, venous stenting would be performed and ICP monitoring would continue for a further 24 h after deployment of the venous stent. Ten patients underwent venous sinus stenting with concomitant ICP monitoring. Nine out of ten patients displayed an immediate reduction in their ICP that was maintained at 24 h. The average reduction in mean ICP and pulsatility was significant (p = 0.003). Six out of ten patients reported a symptomatic improvement within the first 2 weeks. Venous sinus stenting results in an immediate reduction in ICP. This physiological response to venous stenting has not previously been reported. Venous stenting could offer an alternative treatment option in correctly selected patients with IIH.

Thrombotic complications of central venous catheters in cancer patients.

PubMed

Kuter, David J

2004-01-01

Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic. Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic). Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with low-molecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit. Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

Transitioning from anatomic landmarks to ultrasound guided central venous catheterizations: guidelines applied to clinical practice.

PubMed

Oom, Rodrigo; Casaca, Rui; Barroca, Rita; Carvalhal, Sara; Santos, Catarina; Abecasis, Nuno

2017-07-14

Centrally inserted central catheter (CICC) insertion is a commonly performed procedure that may give rise to different complications. Despite the suggestion of guidelines to use ultrasound guidance (USG) for vascular access, not all centers use it systematically. The aim of this study is to illustrate the experience with ultrasound in CICC placement at a high-volume oncological center, in a country where the landmark technique is standard. Retrospective analysis of a prospective database was performed on CICC placement under USG in the Central Venous Catheter Unit of Instituto Português de Oncologia de Lisboa Francisco Gentil, from 2012 to 2015. Three thousand five hundred and seventy-two procedures were recorded. From 2728 CICC placements, 1187 (43.5%) were done using USG. The majority of CICC placements were successful without immediate complications (96.1%). In 55 cases (4.6%), more than three attempts were necessary to puncture the vein. Pneumothorax occurred in 5 cases (0.4%) and arterial puncture was registered in 41 cases (3.5%). An increasing use of USG for placing CICCs was planned and observed over the years and, in the last year of the study, 67.3% of the CICC placements were with USG. CICC placement with USG is a safe and effective technique. Despite some resistance that is observed, these results support that it is worth following the guidelines that advocate the use of the USG in the placement of CICC.

Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

PubMed Central

Januário, Virginia; de Ávila, Dione Augusto; Penetra, Maria Alice; Sampaio, Ana Luisa Bittencourt; Noronha Neta, Maria Isabel; Cassia, Flavia de Freire; Carneiro, Sueli

2016-01-01

BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy. PMID:26982773

Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.

PubMed

Burlacu, Crina L; McKeating, Kevin; McShane, Alan J

2011-06-01

To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration. Double-blinded, randomized, controlled study. Operating theatre of an University hospital. 44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter. Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 μg/kg/min, respectively. Rescue remifentanil 0.5 μg/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 μg/kg/min decrements as necessary. Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps. All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6/15) required remifentanil rate reduction than did patients from Group R50 (1/15) or Group R25 (0/14), P < 0.01, most commonly because of respiratory depression. For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic-efficient. However, the excessive sedation and tendency to respiratory and cardiovascular events associated with the highest

The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study.

PubMed

Rossetti, Francesca; Pittiruti, Mauro; Lamperti, Massimo; Graziano, Ugo; Celentano, Davide; Capozzoli, Giuseppe

2015-01-01

The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients. We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices (VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (<4 years, n = 157), B (4-11 years, n = 119), and C (12-18 years, n = 31). IC-ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina. There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%. We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.

Lack of association between venous hemodynamics, venous morphology and the postthrombotic syndrome after upper extremity deep venous thrombosis.

PubMed

Czihal, M; Paul, S; Rademacher, A; Bernau, C; Hoffmann, U

2015-03-01

To explore the association of the postthrombotic syndrome with venous hemodynamics and morphological abnormalities after upper extremity deep venous thrombosis. Thirty-seven patients with a history of upper extremity deep venous thrombosis treated with anticoagulation alone underwent a single study visit (mean time after diagnosis: 44.4 ± 28.1 months). Presence and severity postthrombotic syndrome were classified according to the modified Villalta score. Venous volume and venous emptying were determined by strain-gauge plethysmography. The arm veins were assessed for postthrombotic abnormalities by ultrasonography. The relationship between postthrombotic syndrome and hemodynamic and morphological sequelae was evaluated using univariate significance tests and Spearman's correlation analysis. Fifteen of 37 patients (40.5%) developed postthrombotic syndrome. Venous volume and venous emptying of the arm affected by upper extremity deep venous thrombosis did not correlate with the Villalta score (rho = 0.17 and 0.19; p = 0.31 and 0.25, respectively). Residual morphological abnormalities, as assessed by ultrasonography, did not differ significantly between patients with and without postthrombotic syndrome (77.3% vs. 86.7%, p = 0.68). Postthrombotic syndrome after upper extremity deep venous thrombosis is not associated with venous hemodynamics or residual morphological abnormalities. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spicer, K.M.; Gordon, L.

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

Ultrasound-guided venous access for pacemakers and defibrillators.

PubMed

Seto, Arnold H; Jolly, Aaron; Salcedo, Jonathan

2013-03-01

Ultrasound guidance is widely recommended to reduce the risk of complications during central venous catheter placement. However, ultrasound guidance is not commonly utilized for implanting leads for cardiac rhythm management devices. We describe our technique of ultrasound-guided pacemaker implantation, including a novel pull-through technique that allows percutaneous guidewire insertion prior to the first incision. We review the literature and recent advances in ultrasound imaging technology that may facilitate the adoption of ultrasound guidance. Ultrasound guidance provides a safe and rapid technique for extrathoracic subclavian or axillary venous lead placement. © 2012 Wiley Periodicals, Inc.

Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bodner, Leonard J.; Nosher, John L.; Patel, Kaushik M.

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. Amore » 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

Duplex imaging of residual venous obstruction to guide duration of therapy for lower extremity deep venous thrombosis.

PubMed

Stephenson, Elliot J P; Liem, Timothy K

2015-07-01

Clinical trials have shown that the presence of ultrasound-identified residual venous obstruction (RVO) on follow-up scanning may be associated with an elevated risk for recurrence, thus providing a potential tool to help determine the optimal duration of anticoagulant therapy. We performed a systematic review to evaluate the clinical utility of post-treatment duplex imaging in predicting venous thromboembolism (VTE) recurrence and in adjusting duration of anticoagulation. The Ovid MEDLINE Database, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were queried for the terms residual thrombus or obstruction, duration of therapy, deep vein thrombosis, deep venous thrombosis, DVT, venous thromboembolism, VTE, antithrombotic therapy, and anticoagulation, and 228 studies were selected for review. Six studies determined the rate of VTE recurrence on the basis of the presence or absence of RVO. Findings on venous ultrasound scans frequently remained abnormal in 38% to 80% of patients, despite at least 3 months of therapeutic anticoagulation. In evaluating for VTE recurrence, the definition of RVO varied widely in the literature. Some studies have shown an association between RVO and VTE recurrence, whereas other studies have not. Overall, the presence of RVO is a mild risk factor for recurrence (odds ratio, 1.3-2.0), but only when surveillance imaging is performed soon after the index deep venous thrombosis (3 months). RVO is a mild risk factor for VTE recurrence. The presence or absence of ultrasound-identified RVO has a limited role in guiding the duration of therapeutic anticoagulation. Further research is needed to evaluate its utility relative to other known risk factors for VTE recurrence. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Thrombotic complications of implanted central venous access devices: prospective evaluation.

PubMed

Labourey, Jean-Luc; Lacroix, Philippe; Genet, Dominique; Gobeaux, François; Martin, Jean; Venat-Bouvet, Laurence; Lavau-Denes, Sandrine; Maubon, Antoine; Tubiana-Mathieu, Nicole

2004-05-01

Implanted venous access devices (IVAD) are routinely used in oncologic patients. Thrombotic complication is a source of morbidity. During one year 246 patients with different solid neoplastic diseases received IVAD for chemotherapy administration. Two hundred forty-nine IVAD were placed percutaneously or by surgical cutdown. IVAD were flushed immediately after implantation with 3-5 mL of heparinized saline (100 U/mL). No monthly flush was required. A prospective evaluation of thrombotic complications was realised. in event of catheter dysfunction and/or clinical symptoms of phlebitis, a catheter opacification and/or a Doppler ultrasonography were performed. Twenty-three catheter dysfunctions were noted, corresponding to 13 catheter occlusions. Twelve patients presented clinical symptoms of phlebitis. Eleven venous thrombosis were diagnosed in this group; 10 by echo-Doppler and one by scanography. A unvaried statistic analysis using Fisher's test was performed to detect risk factors. Two factors were identified: the position of catheter tip above T4 (p < 0.001) and mediastinal or cervical lymph nodes larger than 6 cm (p < 0.001). The first increased the risk of catheter occlusion and the second increased the risk of phlebitis.

Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

PubMed Central

Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

2017-01-01

Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens. PMID:28194286

Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia.

PubMed

Kimura, Masato; Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

2017-01-01

Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.

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

PubMed

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

2009-07-01

Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients. A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare device-specific complications in a hematology population. An observational cohort of patients with hematologic malignancy was prospectively studied following CVC insertion. Participants were reviewed until a CVC-related complication necessitated device removal, completion of therapy, death, or defined end-of-study date. The National Nosocomial Infection Surveillance definition for CR-BSI was used. Overall and device-specific rates of infective and noninfective complications were calculated and potential risk factors were captured. One hundred six CVCs (75 peripherally inserted central venous catheters [PICCs], 31 nontunneled CVCs) were evaluated in 66 patients, over 2,399 CVC days. Thrombosis occurred in 16 cases (15.1%), exit-site infection in two (1.9%), and CR-BSI in 18 (7.5 per 1,000 CVC days). No significant differences were found when complication rates in PICC and nontunneled devices were compared. An underlying diagnosis of acute myeloid leukemia was negatively associated with CR-BSI (odds ratio (OR) 0.14, p = 0.046), and a previous diagnosis of fungal infection was associated with infection (OR 22.82, p = 0.031). CR-BSI rates in our hematology population are comparable to prior reports. A low rate of exit-site infection and high proportion of thrombotic complications were observed. No significant differences in thrombotic or infective complications were evident when PICC and nontunneled devices were compared. PICC devices are a practical and safe option for management of hematology patients.

Surveillance and medical therapy following endovascular treatment of chronic cerebrospinal venous insufficiency.

PubMed

Forbes, Thomas L; Harris, Jeremy R; Kribs, Stewart W

2012-06-01

The debate regarding the possible link between chronic cerebrospinal venous insufficiency and multiple sclerosis (MS) is continuously becoming more and more contentious due to the current lack of level 1 evidence from randomized trials. Regardless of this continued uncertainty surrounding the safety and efficacy of this therapy, MS patients from Canada, and other jurisdictions, are traveling abroad to receive central venous angioplasty and, unfortunately, some also receive venous stents. They often return home with few instructions regarding follow-up or medical therapy. In response we propose some interim, practical recommendations for post-procedural surveillance and medical therapy, until further information is available.

Cost effectiveness of different central venous approaches for port placement and use in adult oncology patients: evidence from a randomized three-arm trial.

PubMed

Biffi, Roberto; Pozzi, Simonetta; Bonomo, Guido; Della Vigna, Paolo; Monfardini, Lorenzo; Radice, Davide; Rotmensz, Nicole; Zampino, Maria Giulia; Fazio, Nicola; Orsi, Franco

2014-11-01

No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients. Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. A total of 401 patients were evaluable-132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was 2,167.85 for subclavian US-guided, 2,335.87 for cephalic, and 2,384.10 for internal jugular access, respectively (p = 0.0001). US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.

Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: a prospective, observational study.

PubMed

Lanspa, Michael J; Brown, Samuel M; Hirshberg, Eliotte L; Jones, Jason P; Grissom, Colin K

2012-12-01

Volume expansion is a common therapeutic intervention in septic shock, although patient response to the intervention is difficult to predict. Central venous pressure (CVP) and shock index have been used independently to guide volume expansion, although their use is questionable. We hypothesize that a combination of these measurements will be useful. In a prospective, observational study, patients with early septic shock received 10-mL/kg volume expansion at their treating physician's discretion after brief initial resuscitation in the emergency department. Central venous pressure and shock index were measured before volume expansion interventions. Cardiac index was measured immediately before and after the volume expansion using transthoracic echocardiography. Hemodynamic response was defined as an increase in a cardiac index of 15% or greater. Thirty-four volume expansions were observed in 25 patients. A CVP of 8 mm Hg or greater and a shock index of 1 beat min(-1) mm Hg(-1) or less individually had a good negative predictive value (83% and 88%, respectively). Of 34 volume expansions, the combination of both a high CVP and a low shock index was extremely unlikely to elicit hemodynamic response (negative predictive value, 93%; P = .02). Volume expansion in patients with early septic shock with a CVP of 8 mm Hg or greater and a shock index of 1 beat min(-1) mm Hg(-1) or less is unlikely to lead to an increase in cardiac index. Copyright © 2012 Elsevier Inc. All rights reserved.

Hemodialysis tunneled central venous catheters: five-year outcome analysis.

PubMed

Mandolfo, Salvatore; Acconcia, Pasqualina; Bucci, Raffaella; Corradi, Bruno; Farina, Marco; Rizzo, Maria Antonietta; Stucchi, Andrea

2014-01-01

Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement. This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis. Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years. Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan.

PubMed

Shiono, Masatoshi; Takahashi, Shin; Takahashi, Masanobu; Yamaguchi, Takuhiro; Ishioka, Chikashi

2016-12-01

We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51-0.91; P = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.

Significance of Blunted Venous Waveforms Seen on Upper Extremity Ultrasound.

PubMed

Pham, Xuan-Binh D; Ihenachor, Ezinne J; Wu, Hoover; Kim, Jerry J; Kaji, Amy H; Koopmann, Matthew C; Ryan, Timothy J; de Virgilio, Christian

2017-07-01

Current guidelines recommend vascular mapping ultrasound (US) prior to arteriovenous fistula creation. Blunted venous waveforms (BVWs) suggest central venous stenosis; however, this relationship and one between BVWs and the presence of a central venous catheter (CVC) remain unclear. All patients who received upper extremity vascular mapping US between January 2013 and October 2014 at a single institution were retrospectively reviewed. Patient demographics, comorbidities, US results, pacemaker history, and CVC status were collected. Waveforms were assessed at the proximal subclavian vein/distal axillary vein and interpreted by radiologists. Patients were determined to have central venous stenosis (CVS) if detected by venography within 6 months of US. There were 342 patients, of which 165 (48%) had a current CVC and 29 (8.5%) had BVW of at least 1 arm. Right-sided BVW were associated with a history of a prior ipsilateral CVC (odds ratio [OR] = 4.5, 95% confidence interval [CI] = 1.6-12.6, P = 0.009). Of the 342 patients, 69 (20%) had a venogram within 6 months. Seventeen (25%) of the 69 patients had CVS, with 7 involving the left subclavian vein, 8 the right subclavian vein, and 3 the superior vena cava (one patient had tandem stenoses). A BVW on the left side was not associated with any CVS. A BVW on the right side was associated with an ipsilateral CVS (OR = 5.8, 95% CI = 1.2-27.4, P = 0.04). This association persisted in the setting of a prior CVC (relative risk = 1.3, 95% CI = 0.9-2, P = 0.01). There are associations between right-sided BVW and an ipsilateral subclavian vein stenosis. We recommend that hemodialysis access planning includes venography to rule out central vein stenosis in patients with BVW, especially if right-sided and in the setting of a prior CVC. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation of a novel venous duplex ultrasound objective structured assessment of technical skills for the assessment of venous reflux.

PubMed

Jaffer, Usman; Normahani, Pasha; Lackenby, Kimberly; Aslam, Mohammed; Standfield, Nigel J

2015-01-01

Duplex ultrasound measurement of reflux time is central to the diagnosis of venous incompetence. We have developed an assessment tool for Duplex measurement of venous reflux for both simulator and patient-based training. A novel assessment tool, Venous Duplex Ultrasound Assessment of Technical Skills (V-DUOSATS), was developed. A modified DUOSATS was used for simulator training. Participants of varying skill level were invited to viewed an instructional video and were allowed ample time to familiarize with the Duplex equipment. Attempts made by the participants were recorded and independently assessed by 3 expert assessors and 5 novice assessors using the modified V-DUOSATS. "Global" assessment was also done by expert assessors on a 4-point Likert scale. Content, construct, and concurrent validities as well as reliability were evaluated. Content and construct validity as well as reliability were demonstrated. Receiver operator characteristic analysis-established cut points of 19/22 and 21/30 were most appropriate for simulator and patient-based assessment, respectively. We have validated a novel assessment tool for Duplex venous reflux measurement. Further work is required to establish transference validity of simulator training to improve skill in scanning patients. We have developed and validated V-DUOSATS for simulator training. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Video-assisted thoracic surgery repair of subclavian artery injury following central venous catheterization: a new approach

PubMed Central

Tam, John Kit Chung; Atasha, Asmat; Tan, Ann Kheng

2013-01-01

OBJECTIVES Iatrogenic subclavian artery puncture following central venous catheterization is a rare but potentially fatal complication. There are very few reports in the literature on this condition. We propose the use of video-assisted thoracic surgery (VATS) in the management of these injuries. METHODS The technique of VATS to manage subclavian artery injury was described. We presented the first reported case of successful repair of subclavian artery injury using VATS. RESULTS Using a two-incisional approach for VATS, the haemothorax was rapidly evacuated and the subclavian artery injury was successfully repaired using pledgetted sutures under direct thoracoscopic visualization. The patient had an uneventful postoperative recovery. CONCLUSIONS VATS can be successfully applied to repair subclavian artery injury. The advantages include rapid intrathoracic access, excellent thoracoscopic visualization of the thoracic inlet, and avoidance of the morbidity associated with open thoracotomy. PMID:23518293

Implementation of a written protocol for management of central venous access devices: a theoretical and practical education, including bedside examinations.

PubMed

Ahlin, Catharina; Klang-Söderkvist, Birgitta; Brundin, Seija; Hellström, Birgitta; Pettersson, Karin; Johansson, Eva

2006-01-01

The objectives of this study were to evaluate registered nurses' (RN) compliance with a local clinical central venous access device (CVAD) protocol after completing an educational program and to determine RNs' perception of the program. Seventy-five RNs working in hematology participated in the educational part of the program. Sixty-eight RNs were examined while changing CVAD dressings or placing a Huber needle into a port on actual patients. Sixty percent of the RNs passed the examination and reported that the program increased their knowledge. The results indicated that the educational program could be recommended for use when implementing a new clinical protocol.

Central nervous system decompression sickness and venous gas emboli in hypobaric conditions.

PubMed

Balldin, Ulf I; Pilmanis, Andrew A; Webb, James T

2004-11-01

Altitude decompression sickness (DCS) that involves the central nervous system (CNS) is a rare but potentially serious condition. Identification of early symptoms and signs of this condition might improve treatment. We studied data from 26 protocols carried out in our laboratory over the period 1983-2003; all were designed to provoke DCS in a substantial proportion of subjects. The data set included 2843 cases. We classified subject-exposures that resulted in DCS as: 1) neurological DCS of peripheral and/or central origin (NEURO); 2) a subset of those that involved only the CNS (CNS); and 3) all other cases, i.e., DCS cases that did not have a neurological component (OTHER). For each case, echo imaging data were used to document whether venous gas emboli (VGE) were present, and their level was classified as: 1) any level, i.e., Grade 1 or higher (VGE-1); and 2) high level, Grade 4 (VGE-4). There were 1108 cases of altitude DCS in the database; 218 were classified as NEURO and 49 of those as CNS. VGE-1 were recorded in 83.8% of OTHER compared with 58.7% of NEURO and 55.1% of CNS (both p < 0.001 compared with OTHER). The corresponding values for VGE-4 were 48.8%, 37.0%, and 34.7% (p < 0.001, compared to OTHER). Hyperbaric oxygen (HBO) was used to treat about half of the CNS cases, while all other cases were treated with 2 h breathing 100% oxygen at ground level. Since only about half of the rare cases of hypobaric CNS DCS cases were accompanied by any level of VGE, echo imaging for bubbles may have limited application for use as a predictor of such cases.

Improved ex vivo blood compatibility of central venous catheter with noble metal alloy coating.

PubMed

Vafa Homann, Manijeh; Johansson, Dorota; Wallen, Håkan; Sanchez, Javier

2016-10-01

Central line associated bloodstream infections (CLABSIs) are a serious cause of morbidity and mortality induced by the use of central venous catheters (CVCs). Nobel metal alloy (NMA) coating is an advanced surface modification that prevents microbial adhesion and growth on catheters and thereby reduces the risk of infection. In vitro microbiological analyses have shown up to 90% reduction in microbial adhesion on coated CVC compared to uncoated ones. This study aimed to assess the blood compatibility of NMA-coated CVC according to ISO 10993-4. Hemolysis, thrombin-antithrombin (TAT) complex, platelet counts, fibrin deposition, and C3a and SC5b-9 complement activation were analyzed in human blood exposed to the NMA-coated and control CVCs using a Chandler-loop model. NMA-coated CVC did not induce hemolysis and fell in the "nonhemolytic" category according to ASTM F756-00. Significantly lower amounts of TAT were generated and less fibrin was deposited on NMA-coated CVC than on uncoated ones. Slightly higher platelet counts and lower complement markers were observed for NMA-coated CVC compared to uncoated ones. These data suggest that the NMA-coated CVC has better ex vivo blood compatibility compared to uncoated CVC. © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1359-1365, 2016. © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.

Internal jugular vein thrombosis associated with venous hypoplasia and protein S deficiency revealed by ultrasonography.

PubMed

Lim, Byung Gun; Kim, Young Min; Kim, Heezoo; Lim, Sang Ho; Lee, Mi Kyoung

2011-12-01

A 41-year-old woman, who had no thrombotic risk factors and past history except congenital scoliosis, underwent central venous catheterization (CVC) before correction of the scoliosis. When internal jugular vein (IJV) catheterization using the anatomical landmark technique failed, CVC under ultrasound guidance was tried. As a consequence, thrombosis and hypoplasia of the right IJV were incidentally detected by ultrasonography. Central venous catheters were then successfully placed in other veins under ultrasound guidance. Also, after examinations to rule out the possibility of pulmonary embolism and to clarify the causes of the IJV thrombosis, the patient was found to have protein S deficiency. CVC under ultrasound guidance should be recommended to prevent the failure of cannulation and complications such as thromboembolism in patients who could possibly have anomalies of vessels as a result of anatomical deformities caused by severe scoliosis, even if patients do not have thrombotic risk factors such as a history of central catheter insertion or intravenous drug abuse, cancer, advanced age, cerebral infarction, and left ventricular dysfunction. Also, if venous thrombosis is found in patients without predisposing risk factors, one should ascertain the cause of the hypercoagulable state, for example protein S deficiency, and perform appropriate treatment and prevention of venous thromboembolism.

Association of Proteinuria with Central Venous Catheter Use at Initial Hemodialysis.

PubMed

Park, Ken J; Johnson, Eric S; Smith, Ning; Mosen, David M; Thorp, Micah L

2017-01-01

Central venous catheter (CVC) use is associated with increased mortality and complications in hemodialysis recipients. Although prevalent CVC use has decreased, incident use remains high. To examine characteristics associated with CVC use at initial dialysis, specifically looking at proteinuria as a predictor of interest. Retrospective cohort of 918 hemodialysis recipients from Kaiser Permanente Northwest who started hemodialysis from January 1, 2004, to January 1, 2014. Multivariable logistic regression was used to examine an association of proteinuria with the primary outcome of CVC use. More than one-third (36%) of patients in our cohort started hemodialysis with an arteriovenous fistula, and 64% started with a CVC. Proteinuria was associated with starting hemodialysis with a CVC (likelihood ratio test, p < 0.001) after adjustment for age, peripheral vascular disease, congestive heart failure, diabetes, sex, race, and length of predialysis care. However, on pairwise comparison, only patients with midgrade proteinuria (0.5-3.5 g) had lower odds of starting hemodialysis with a CVC (odds ratio = 0.39, 95% confidence interval = 0.24-0.65). Proteinuria was associated with use of CVC at initial hemodialysis. However, a graded association did not exist, and only patients with midgrade proteinuria had significantly lower odds of CVC use. Our findings suggest that proteinuria is an explanatory finding for CVC use but may not have pragmatic value for decision making. Patients with lower levels of proteinuria may have a higher risk of starting dialysis with a CVC.

CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khalifa, Mohamed, E-mail: mkhalifa@nhs.net; Patel, Neeral R., E-mail: neeral.patel06@gmail.com; Moser, Steven, E-mail: steven.moser@imperial.nhs.uk

PurposeThe purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD.MethodsThree successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed.ResultsNomore » immediate complications were identified. There was resumption of HD in all three patients with a 100 % success rate. One patient’s HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines.ConclusionCT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.« less

Venous thromboembolism after major venous injuries: Competing priorities.

PubMed

Frank, Brian; Maher, Zoё; Hazelton, Joshua P; Resnick, Shelby; Dauer, Elizabeth; Goldenberg, Anna; Lubitz, Andrea L; Smith, Brian P; Saillant, Noelle N; Reilly, Patrick M; Seamon, Mark J

2017-12-01

Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging because the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type, and intraoperative anticoagulation would influence VTE formation after MVI. A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at three urban, Level I centers (2005-2013). Patients with MVI of the neck, torso, or proximal extremities (to elbows/knees) were included. Our primary study endpoint was the development of VTE (DVT or pulmonary embolism [PE]). The 435 major vascular injury patients were primarily young (27 years) men (89%) with penetrating (84%) injuries. When patients with (n = 108) and without (n = 327) VTE were compared, we observed no difference in age, mechanism, extremity injury, tourniquet use, orthopedic and spine injuries, damage control, local heparinized saline, or vascular surgery consultation (all p > 0.05). VTE patients had greater Injury Severity Score (ISS) (17 vs. 12), shock indices (1 vs. 0.9), and more torso (58% vs. 35%) and venous (73% vs. 48%) injuries, but less often received systemic intraoperative anticoagulation (39% vs. 53%) or postoperative enoxaparin (47% vs. 61%) prophylaxis (all p < 0.05). After controlling for ISS, hemodynamics, injured vessel, intraoperative anticoagulation, and postoperative prophylaxis, multivariable analysis revealed venous injury was independently predictive of VTE (odds ratio, 2.7; p = 0.002). Multivariable analysis of the venous injuries subset (n = 237) then determined that only delay in starting VTE chemoprophylaxis (odds ratio, 1.3/day; p = 0.013) independently predicted VTE after controlling for ISS, hemodynamics, injured vessel, surgical subspecialty, intraoperative anticoagulation, and postoperative prophylaxis. Overall, 3.4% of venous injury patients developed PE, but PE

A survey of the use of ultrasound guidance in internal jugular venous cannulation.

PubMed

McGrattan, T; Duffty, J; Green, J S; O'Donnell, N

2008-11-01

It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 2002, promoting the use of ultrasound in placement of internal jugular venous cannulae, utilisation of ultrasound has increased throughout the United Kingdom. We report the findings of a postal survey of 2000 senior anaesthetists in the United Kingdom which enquired about their use of ultrasound for internal jugular vein cannulae placement. Only 27% use 2D ultrasound as their first choice technique, although 35% use it as their first choice when teaching. There was no significant difference in practice between those working within a sub specialty in anaesthesia. There continues to be discrepancies between the application of the guideline and how senior anaesthetists both site and teach the placement of internal jugular vein central venous cannulae.

Lower initial central venous pressure in septic patients from long-term care facilities than in those from the community.

PubMed

Lin, Chun-Yu; Chen, Tun-Chieh; Lu, Po-Liang; Chen, Hui-Juan; Bojang, Kebba S; Chen, Yen-Hsu

2014-10-01

The cornerstone of emergency management of severe sepsis and septic shock is early (within 6 hours) goal-directed therapy, including maintenance of central venous pressure (CVP) at 8-12 mmHg. It is unclear whether there is a difference in initial (baseline) CVP between septic patients who are referred from the community and those who come from long-term care facilities (LTCFs) in Taiwan. We designed this study to investigate the difference in hemodynamic parameters between these two groups. Every patient with severe sepsis or septic shock who had a central venous catheter inserted via the internal jugular or subclavian vein at Kaohsiung Medical University Hospital between April 2007 and October 2007 was enrolled. CVP was measured immediately at the emergency department. Patient demographics, including residence, were retrospectively recorded and analyzed. There were 166 evaluable patients; 125 (75.3%) came from the community and 41 (24.7%) from LTCFs. There were no significant differences in age, sex, initial body temperature, heart rate, blood pressure, or leukocyte count between the two groups. However, patients who were referred from LTCFs had a significantly lower initial CVP than those from the community (5.0 ± 4.5 mmHg vs. 7.0 ± 4.8 mmHg, p = 0.023). The difference was more significant between mechanically ventilated patients from LTCFs and those from the community (5.0 ± 3.0 mmHg vs. 8.1 ± 5.6 mmHg, p = 0.006). Severely septic patients referred from LTCFs may require more aggressive fluid resuscitation within the first 6 hours of the diagnostic criteria met at the emergency department to achieve the CVP target of early goal-directed therapy. Copyright © 2013. Published by Elsevier B.V.

Comparison of telavancin and vancomycin lock solutions in eradication of biofilm-producing staphylococci and enterococci from central venous catheters.

PubMed

Luther, Megan K; Mermel, Leonard A; LaPlante, Kerry L

2016-03-01

Results of a study of the activity of antibiotic lock solutions of vancomycin and telavancin against biofilm-forming strains of Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus are reported. An established in vitro central venous catheter model was used to evaluate lock solutions containing vancomycin (5 mg/mL) or telavancin (5 mg/mL), with and without preservative-containing heparin sodium (with 0.45% benzyl alcohol) 2500 units/mL, heparin, and 0.9% sodium chloride solution. Lock solutions were introduced after 24-hour bacterial growth in catheters incubated at 35 °C. After 72 hours of exposure to the lock solutions, catheters were drained, flushed, and cut into segments for quantification of colony-forming units. Against S. epidermidis, vancomycin and telavancin (with or without heparin) had similar activity. Against E. faecalis, vancomycin alone was more active than telavancin alone (p < 0.01). Against S. aureus, vancomycin plus heparin had activity similar to that of vancomycin alone; both lock agents had greater activity than telavancin (p < 0.02). The addition of heparin was associated with reduced activity of the vancomycin lock solution against S. epidermidis and E. faecalis (p < 0.01). Telavancin activity was not significantly changed with the addition of heparin. In a central venous catheter model, vancomycin and telavancin activity was similar in reducing biofilm-producing S. epidermidis. However, vancomycin was more active than telavancin against E. faecalis and S. aureus. None of the tested agents eradicated biofilm-forming strains. The addition of preservative-containing heparin sodium 2500 units/mL to vancomycin was associated with reduced activity against S. epidermidis and E. faecalis. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Computational modeling of venous sinus stenosis in idiopathic intracranial hypertension

PubMed Central

Levitt, Michael R; McGah, Patrick M; Moon, Karam; Albuquerque, Felipe C; McDougall, Cameron G; Kalani, M Yashar S; Kim, Louis J; Aliseda, Alberto

2016-01-01

Background and Purpose Idiopathic intracranial hypertension has been associated with dural venous sinus stenosis in some patients, but the hemodynamic environment of the dural venous sinuses has not been quantitatively described. Here, we present the first such computational fluid dynamics model using patient-specific blood pressure measurements. Materials and Methods Six patients with idiopathic intracranial hypertension and at least one stenosis or atresia at the transverse-sigmoid sinus junction underwent MRV followed by cerebral venography and manometry throughout the dural venous sinuses. Patient-specific computational fluid dynamics models were created using MRV anatomy, with venous pressure measurements as boundary conditions. Blood flow and wall shear stress were calculated for each patient. Results Computational models of dural venous sinuses were successfully reconstructed in all six patients with patient-specific boundary conditions. Three patients demonstrated a pathologic pressure gradient (≥ 8 mm Hg) across four dural venous sinus stenoses. Small sample size precludes statistical comparisons, but average overall flow throughout the dural venous sinuses of patients with pathologic pressure gradients was higher than in those without (1041.00 ± 506.52 vs. 358.00 ± 190.95 mL/min). Wall shear stress was also higher across stenoses in patients with pathologic pressure gradients (37.66 ± 48.39 vs 7.02 ± 13.60 Pa). Conclusion The hemodynamic environment of the dural venous sinuses can be computationally modeled using patient-specific anatomy and physiological measurements in patients with idiopathic intracranial hypertension. There was substantially higher blood flow and wall shear stress in patients with pathological pressure gradients. PMID:27197986

Horner syndrome after unsuccessful venous port implantation by cannulation of the right internal jugular vein.

PubMed

Nowak, Łukasz R; Duda, Krzysztof; Mizianty, Marek; Wilczek, Małgorzata; Bieda, Tomasz

2015-01-01

Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation. We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach. Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis.

Sharp Central Venous Recanalization by Means of a TIPS Needle

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honnef, Dagmar, E-mail: honnef@rad.rwth-aachen.de; Wingen, Markus; Guenther, Rolf W.

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 themore » 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.« less

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

PubMed

Atchison, Christie M; Amankwah, Ernest; Wilhelm, Jean; Arlikar, Shilpa; Branchford, Brian R; Stock, Arabela; Streiff, Michael; Takemoto, Clifford; Ayala, Irmel; Everett, Allen; Stapleton, Gary; Jacobs, Marshall L; Jacobs, Jeffrey P; Goldenberg, Neil A

2018-02-01

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals. The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression. Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walser, Eric M., E-mail: walser.eric@mayo.edu

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 ofmore » 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.« less

A Case of Neuro-Behcet’s Disease Presenting with Central Neurogenic Hyperventilation

PubMed Central

Alkhachroum, Ayham M.; Saeed, Saba; Kaur, Jaspreet; Shams, Tanzila; De Georgia, Michael A.

2016-01-01

Patient: Female, 46 Final Diagnosis: Central hyperventilation Symptoms: Hyperventilation Medication: — Clinical Procedure: None Specialty: Neurology Objective: Unusual clinical course Background: Behcet’s disease is a chronic inflammatory disorder usually characterized by the triad of oral ulcers, genital ulcers, and uveitis. Central to the pathogenesis of Behcet’s disease is an autoimmune vasculitis. Neurological involvement, so called “Neuro-Behcet’s disease”, occurs in 10–20% of patients, usually from a meningoencephalitis or venous thrombosis. Case Report: We report the case of a 46-year-old patient with Neuro-Behcet’s disease who presented with central neurogenic hyperventilation as a result of brainstem involvement from venulitis. Conclusions: To the best of our knowledge, central neurogenic hyperventilation has not previously been described in a patient with Neuro-Behcet’s disease. PMID:26965646

Risk factors for venous port migration in a single institute in Taiwan.

PubMed

Fan, Wen-Chieh; Wu, Cheng-Han; Tsai, Ming-Ju; Tsai, Ying-Ming; Chang, Hsu-Liang; Hung, Jen-Yu; Chen, Pei-Huan; Yang, Chih-Jen

2014-01-14

An implantable port device provides an easily accessible central route for long-term chemotherapy. Venous catheter migration is one of the rare complications of venous port implantation. It can lead to side effects such as pain in the neck, shoulder, or ear, venous thrombosis, and even life-threatening neurologic problems. To date, there are few published studies that discuss such complications. This retrospective study of venous port implantation in a single center, a Taiwan hospital, was conducted from January 2011 to March 2013. Venous port migration was recorded along with demographic and characteristics of the patients. Of 298 patients with an implantable import device, venous port migration had occurred in seven, an incidence rate of 2.3%. All seven were male and had received the Bard port Fr 6.6 which had smaller size than TYCO port Fr 7.5 and is made of silicon. Significantly, migration occurred in male patients (P = 0.0006) and in those with lung cancer (P = 0.004). Multivariable logistic regression analysis revealed that lung cancer was a significant risk factor for port migration (odds ratio: 11.59; P = 0.0059). The migration rate of the Bard port Fr 6.6 was 6.7%. The median time between initial venous port implantation and port migration was 35.4 days (range, 7 to 135 days) and 71.4% (5/7) of patients had port migration within 30 days after initial port implantation. Male sex and lung cancer are risk factors for venous port migration. The type of venous port is also an important risk factor.

Cost-effectiveness of a central venous catheter care bundle.

PubMed

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

2010-09-17

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

Management of complications related to central venous catheters in cancer patients: an update.

PubMed

Linnemann, Birgit

2014-04-01

Central venous catheters (CVCs) are important for the treatment of patients with cancer, especially in the perioperative and palliative care settings. These devices not only allow for the administration of chemotherapy, parenteral nutrition, and other intravenous therapies, but they may also improve the patients' quality of life by reducing the need for repeated peripheral venipunctures. Thrombotic and infectious complications are common, especially in the long-term use of CVCs. There are different types of thrombotic complications associated with CVCs, that is, a thrombotic occlusion of the catheter, a mural thrombus at the catheter tip and classical deep vein thrombosis, which occurs most frequently in the upper extremity where the majority of long-term catheters are inserted. Infections are common complications associated with CVCs. Patients with cancer who receive intensive chemotherapy and those patients who undergo hematopoietic stem cell transplantation have a markedly increased risk for insertion site and bloodstream infections. In this review, the epidemiology and risk factors that predispose patients to CVC-related thrombosis and infection are discussed. The diagnostic and therapeutic options according to the published data and the current guidelines are summarized and data for establishing primary and secondary preventative strategies are provided. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

PubMed

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

2014-10-01

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

Association of Proteinuria with Central Venous Catheter Use at Initial Hemodialysis

PubMed Central

Park, Ken J; Johnson, Eric S; Smith, Ning; Mosen, David M; Thorp, Micah L

2018-01-01

Context Central venous catheter (CVC) use is associated with increased mortality and complications in hemodialysis recipients. Although prevalent CVC use has decreased, incident use remains high. Objective To examine characteristics associated with CVC use at initial dialysis, specifically looking at proteinuria as a predictor of interest. Design Retrospective cohort of 918 hemodialysis recipients from Kaiser Permanente Northwest who started hemodialysis from January 1, 2004, to January 1, 2014. Main Outcome Measures Multivariable logistic regression was used to examine an association of proteinuria with the primary outcome of CVC use. Results More than one-third (36%) of patients in our cohort started hemodialysis with an arteriovenous fistula, and 64% started with a CVC. Proteinuria was associated with starting hemodialysis with a CVC (likelihood ratio test, p < 0.001) after adjustment for age, peripheral vascular disease, congestive heart failure, diabetes, sex, race, and length of predialysis care. However, on pairwise comparison, only patients with midgrade proteinuria (0.5–3.5 g) had lower odds of starting hemodialysis with a CVC (odds ratio = 0.39, 95% confidence interval = 0.24–0.65). Conclusion Proteinuria was associated with use of CVC at initial hemodialysis. However, a graded association did not exist, and only patients with midgrade proteinuria had significantly lower odds of CVC use. Our findings suggest that proteinuria is an explanatory finding for CVC use but may not have pragmatic value for decision making. Patients with lower levels of proteinuria may have a higher risk of starting dialysis with a CVC. PMID:29236655

Are central venous catheter tip cultures reliable after 6-day refrigeration?

PubMed

Bouza, Emilio; Guembe, Maria; Gómez, Haydee; Martín-Rabadán, Pablo; Rivera, Marisa; Alcalá, Luis

2009-07-01

Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

Antibiotic-Impregnated Central Venous Catheters Do Not Change Antibiotic Resistance Patterns.

PubMed

Turnbull, Isaiah R; Buckman, Sara A; Horn, Christopher B; Bochicchio, Grant V; Mazuski, John E

2018-01-01

Antibiotic-impregnated central venous catheters (CVCs) decrease the incidence of infection in high-risk patients. However, use of these catheters carries the hypothetical risk of inducing antibiotic resistance. We hypothesized that routine use of minocycline and rifampin-impregnated catheters (MR-CVC) in a single intensive care unit (ICU) would change the resistance profile for Staphylococcus aureus. We reviewed antibiotic susceptibilities of S. aureus isolates obtained from blood cultures in a large urban teaching hospital from 2002-2015. Resistance patterns were compared before and after implementation of MR-CVC use in the surgical ICU (SICU) in August 2006. We also compared resistance patterns of S. aureus obtained in other ICUs and in non-ICU patients, in whom MR-CVCs were not used. Data for rifampin, oxacillin, and clindamycin were available for 9,703 cultures; tetracycline resistance data were available for 4,627 cultures. After implementation of MR-CVC use in the SICU, rifampin resistance remained unchanged, with rates the same as in other ICU and non-ICU populations (3%). After six years of use of MR-CVCs in the SICU, the rate of tetracycline resistance was unchanged in all facilities (1%-3%). The use of MR-CVCs was not associated with any change in S. aureus oxacillin-resistance rates in the SICU (66% vs. 60%). However, there was a significant decrease in S. aureus clindamycin resistance (59% vs. 34%; p < 0.05) in SICU patients. Routine use of rifampin-minocycline-impregnated CVCs in the SICU was not associated with increased resistance of S. aureus isolates to rifampin or tetracyclines.

Postoperative Chylothorax of Unclear Etiology in a Patient with Right-sided Subclavian Central Venous Catheter Placement

PubMed Central

Asghar, Samie; Shamim, Faisal

2017-01-01

A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically. PMID:29284881

Postoperative Chylothorax of Unclear Etiology in a Patient with Right-sided Subclavian Central Venous Catheter Placement.

PubMed

Asghar, Samie; Shamim, Faisal

2017-01-01

A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2 nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically.

Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters.

PubMed

Schoot, Reineke A; Kremer, Leontien C M; van de Wetering, Marianne D; van Ommen, Cornelia H

2013-09-11

Venous thrombo-embolic events (VTEs) occur in 2.2% to 14% of paediatric cancer patients and cause significant morbidity and mortality. The malignant disease itself, the cancer treatment and the presence of central venous catheters (CVCs) increase the risk of VTE. The primary objective of this review was to investigate the effects of preventive systemic treatments in paediatric cancer patients with tunnelled CVCs on (a)symptomatic VTE. Secondary objectives of this review were to investigate adverse effects of systemic treatments for the prevention of (a)symptomatic VTE in paediatric cancer patients with tunnelled CVCs; and to investigate the effects of systemic treatments in the prevention of (a)symptomatic VTE with CVC-related infection in paediatric cancer patients with tunnelled CVCs. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 8 2012), MEDLINE (1966 to August 2012) and EMBASE (1966 to August 2012). In addition, we searched reference lists from relevant articles and conference proceedings of the International Society for Paediatric Oncology (SIOP) (from 2006 to 2011), the American Society of Clinical Oncology (ASCO) (from 2006 to 2011), the American Society of Hematology (ASH) (from 2006 to 2011) and the International Society of Thrombosis and Haematology (ISTH) (from 2006 to 2011). We scanned the International Standard Randomised Controlled Trial Number (ISRCTN) Register and the National Institute of Health (NIH) Register for ongoing trials (www.controlled-trials.com) (August 2012), and we contacted the authors of eligible studies if additional information was required. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing systemic treatments to prevent venous thrombo-embolic events (VTEs) in paediatric cancer patients with tunnelled CVCs with a control intervention or no systemic treatment. For the description of adverse events, cohort studies were eligible for inclusion

Decreased brain venous vasculature visibility on susceptibility-weighted imaging venography in patients with multiple sclerosis is related to chronic cerebrospinal venous insufficiency

PubMed Central

2011-01-01

Background The potential pathogenesis between the presence and severity of chronic cerebrospinal venous insufficiency (CCSVI) and its relation to clinical and imaging outcomes in brain parenchyma of multiple sclerosis (MS) patients has not yet been elucidated. The aim of the study was to investigate the relationship between CCSVI, and altered brain parenchyma venous vasculature visibility (VVV) on susceptibility-weighted imaging (SWI) in patients with MS and in sex- and age-matched healthy controls (HC). Methods 59 MS patients, 41 relapsing-remitting and 18 secondary-progressive, and 33 HC were imaged on a 3T GE scanner using pre- and post-contrast SWI venography. The presence and severity of CCSVI was determined using extra-cranial and trans-cranial Doppler criteria. Apparent total venous volume (ATVV), venous intracranial fraction (VIF) and average distance-from-vein (DFV) were calculated for various vein mean diameter categories: < .3 mm, .3-.6 mm, .6-.9 mm and > .9 mm. Results CCSVI criteria were fulfilled in 79.7% of MS patients and 18.2% of HC (p < .0001). Patients with MS showed decreased overall ATVV, ATVV of veins with a diameter < .3 mm, and increased DFV compared to HC (all p < .0001). Subjects diagnosed with CCSVI had significantly increased DFV (p < .0001), decreased overall ATVV and ATVV of veins with a diameter < .3 mm (p < .003) compared to subjects without CCSVI. The severity of CCSVI was significantly related to decreased VVV in MS (p < .0001) on pre- and post-contrast SWI, but not in HC. Conclusions MS patients with higher number of venous stenoses, indicative of CCSVI severity, showed significantly decreased venous vasculature in the brain parenchyma. The pathogenesis of these findings has to be further investigated, but they suggest that reduced metabolism and morphological changes of venous vasculature may be taking place in patients with MS. PMID:22011402

Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery

PubMed Central

2010-01-01

Introduction Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk surgery. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (P(cv-a)CO2), a global index of tissue perfusion, could be used as a complementary tool to ScvO2 for goal-directed fluid therapy (GDT) to identify persistent low flow after optimization of preload has been achieved by fluid loading during high-risk surgery. Methods This is a secondary analysis of results obtained in a study involving 70 adult patients (ASA I to III), undergoing major abdominal surgery, and treated with an individualized goal-directed fluid replacement therapy. All patients were managed to maintain a respiratory variation in peak aortic flow velocity below 13%. Cardiac index (CI), oxygen delivery index (DO2i), ScvO2, P(cv-a)CO2 and postoperative complications were recorded blindly for all patients. Results A total of 34% of patients developed postoperative complications. At baseline, there was no difference in demographic or haemodynamic variables between patients who developed complications and those who did not. In patients with complications, during surgery, both mean ScvO2 (78 ± 4 versus 81 ± 4%, P = 0.017) and minimal ScvO2 (minScvO2) (67 ± 6 versus 72 ± 6%, P = 0.0017) were lower than in patients without complications, despite perfusion of similar volumes of fluids and comparable CI and DO2i values. The optimal ScvO2 cut-off value was 70.6% and minScvO2 < 70% was independently associated with the development of postoperative complications (OR = 4.2 (95% CI: 1.1 to 14.4), P = 0.025). P(cv-a)CO2 was larger in patients with complications (7.8 ± 2 versus 5.6 ± 2 mmHg, P < 10-6). In patients with complications and ScvO2 ≥71%, P(cv-a)CO2 was also significantly larger (7.7 ± 2 versus 5.5 ± 2 mmHg, P < 10-6) than in patients without complications. The area under the receiver operating characteristic (ROC) curve was 0.785 (95% CI: 0.74 to

[Continual venous haemofiltration in severe hypothermia].

PubMed

Nielsen, Jane Stab; Gilsaa, Torben

2010-02-22

A seventy-year-old male was brought to the emergency department severely hypothermic with a core temperature of 27 degrees C. He had sustained circulation and was actively rewarmed for 6,5 hours using central veno-venous haemofiltration. The rewarming was uneventful and the patient was discharged without sequelae. This case is an example of efficient and fast rewarming of severe accidental hypothermia by use of CVVH - a method currently available at most intensive care units in Denmark.

A review of the nursing role in central venous cannulation: implications for practice policy and research.

PubMed

Alexandrou, Evan; Spencer, Timothy R; Frost, Steve A; Parr, Michael J A; Davidson, Patricia M; Hillman, Kenneth M

2010-06-01

The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role. Modified integrative literature review. Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, Embase, and the World Wide Web were undertaken using MeSH key words. Hand searching for relevant articles was also undertaken. All studies relating to the nurses role inserting central venous cannulae in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Ten studies met the inclusion criteria for the review, all reported data were from the UK. There were disparate models of service delivery and study populations and the studies were predominantly non experimental in design. The results of this review need to be considered within the methodological caveats associated with this approach. The studies identified did not demonstrate differences in rates of adverse events between a specialist nurse and a medical officer. There were only a small number of studies found in the literature review and the limited availability of clinical outcome data precluded formal analysis from being generated. Central vein cannulation is potentially an emerging practice area with important considerations for policy practice and research. Training specialist nurses to provide such a service may facilitate standardising of practice and improving surveillance of lines, and possibly improve the training and accreditation process for CVC insertions for junior medical officers. For this to occur, there is a need to undertake well-conducted clinical studies to clearly document the value and efficacy of this advanced practice nursing role.

Analysis of risk factors for central venous port failure in cancer patients

PubMed Central

Hsieh, Ching-Chuan; Weng, Hsu-Huei; Huang, Wen-Shih; Wang, Wen-Ke; Kao, Chiung-Lun; Lu, Ming-Shian; Wang, Chia-Siu

2009-01-01

AIM: To analyze the risk factors for central port failure in cancer patients administered chemotherapy, using univariate and multivariate analyses. METHODS: A total of 1348 totally implantable venous access devices (TIVADs) were implanted into 1280 cancer patients in this cohort study. A Cox proportional hazard model was applied to analyze risk factors for failure of TIVADs. Log-rank test was used to compare actuarial survival rates. Infection, thrombosis, and surgical complication rates (χ2 test or Fisher’s exact test) were compared in relation to the risk factors. RESULTS: Increasing age, male gender and open-ended catheter use were significant risk factors reducing survival of TIVADs as determined by univariate and multivariate analyses. Hematogenous malignancy decreased the survival time of TIVADs; this reduction was not statistically significant by univariate analysis [hazard ratio (HR) = 1.336, 95% CI: 0.966-1.849, P = 0.080)]. However, it became a significant risk factor by multivariate analysis (HR = 1.499, 95% CI: 1.079-2.083, P = 0.016) when correlated with variables of age, sex and catheter type. Close-ended (Groshong) catheters had a lower thrombosis rate than open-ended catheters (2.5% vs 5%, P = 0.015). Hematogenous malignancy had higher infection rates than solid malignancy (10.5% vs 2.5%, P < 0.001). CONCLUSION: Increasing age, male gender, open-ended catheters and hematogenous malignancy were risk factors for TIVAD failure. Close-ended catheters had lower thrombosis rates and hematogenous malignancy had higher infection rates. PMID:19787834

Measurement of cardiac index by transpulmonary thermodilution using an implanted central venous access port: a prospective study in patients scheduled for oncologic high-risk surgery.

PubMed

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

2014-01-01

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

Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer.

PubMed

Revel-Vilk, S; Yacobovich, J; Tamary, H; Goldstein, G; Nemet, S; Weintraub, M; Paltiel, O; Kenet, G

2010-09-01

The use of central venous catheters (CVCs) has greatly improved the quality of care in children with cancer, yet these catheters may cause serious infectious and thrombotic complications. The aim of this prospective registry study was to assess the host and CVC-related risk factors for CVC-created thrombotic complications. Patients undergoing CVC insertion for chemotherapy were followed prospectively for CVC complications. At the time of enrollment, demographic, clinical, and CVC-related data, and family history of thrombosis were collected. Survival and Cox regression analyses were performed. A total of 423 CVCs were inserted into 262 patients for a total of 76,540 catheter days. The incidence of CVC-related deep-vein thrombosis (DVT) was 0.13 per 1000 catheter-days (95% confidence interval [CI], 0.06-0.24). Insertion of peripherally inserted central catheters (PICCs) and insertion in an angiography suite significantly increased the risk of symptomatic CVC-related DVT. The incidence of CVC occlusion was 1.35 per 1000 catheter-days (95% CI, 1.1-1.63). Positive family history of thrombosis significantly increased the risk of CVC occlusion (hazard ratio [HR], 2.16; 95% CI, 1.2-3.8). The CVC-related risk factors were insertion of Hickman catheters, insertion in angiography suite, and proximal-tip location. Patients developing at least 1 episode of both CVC occlusion and infection had an increased risk for developing symptomatic CVC-related DVT (HR, 4.15; 95% CI, 1.2-14.4). Both patient-related and CVC-related factors are associated with higher risk of symptomatic thrombotic complications. These risk factors could be used in the clinical setting and in developing future studies for CVC thromboprophylaxis.

The alternative sigma factor sigma B of Staphylococcus aureus modulates virulence in experimental central venous catheter-related infections.

PubMed

Lorenz, Udo; Hüttinger, Christian; Schäfer, Tina; Ziebuhr, Wilma; Thiede, Arnulf; Hacker, Jörg; Engelmann, Susanne; Hecker, Michael; Ohlsen, Knut

2008-03-01

The impact of the alternative sigma factor sigma B (SigB) on pathogenesis of Staphylococcus aureus is not conclusively clarified. In this study, a central venous catheter (CVC) related model of multiorgan infection was used to investigate the role of SigB for the pathogenesis of S. aureus infections and biofilm formation in vivo. Analysis of two SigB-positive wild-type strains and their isogenic mutants revealed uniformly that the wild-type was significantly more virulent than the SigB-deficient mutant. The observed difference in virulence was apparently not linked to the capability of the strains to form biofilms in vivo since wild-type and mutant strains were able to produce biofilm layers inside of the catheter. The data strongly indicate that the alternative sigma factor SigB plays a role in CVC-associated infections caused by S. aureus.

Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gonsalves, Carin F., E-mail: Carin.Gonsalves@mail.tju.edu; Eschelman, David J.; Sullivan, Kevin L.

2003-04-15

The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters(PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine cathetermore » dwelltime and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154)at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p =0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access

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

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

Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study.

PubMed

Cameron, Kenzie A; Cohen, Elaine R; Hertz, Joelle R; Wayne, Diane B; Mitra, Debi; Barsuk, Jeffrey H

2018-03-14

The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.

Evidence for central venous pressure resetting during initial exposure to microgravity

NASA Technical Reports Server (NTRS)

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

2001-01-01

We measured central venous pressure (CVP); plasma volume (PV); urine volume rate (UVR); renal excretion of sodium (UNa); and renal clearances of creatinine, sodium, and osmolality before and after acute volume infusion to test the hypothesis that exposure to microgravity causes resetting of the CVP operating point. Six rhesus monkeys underwent two experimental conditions in a crossover counterbalance design: 1) continuous exposure to 10 degrees head-down tilt (HDT) and 2) a control, defined as 16 h/day of 80 degrees head-up tilt and 8 h prone. After 48 h of exposure to either test condition, a 120-min course of continuous infusion of isotonic saline (0.4 ml. kg(-1). min(-1) iv) was administered. Baseline CVP was lower (P = 0.011) in HDT (2.3 +/- 0.3 mmHg) compared with the control (4.5 +/- 1.4 mmHg) condition. After 2 h of saline infusion, CVP was elevated (P = 0.002) to a similar magnitude (P = 0.485) in HDT (DeltaCVP = 2.7 +/- 0.8 mmHg) and control (DeltaCVP = 2.3 +/- 0.8 mmHg) conditions and returned to preinfusion levels 18 h postinfusion in both treatments. PV followed the same pattern as CVP. The response relationships between CVP and UVR and between CVP and UNa shifted to the left with HDT. The restoration of CVP and PV to lower preinfusion levels after volume loading in HDT compared with control supports the notion that lower CVP during HDT may reflect a new operating point about which vascular volume is regulated. These results may explain the ineffective fluid intake procedures currently employed to treat patients and astronauts.

The complicated role of venous drainage on the survival of arterialized venous flaps

PubMed Central

Weng, Weidong; Zhang, Feng; Zhao, Bin; Wu, Zhipeng; Gao, Weiyang; Li, Zhijie; Yan, Hede

2017-01-01

The arterialized venous flap (AVF) has been gradually popularized in clinical settings; however, its survival is still inconsistent and the role of venous drainage remains elusive. In this study, we aimed to investigate the role of venous drainage on the flap survival of arterialized venous flaps. An arterialized venous flap was outlined symmetrically in the rabbit abdomen. The arterial perfusion flap with a unilateral vascular pedicle was taken as the control group and three other experimental groups (I, II and III) were designed based on the number of drainage veins (n = 1, 2 and 3 in the three groups, respectively). Compared with the control group, significant venous congestion was noted in all the experimental groups and the most severe one was seen in group I; while no statistical difference was observed between groups II and III. Similar results regarding blood perfusion state, epidermal metabolite levels and flap survival status were obtained among the three groups. These findings suggested that venous drainage is vital in the survival of the flap, but unlike in the arterial perfusion flaps, the problem of venous congestion can only be partially solved by increasing the number of draining veins. Further studies are warranted to gain insight into this complicated issue. PMID:28145882

Differentiation of deep venous thrombosis from femoral vein mixing artifact on routine abdominopelvic CT.

PubMed

Doshi, Ankur M; Hoffman, David; Kierans, Andrea S; Ream, Justin M; Rosenkrantz, Andrew B

2015-10-01

The objective of this study is to assess the performance of qualitative and quantitative imaging features for the differentiation of deep venous thrombosis (DVT) from mixing artifact on routine portal venous phase abdominopelvic CT. This retrospective study included 40 adult patients with a femoral vein filling defect on portal venous phase CT and a Duplex ultrasound (n = 36) or catheter venogram (n = 4) to confirm presence or absence of DVT. Two radiologists (R1, R2) assessed the femoral veins for various qualitative and quantitative features. 60% of patients were confirmed to have DVT and 40% had mixing artifact. Features with significantly greater frequency in DVT than mixing artifact (all p ≤ 0.006) were central location (R1 90% vs. 28%; R2 96% vs. 31%), sharp margin (R1 83% vs. 28%; R2 96% vs. 31%), venous expansion (R1 48% vs. 6%, R2 56% vs. 6%), and venous wall enhancement (R1 62% vs. 0%; R2 48% vs. 0%). DVT exhibited significantly lower mean attenuation than mixing artifact (R1 42.1 ± 20.2 vs. 57.1 ± 23.6 HU; R2 43.6 ± 19.4 vs. 58.8 ± 23.4 HU, p ≤ 0.031) and a significantly larger difference in vein diameter compared to the contralateral vein (R1 0.4 ± 0.4 vs. 0.1 ± 0.2 cm; R2 0.3 ± 0.4 vs. 0.0 ± 0.1 cm, p ≤ 0.026). At multivariable analysis, central location and sharp margin were significant independent predictors of DVT for both readers (p ≤ 0.013). Awareness of these qualitative and quantitative imaging features may improve radiologists' confidence for differentiating femoral vein DVT and mixing artifact on routine portal venous phase CT. However, given overlap with mixing artifact, larger studies remain warranted.

Prevention of Contrast-Induced Nephropathy by Central Venous Pressure-Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients.

PubMed

Qian, Geng; Fu, Zhenhong; Guo, Jun; Cao, Feng; Chen, Yundai

2016-01-11

This study aimed to explore the hemodynamic index-guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure. Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application. This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr. Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500). CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Distension of central great vein decreases sympathetic outflow in humans

PubMed Central

Cui, Jian; Gao, Zhaohui; Blaha, Cheryl; Herr, Michael D.; Mast, Jessica

2013-01-01

Classic canine studies suggest that central great vein distension evokes an autonomic reflex tachycardia (Bainbridge reflex). It is unclear whether central venous distension in humans is a necessary and sufficient stimulus to evoke a reflex increase in heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA). Prior work from our laboratory suggests that limb venous distension evokes a reflex increase in BP and MSNA in humans. We hypothesized that in humans, compared with the limb venous distension, inferior vena cava (IVC) distension would evoke a less prominent increase in HR and MSNA. IVC distension (monitored with ultrasonography) was induced by two methods: 1) head-down tilt (HDT, N = 13); and 2) lower-body positive pressure (LBPP, N = 10). Two minutes of HDT induced IVC distension (Δ2.6 ± 0.2 mm, P < 0.001, ∼27% in cross-sectional area), slightly increased mean BP (Δ2.3 ± 0.7 mmHg, P = 0.005), decreased MSNA (Δ5.2 ± 0.8 bursts/min, P < 0.001, N = 10), and did not alter HR (P = 0.37). LBPP induced similar IVC distension, increased BP (Δ2.0 ± 0.7 mmHg, P < 0.01), and did not alter HR (P = 0.34). Thus central venous distension leads to a rapid increase in BP and a subsequent fall in MSNA. Central venous distension does not evoke either bradycardia or tachycardia in humans. The absence of a baroreflex-mediated bradycardia suggests that the Bainbridge reflex is engaged. Clearly, this reflex differs from the powerful sympathoexcitation peripheral venous distension reflex described in humans. PMID:23729210

Distension of central great vein decreases sympathetic outflow in humans.

PubMed

Cui, Jian; Gao, Zhaohui; Blaha, Cheryl; Herr, Michael D; Mast, Jessica; Sinoway, Lawrence I

2013-08-01

Classic canine studies suggest that central great vein distension evokes an autonomic reflex tachycardia (Bainbridge reflex). It is unclear whether central venous distension in humans is a necessary and sufficient stimulus to evoke a reflex increase in heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA). Prior work from our laboratory suggests that limb venous distension evokes a reflex increase in BP and MSNA in humans. We hypothesized that in humans, compared with the limb venous distension, inferior vena cava (IVC) distension would evoke a less prominent increase in HR and MSNA. IVC distension (monitored with ultrasonography) was induced by two methods: 1) head-down tilt (HDT, N = 13); and 2) lower-body positive pressure (LBPP, N = 10). Two minutes of HDT induced IVC distension (Δ2.6 ± 0.2 mm, P < 0.001, ~27% in cross-sectional area), slightly increased mean BP (Δ2.3 ± 0.7 mmHg, P = 0.005), decreased MSNA (Δ5.2 ± 0.8 bursts/min, P < 0.001, N = 10), and did not alter HR (P = 0.37). LBPP induced similar IVC distension, increased BP (Δ2.0 ± 0.7 mmHg, P < 0.01), and did not alter HR (P = 0.34). Thus central venous distension leads to a rapid increase in BP and a subsequent fall in MSNA. Central venous distension does not evoke either bradycardia or tachycardia in humans. The absence of a baroreflex-mediated bradycardia suggests that the Bainbridge reflex is engaged. Clearly, this reflex differs from the powerful sympathoexcitation peripheral venous distension reflex described in humans.

Venous thromboembolism in adults with sickle cell disease: A serious and under-recognized complication

PubMed Central

Naik, Rakhi P.; Streiff, Michael B.; Haywood, Carlton; Nelson, Julie A.; Lanzkron, Sophie

2013-01-01

BACKGROUND Sickle cell disease is recognized as a hypercoagulable state; however the frequency and characteristics of venous thromboembolism in sickle cell patients have not been well-defined. PURPOSE To establish the prevalence and risk factors for venous thromboembolism in a large cohort of patients with sickle cell disease and determine the relationship between venous thromboembolism and mortality. METHODS We performed a cross-sectional study of 404 sickle cell disease patients cared for at the Sickle Cell Center for Adults at Johns Hopkins. Demographic, sickle cell disease-specific comorbidity, and venous thromboembolism data were collected on all patients. RESULTS 101 patients (25%) had a history of venous thromboembolism with a median age at diagnosis of 29.9 years. A history of non-catheter-related venous thromboembolism was found in 18.8% of patients. Sickle variant genotypes conferred a higher risk of non-catheter-related venous thromboembolism compared to sickle cell anemia genotypes (SS/Sβ0) (relative risk (RR) 1.77, 95% confidence interval (CI) 1.18–2.66). Tricuspid regurgitant jet velocity ≥ 2.5 m/s was also associated with non-catheter-related venous thromboembolism (RR 1.65, CI 1.12–2.45). Thirty patients (7.4%) died during the study period. Adjusting for all variables, non-catheter-related venous thromboembolism was independently correlated with death (RR 3.63, CI 1.66–7.92). CONCLUSION Venous thromboembolism is common in adults with sickle cell disease. Sickle variant genotypes and tricuspid regurgitant jet velocity ≥ 2.5m/s are associated with non-catheter-related venous thromboembolism. In addition, non-catheter-related venous thromboembolism appears to be an independent risk factor for death in our cohort. These results suggest that disease-specific prophylaxis and treatment strategies for venous thromboembolism should be investigated in sickle cell disease patients. PMID:23582935

Monitoring mixed venous oxygen saturation in patients with obstructive shock after massive pulmonary embolism.

PubMed

Krivec, Bojan; Voga, Gorazd; Podbregar, Matej

2004-05-31

Patients with massive pulmonary embolism and obstructive shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with obstructive shock following massive pulmonary embolism. Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with obstructive shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter. At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31+/-10 vs. 49+/-12%, p<0.0001; 86+/-12 vs. 105+/-17 mmHg, p<0.01; 1.5+/-0.4 vs. 1.9+/-0.7 L/min/m2, p<0.05; respectively), whereas heart rate, central venous pressure, mean pulmonary-artery pressure and urine output remained unchanged. Total pulmonary vascular-resistance index was lower than at admission (29+/-10 vs. 21+/-12 mmHg/L/min/m2, p<0.05). The relative change of mixed venous oxygen saturation at hour 1 was higher than the relative changes of all other studied variables (p<0.05). Serum lactate on admission and at 12 hours correlated to mixed venous oxygen saturation (r=-0.855, p<0.001). In obstructive shock after massive pulmonary embolism, mixed venous oxygen saturation changes more rapidly than other standard hemodynamic variables.

High Background Ozone Events in the Houston-Galveston-Brazoria Area: Effects from Central American Fires

NASA Astrophysics Data System (ADS)

Lei, R.; Wang, S. C.; Yang, S.; Wang, Y.; Talbot, R. W.

2016-12-01

The policy-relevant background (PRB) ozone is defined by the U.S. Environmental Protection Agency (EPA) as the surface ozone mixing ratio that would occur over the U.S. without North American anthropogenic emission influences. PRB ozone over the Houston-Galveston-Brazoria (HGB) area may be affected by foreign sources due to its unique geographical location and meteorology. Our monitoring data revealed several high ozone events over HGB area which might be caused by Central American fire during the years of 2013-2015. To qualify the effects from Central American fire, we estimated the US, Central American and worldwide background over HGB area during those events using the GEOS-Chem global 3-D model. Anomalies in fire emissions leading to high PRB ozone were mapped through spatiotemporal sampling of the Fire INventory from NCAR (FINN) along background trajectories of air masses affecting the HGB area prior to and during the selected high PRB ozone days. Daily HGB PRB ozone estimated by researchers at the Texas Commission on Environmental Quality (TCEQ) was used as the data source to validate model results. Results showed that contribution of emission from Central American to HGB PRB ozone could be tripled during fire events compared to non-impacted fire days. Besides fire emissions from Central American, different types of meteorological events (e.g., cold fronts and thunderstorms) and high local photochemical production (e.g., heat waves and stagnation) are also found associated with high PRB ozone in HGB area during these events. Thus we imply that synthetic contribution from foreign sources and local meteorology to HGB PRB ozone warrants further investigated.

Medical management of venous ulcers.

PubMed

Pascarella, Luigi; Shortell, Cynthia K

2015-03-01

Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

Pentoxifylline for treating venous leg ulcers.

PubMed

Jull, A; Arroll, B; Parag, V; Waters, J

2007-07-18

Healing of venous leg ulcers is improved by the use of compression bandaging but some venous ulcers remain unhealed, and some people are unsuitable for compression therapy. Pentoxifylline, a drug which helps blood flow, has been used to treat venous leg ulcers. An earlier version of this review included 9 randomised controlled trials, but more research has been since been conducted and an updated review is required. To assess the effects of pentoxifylline (oxpentifylline or Trental 400) for treating venous leg ulcers, compared with placebo, or other therapies, in the presence or absence of compression therapy. For this second update we searched the Cochrane Wounds Group Specialised Register, CENTRAL, MEDLINE, EMBASE and Cinahl (date of last search was February 2007), and reference lists of relevant articles. Randomised trials comparing pentoxifylline with placebo or other therapy in the presence or absence of compression, in people with venous leg ulcers. Details from eligible trials were extracted and summarised by one author using a coding sheet. Data extraction was independently verified by one other author. Twelve trials involving 864 participants were included. The quality of trials was variable. Eleven trials compared pentoxifylline with placebo or no treatment; in seven of these trials patients received compression therapy. In one trial pentoxifylline was compared with defibrotide in patients who also received compression. Combining 11 trials that compared pentoxifylline with placebo or no treatment (with or without compression) demonstrated that pentoxifylline is more effective than placebo in terms of complete ulcer healing or significant improvement (RR 1.70, 95% CI 1.30 to 2.24). Significant heterogeneity was associated with differences in sample populations (hard-to-heal samples compared with "normal" healing samples). Pentoxifylline plus compression is more effective than placebo plus compression (RR 1.56, 95% CI 1.14 to 2.13). Pentoxifylline in the

Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections.

PubMed

van der Kooi, Tjallie; Sax, Hugo; Pittet, Didier; van Dissel, Jaap; van Benthem, Birgit; Walder, Bernhard; Cartier, Vanessa; Clack, Lauren; de Greeff, Sabine; Wolkewitz, Martin; Hieke, Stefanie; Boshuizen, Hendriek; van de Kassteele, Jan; Van den Abeele, Annemie; Boo, Teck Wee; Diab-Elschahawi, Magda; Dumpis, Uga; Ghita, Camelia; FitzGerald, Susan; Lejko, Tatjana; Leleu, Kris; Martinez, Mercedes Palomar; Paniara, Olga; Patyi, Márta; Schab, Paweł; Raglio, Annibale; Szilágyi, Emese; Ziętkiewicz, Mirosław; Wu, Albert W; Grundmann, Hajo; Zingg, Walter

2018-01-01

To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.

[Thrombosis and obstruction associated with central venous lines. Incidence and risk factors].

PubMed

Vivanco Allende, A; Rey Galán, C; Rodríguez de la Rúa, M V; Alvarez García, F; Medina Villanueva, A; Concha Torre, A; Mayordomo Colunga, J; Martínez Camblor, P

2013-09-01

To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Prevention of central venous catheter-related bloodstream infections using non-technologic strategies.

PubMed

Gnass, Silvia Acosta; Barboza, Luisa; Bilicich, Dafne; Angeloro, Pablo; Treiyer, Walter; Grenóvero, Silvia; Basualdo, Juan

2004-08-01

To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from April 1997 to December 2001. The medical-surgical ICU of a tertiary-care, university-affiliated hospital in Argentina. We studied all patients admitted to the ICU using non-impregnated CVCs. Maximal sterile barrier precautions (ie, use of cap, mask, sterile gown, sterile gloves, and large sterile drape), strict handwashing, preparation of the patients' skin with antiseptic solutions, insertion and management of catheters by trained personnel, and continuing quality improvement programs aimed at appropriate insertion and maintenance of catheters were employed. During the study period, 2,525 patients were admitted to the ICU. Eight hundred sixty-eight patients had 1,037 CVCs inserted. The number of CVC-related bloodstream infections (BSIs), acquired in the ICU, was 2.7 per 1,000 CVC-days (13 nosocomial CVC-related BSIs during 4,770 days of CVC use). Microorganisms isolated included methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), coagulase-negative methicillin-resistant Staphylococcus (n = 2), Escherichia coli (n = 1), Klebsiella pneumoniae (n = 1), and Enterobacter cloacae (n = 1). A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters. The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU.

Risk of Venous Thromboembolism Following Peripherally Inserted Central Catheter Exchange: An Analysis of 23,000 Hospitalized Patients.

PubMed

Chopra, Vineet; Kaatz, Scott; Grant, Paul; Swaminathan, Lakshmi; Boldenow, Tanya; Conlon, Anna; Bernstein, Steven J; Flanders, Scott A

2018-02-01

Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known. We performed a retrospective cohort study to assess the association between PICC exchange and risk of thromboembolism. Adult hospitalized patients that received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety consortium were included. The primary outcome was hazard of symptomatic venous thromboembolism (radiographically confirmed upper-extremity deep vein thrombosis and pulmonary embolism) in those that underwent PICC exchange vs those that did not. Of 23,010 patients that underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC exchange. Almost half of all exchanges were performed for catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced PICC-associated deep vein thrombosis. The incidence of deep vein thrombosis was greater in those that underwent PICC exchange vs those that did not (3.6% vs 2.0%, P < .001). Median time to thrombosis was shorter among those that underwent exchange vs those that did not (5 vs 11 days, P = .02). Following adjustment, PICC exchange was independently associated with twofold greater risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37-2.85) vs no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumens (HR 2.06; 95% CI, 1.59-2.66 and HR 2.31; 95% CI, 1.6-3.33 for double- and triple-lumen devices, respectively). Guidewire exchange of PICCs may be associated with increased risk of thrombosis. As some exchanges may be preventable, consideration of risks and benefits of exchanges in clinical practice is needed. Published by Elsevier Inc.

[Catheter occlusion and venous thrombosis prevention and incidence in adult home parenteral nutrition (HPN) programme patients].

PubMed

Puiggròs, C; Cuerda, C; Virgili, N; Chicharro, M L; Martínez, C; Garde, C; de Luis, D

2012-01-01

In adult home parenteral nutrition (HPN) programme patients up to now no evidence-based recommendations exist on the central venous catheter maintenance nor venous thrombosis prevention. The use of heparin flushes could be linked with long term complications, besides, anticoagulants use is controversial. To be aware of the usual maintenance practice for HPN central venous catheters, catheter occlusion and related venous thrombosis incidence in our country. Retrospective study of active HPN patients older than 18 years registered by the NADYA- SENPE working group until November 2008. 49 patients were registered (16 males and 33 females), with an average age of 52.1 ± 13.9 years, belonging to 6 hospitals. HPN length was 57.4 ± 73.3 months with 5.8 ± 1.8 PN days a week. The most frequent pathologies were actinic enteritis, intestinal motility disorders and mesenteric ischemia (20.4% each), and neoplasm (16.3%). The reason for HPN provision was short bowel syndrome (49.0%), and intestinal obstruction (28.6%). Neoplasm (16.3%), thrombotic diathesis, thromboembolic syndrome and bed rest (6.1% each) were the main venous thrombosis adjuvant factors. Tunnelled catheters were used in 77.6% of patients, with implanted port-catheters in the remainder. Maintenance of the line was done with saline solution flushes (28.6%) and different concentrations of heparin solutions (69.4%). When heparin was used, it was removed before PN infusion in 63.3% of patients. Catheter occlusion and venous thrombotic events rates were 0.061/10³ and 0.115/10³ HPN days respectively. Eleven patients (22.4%) were treated with anticoagulant drugs due to previous episodes of venous thrombosis or pulmonary embolism. [corrected] The incidence of catheter related thrombotic complications incidence is low in this group of patients on HPN. There is a great variety of practices focused on the prevention of both: line occlusion and catheter related venous thrombosis. In conclusion, it would be necessary to

Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients.

PubMed

Díaz-Regañón, Genaro; Miñambres, Eduardo; Holanda, Marisol; González-Herrera, Segundo; López-Espadas, Francisco; Garrido-Díaz, Carlos

2002-12-01

To assess the usefulness of venous oxygen saturation in the jugular bulb (SjO(2)) as a complementary test for the diagnosis of brain death. Prospective observational study. Polytrauma intensive care unit (ICU) of an acute-care teaching hospital in Santander, Spain. We studied 118 (44%) out of 270 patients with severe head injury and intracranial hemorrhage meeting criteria of brain death (lack of cardiac response to atropine, unresponsive apnea, and iso-electric EEG in the absence of shock, hypotension and treatment with muscle relaxants and/or central nervous system (CNS) depressant drugs). At the moment at which clinical diagnosis of brain death was made and an iso-electric EEG was obtained, simultaneous oxygen saturation in central venous blood (right atrium) (SvO(2)) and jugular venous bulb (SjO(2)) samples was measured. The ratio between SvO(2) and SjO(2), expressed as CvjO(2) (the so-called central venous-jugular bulb oxygen saturation rate; CvjO(2) = SvO(2)/SjO(2)) was calculated. CvjO(2) less than 1 was obtained in 114 patients [mean (SD): 0.89 (0.02)], whereas CvjO(2) greater than 1 was obtained in only 4 (3.38%). In the group of 152 survivors, a single patient was discharged from the ICU in a vegetative state in which CvjO(2) was below 1. CvjO(2)as a complementary test for the diagnosis of brain death showed 96.6% sensitivity, 99.3% specificity, and 99.1% and 97.4% positive and negative predictive values, respectively. Central venous-jugular bulb oxygen saturation rate below 1 together with accepted clinical criteria (unresponsive coma with brainstem areflexia) provides non-invasive assessment of cerebral circulatory arrest that can help to suspect brain death.

Training Surgical Residents With a Haptic Robotic Central Venous Catheterization Simulator.

PubMed

Pepley, David F; Gordon, Adam B; Yovanoff, Mary A; Mirkin, Katelin A; Miller, Scarlett R; Han, David C; Moore, Jason Z

Ultrasound guided central venous catheterization (CVC) is a common surgical procedure with complication rates ranging from 5 to 21 percent. Training is typically performed using manikins that do not simulate anatomical variations such as obesity and abnormal vessel positioning. The goal of this study was to develop and validate the effectiveness of a new virtual reality and force haptic based simulation platform for CVC of the right internal jugular vein. A CVC simulation platform was developed using a haptic robotic arm, 3D position tracker, and computer visualization. The haptic robotic arm simulated needle insertion force that was based on cadaver experiments. The 3D position tracker was used as a mock ultrasound device with realistic visualization on a computer screen. Upon completion of a practice simulation, performance feedback is given to the user through a graphical user interface including scoring factors based on good CVC practice. The effectiveness of the system was evaluated by training 13 first year surgical residents using the virtual reality haptic based training system over a 3 month period. The participants' performance increased from 52% to 96% on the baseline training scenario, approaching the average score of an expert surgeon: 98%. This also resulted in improvement in positive CVC practices including a 61% decrease between final needle tip position and vein center, a decrease in mean insertion attempts from 1.92 to 1.23, and a 12% increase in time spent aspirating the syringe throughout the procedure. A virtual reality haptic robotic simulator for CVC was successfully developed. Surgical residents training on the simulation improved to near expert levels after three robotic training sessions. This suggests that this system could act as an effective training device for CVC. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Interaction of central venous pressure, intramuscular pressure, and carotid baroreflex function

NASA Technical Reports Server (NTRS)

Shi, X.; Foresman, B. H.; Raven, P. B.; Blomqvist, C. G. (Principal Investigator)

1997-01-01

Seven healthy volunteer men participated in an experiment involving lower body positive pressure (LBPP) of 30 Torr and acute volume expansions of 5-6% (VE-I) and 9-10% (VE-II) of their total blood volume (TBV) to differentiate the effect of increased intramuscular pressure and central venous pressure (CVP) on the maximal gain (Gmax) of the carotid baroreflex. During each experimental condition, the heart rate (HR), mean arterial pressure (MAP; intraradial artery or Finapres), and CVP (at the 3rd-4th intercostal space) were monitored continuously. Gmax was derived from the logistic modeling of the HR and MAP responses to ramped changes in carotid sinus transmural pressure using a protocol of pulsatile changes in neck chamber pressure from +40 to -65 Torr. The increase in CVP during +30-Torr LBPP was 1.5 mmHg (P < 0.05) and was similar to that observed during VE-I (1.7 mmHg, P > 0.05). The Gmax of the carotid baroreflex of HR and MAP was significantly decreased during LBPP by -0.145 +/- 0.039 beats x min(-1) x mmHg(-1) (38%) and -0.071 +/- 0.013 mmHg/mmHg (25%), respectively; however, VE-I did not affect Gmax. During VE-II, CVP was significantly greater than that elicited by LBPP, and the Gmax of the carotid baroreflex of the HR and MAP responses was significantly reduced. We conclude that carotid baroreflex responsiveness was selectively inhibited by increasing intramuscular pressure, possibly resulting in an activation of the intramuscular mechanoreceptors during LBPP. Furthermore, it would appear that the inhibition of the carotid baroreflex, via cardiopulmonary baroreceptor loading (increased CVP), occurred when a threshold pressure (CVP) was achieved.

Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage.

PubMed

Wright, Thomas C; Mossaad, Bassem M; Chummun, Shaheel; Khan, Umraz; Chapman, Thomas W L

2013-07-01

The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Vasopressin-induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection.

PubMed

Bown, L Sand; Ricksten, S-E; Houltz, E; Einarsson, H; Söndergaard, S; Rizell, M; Lundin, S

2016-05-01

To minimize blood loss during hepatic surgery, various methods are used to reduce pressure and flow within the hepato-splanchnic circulation. In this study, the effect of low- to moderate doses of vasopressin, a potent splanchnic vasoconstrictor, on changes in portal and hepatic venous pressures and splanchnic and hepato-splanchnic blood flows were assessed in elective liver resection surgery. Twelve patients were studied. Cardiac output (CO), stroke volume (SV), mean arterial (MAP), central venous (CVP), portal venous (PVP) and hepatic venous pressures (HVP) were measured, intraoperatively, at baseline and during vasopressin infusion at two infusion rates (2.4 and 4.8 U/h). From arterial and venous blood gases, the portal (splanchnic) and hepato-splanchnic blood flow changes were calculated, using Fick's equation. CO, SV, MAP and CVP increased slightly, but significantly, while systemic vascular resistance and heart rate remained unchanged at the highest infusion rate of vasopressin. PVP was not affected by vasopressin, while HVP increased slightly. Vasopressin infusion at 2.4 and 4.8 U/h reduced portal blood flow (-26% and -37%, respectively) and to a lesser extent hepato-splanchnic blood flow (-9% and -14%, respectively). The arterial-portal vein lactate gradient was not significantly affected by vasopressin. Postoperative serum creatinine was not affected by vasopressin. Short-term low to moderate infusion rates of vasopressin induced a splanchnic vasoconstriction without metabolic signs of splanchnic hypoperfusion or subsequent renal impairment. Vasopressin caused a centralization of blood volume and increased cardiac output. Vasopressin does not lower portal or hepatic venous pressures in this clinical setting. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

An Isolated Venous Sac as a Novel Site for Cell Therapy in Diabetes Mellitus

PubMed Central

Kakabadze, Zurab; Shanava, Koba; Ricordi, Camillo; Shapiro, A.M. James; Gupta, Sanjeev; Berishvili, Ekaterine

2013-01-01

Background Transplanting pancreatic islets is of significant interest for type 1 diabetes mellitus. After intraportal injection of islets, inferior engraftment and eventual loss of transplanted islets constitute major limitations. Therefore, alternative approaches will be helpful. Here, we evaluated in animals whether an isolated venous sac would support survival of transplanted islets, along with correction of hyperglycemia. Methods Pancreatic islets isolated from adult Lewis rats were transplanted either into an isolated venous sac made from lumbar vein or into the portal vein of syngeneic rats. The integrity and vascular organization of the venous sac was determined by studies of the local microcirculation. The engraftment, survival, and function of transplanted islets were analyzed by histology, including endocrine function in situ and by glycemic control in rats with streptozotocin-induced diabetes. Results Transplanted islets showed normal morphology with insulin expression in isolated venous sac during the long term. Transplanted islets received blood supply from vasa vasorum and had access to drainage through venous tributaries in the venous sac. This resulted in restoration of euglycemia in diabetic rats. Removal of islet graft-bearing venous sac in diabetic rats led to recurrence of hyperglycemia. By contrast, euglycemia was not restored in rats treated by intraportal transplantation of islets. Conclusions We demonstrated that pancreatic islets successfully engrafted and functioned in the isolated venous sac with ability to restore euglycemia in diabetic rats. Therefore, the isolated venous sac offers a new site for transplantation of pancreatic islets. This would be clinically beneficial as an alternative to intrahepatic islet transplantation. PMID:22814331

Cocaine and metabolite concentrations in DBS and venous blood after controlled intravenous cocaine administration

PubMed Central

Ellefsen, Kayla N; da Costa, Jose Luiz; Concheiro, Marta; Anizan, Sebastien; Barnes, Allan J; Pirard, Sandrine; Gorelick, David A; Huestis, Marilyn A

2015-01-01

Background: DBS are an increasingly common clinical matrix. Methods & results: Sensitive and specific methods for DBS and venous blood cocaine and metabolite detection by LC–HRMS and 2D GC–MS, respectively, were validated to examine correlation between concentrations following controlled intravenous cocaine administration. Linear ranges from 1 to 200 µg/l were achieved, with acceptable bias and imprecision. Authentic matched specimens’ (392 DBS, 97 venous blood) cocaine and benzoylecgonine concentrations were qualitatively similar, but DBS had much greater variability (21.4–105.9 %CV) and were lower than in blood. Conclusion: DBS offer advantages for monitoring cocaine intake; however, differences between capillary and venous blood and DBS concentration variability must be addressed. PMID:26327184

The modern atmospheric background dust load: Recognition in Central Asian snowpack, and compositional constraints

USGS Publications Warehouse

Hinkley, T.; Pertsiger, F.; Zavjalova, L.

1997-01-01

Dusts in strata of snowpack in the Alai-Pamir range, Kirghizstan, Central Asia, have chemical compositions that are in the same restricted range as those of the dusts found in snowpacks at three other locations: central south Greenland, the St. Elias range (Alaska), and coastal Antarctica, where special-type local dust sources certainly cannot dominate. This similarity at the four widely separated sites appears to indicate that there is a modern atmospheric background dust that is the same on a regional, hemispheric, or global scale. The common compositional range is that of average crustal rock, or of moderately ferromagnesian volcanic rock. It is not that of carbonate, nor highly siliciceous rocks. Previously, the existence of an atmospheric background dust has been postulated only on the basis of its particle size distribution, and only from observations in polar regions. The present study partially determines the chemical composition of the background dust, and confirms its existence in snowpack at four localities worldwide, including the center of the earth's largest continent where dusts of local source have considerable influence. U.S. copyright. Published in 1997 by the American Geophysical Union.

Cardiovascular Deconditioning and Venous Air Embolism in Simulated Microgravity in the Rat

NASA Technical Reports Server (NTRS)

Robinson, R. R.; Doursout, M.-F.; Chelly, J. E.; Powell, M. R.; Little, T. M.; Butler,B. D.

1996-01-01

Astronauts conducting extravehicular activities undergo decompression to a lower ambient pressure, potentially resulting in gas bubble formation within the tissues and venous circulation. Additionally, exposure to microgravity produces fluid shifts within the body leading to cardiovascular deconditioning. A lower incidence of decompression illness in actual spaceflight compared with that in ground-based altitude chamber flights suggests that there is a possible interaction between microgravity exposure and decompression illness. The purpose of this study was to evaluate the cardiovascular and pulmonary effects of simulated hypobaric decompression stress using a tail suspension (head-down tilt) model of microgravity to produce the fluid shifts associated with weightlessness in conscious, chronically instrumented rats. Venous bubble formation resulting from altitude decompression illness was simulated by a 3-h intravenous air infusion. Cardiovascular deconditioning was simulated by 96 h of head-down tilt. Heart rate, mean arterial blood pressure, central venous pressure, left ventricular wall thickening and cardiac output were continuously recorded. Lung studies were performed to evaluate edema formation and compliance measurement. Blood and pleural fluid were examined for changes in white cell counts and protein concentration. Our data demonstrated that in tail-suspended rats subjected to venous air infusions, there was a reduction in pulmonary edema formation and less of a decrease in cardiac output than occurred following venous air infusion alone. Mean arterial blood pressure and myocardial wall thickening fractions were unchanged with either tail-suspension or venous air infusion. Heart rate decreased in both conditions while systemic vascular resistance increased. These differences may be due in part to a change or redistribution of pulmonary blood flow or to a diminished cellular response to the microvascular insult of the venous air embolization.

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

PubMed

Sabel, M S; Smith, J L

1997-11-01

At Roswell Park Cancer Institute, we have seen a dramatic increase in the need for long-term venous access. Chronic venous catheters are an indispensible part of the treatment provided to oncology patients. Cancer patients are often at higher risk for complications secondary to their underlying disease and treatments. These risks may be minimized by paying close attention to several important aspects of central line placement. These include matching individual patient needs with the access device most suited to those needs, a thorough preoperative assessment, and the safest and most appropriate operative approach for placement. Likewise, the prompt recognition and treatment of complications when they do occur is crucial to the care of these patients. In order to optimize the care of patients with long-term venous access devices, we have reviewed our experience of over 700 vascular access consultations and offer the following recommendations.

Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters.

PubMed

Lobo, Bob L; Vaidean, Georgeta; Broyles, Joyce; Reaves, Anne B; Shorr, Ronald I

2009-09-01

Peripherally inserted central catheters (PICC) are increasingly used in hospitalized patients. The benefit can be offset by complications such as upper extremity deep vein thrombosis (UEDVT). Retrospective study of patients who received a PICC while hospitalized at the Methodist University Hospital (MUH) in Memphis, TN. All adult consecutive patients who had PICCs inserted during the study period and who did not have a UEDVT at the time of PICC insertion were included in the study. A UEDVT was defined as a symptomatic event in the ipsilateral extremity, leading to the performance of duplex ultrasonography, which confirmed the diagnosis of UEDVT. Pulmonary embolism (PE) was defined as a symptomatic event prompting the performance of ventilation-perfusion lung scan or spiral computed tomography (CT). Among 777 patients, 38 patients experienced 1 or more venous thromboembolisms (VTEs), yielding an incidence of 4.89%. A total of 7444 PICC-days were recorded for 777 patients. This yields a rate of 5.10 VTEs/1000 PICC-days. Compared to patients whose PICC was inserted in the SVC, patients whose PICC was in another location had an increased risk (odds ratio = 2.61 [95% CI = 1.28-5.35]) of VTE. PICC related VTE was significantly more common among patients with a past history of VTE (odds ratio = 10.83 [95% CI = 4.89-23.95]). About 5% of patients undergoing PICC placement in acute care hospitals will develop thromboembolic complications. Thromboembolic complications were especially common among persons with a past history of VTE. Catheter tip location at the time of insertion may be an important modifiable risk factor. Copyright 2009 Society of Hospital Medicine.

A Review of Central Venous Pressure and Its Reliability as a Hemodynamic Monitoring Tool in Veterinary Medicine.

PubMed

Hutchinson, Kristen M; Shaw, Scott P

2016-09-01

To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient. A thorough evaluation of the veterinary and human literature should be performed to evaluate the role of CVP measurements in assessing volume status in veterinary patients. Veterinary patients that benefit from accurate CVP readings include those suffering from hypovolemic or septic shock, heart disease, or renal disease or all of these. Other patients that may benefit from CVP monitoring include high-risk anesthetic patients undergoing major surgery, trending of fluid volume status in critically ill patients, patients with continued shock, and patients that require rapid or large amounts of fluids. The goal of CVP use is to better understand a patient's intravascular volume status, which would allow early goal-directed therapy. CVP would most likely continue to play an important role in the hemodynamic monitoring of the critically ill veterinary patient; however, when available, cardiac output methods should be considered the first choice for hemodynamic monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2013-01-01

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

Effect of Vacuum on Venous Drainage: an Experimental Evaluation on Pediatric Venous Cannulas and Tubing Systems.

PubMed

Vida, V L; Bhattarai, A; Speggiorin, S; Zanella, F; Stellin, G

2014-01-01

To observe how vacuum assisted venous drainage (VAVD) may influence the flow in a cardiopulmonary bypass circuit with different size of venous lines and cannulas. The experimental circuit was assembled to represent the cardiopulmonary bypass circuit routinely used during cardiac surgery. Wall suction was applied directly, modulated and measured into the venous reservoir. The blood flow was measured with a flow-meter positioned on the venous line. The circuit prime volume was replaced with group O date expired re-suspended red cells and Plasmalyte 148 to a hematocrit of 28% to 30%. In an open circuit with gravity siphon venous drain, angled cannulae drain more than straight ones regardless the amount of suction applied to the venous line (16 Fr straight cannula (S) drains 90 ml/min less than a 16 Fr angled (A) with a siphon gravity). The same flow can be obtained with lower cannula size and higher suction (i.e. 12 A with and -30 mmHg). Tables have been created to list how the flow varies according to the size of the cannulas, the size of the venous tubes, and the amount of suction applied to the system. Vacuum assisted venous drainage allows the use of smaller cannulae and venous lines to maintain a good venous return, which is very useful during minimally invasive approaches. The present study should be considered as a preliminary attempt to create a scientific-based starting point for a uniform the use of VAVD.

Vasopressin and nitroglycerin decrease portal and hepatic venous pressure and hepato-splanchnic blood flow.

PubMed

Wisén, E; Svennerholm, K; Bown, L S; Houltz, E; Rizell, M; Lundin, S; Ricksten, S-E

2018-03-26

Various methods are used to reduce venous blood pressure in the hepato-splanchnic circulation, and hence minimise blood loss during liver surgery. Previous studies show that combination of vasopressin and nitroglycerin reduces portal pressure and flow in patients with portal hypertension, and in this study we investigated this combination in patients with normal portal pressure. In all, 13 patients were studied. Measurements were made twice to confirm baseline (C1 and BL), during vasopressin infusion 4.8 U/h (V), and during vasopressin infusion combined with nitroglycerin infusion (V + N). Portal venous pressure (PVP), hepatic venous pressure (HVP), central haemodynamics and arterial and venous blood gases were obtained at each measuring point, and portal (splanchnic) and hepato-splanchnic blood flow changes were calculated. Vasopressin alone did not affect PVP, whereas HVP increased slightly. In combination with nitroglycerin, PVP decreased from 10.1 ± 1.6 to 8.9 ± 1.3 mmHg (P < 0.0001), and HVP decreased from 7.9 ± 1.9 to 6.2 ± 1.3 mmHg (P = 0.001). Vasopressin reduced portal blood flow by 47 ± 19% and hepatic venous flow by 11 ± 18%, respectively. Addition of nitroglycerin further reduced portal- and hepatic flow by 55 ± 13% and 30 ± 13%, respectively. Vasopressin alone had minor effects on central haemodynamics, whereas addition of nitroglycerin reduced cardiac index (3.2 ± 0.7 to 2.7 ± 0.5; P < 0.0001). The arterial-portal vein lactate gradient was unaffected. The combination of vasopressin and nitroglycerin decreases portal pressure and hepato-splanchnic blood flow, and could be a potential treatment to reduce bleeding in liver resection surgery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Prospective evaluation of chronic venous insufficiency based on foot venous pressure measurements and air plethysmography findings.

PubMed

Fukuoka, Masato; Sugimoto, Takaki; Okita, Yutaka

2003-10-01

The purpose of this study was to evaluate lower extremity venous function in patients with chronic venous insufficiency, with foot venous pressure (FVP) measurements and air plethysmography (APG). Eighty-five limbs of 63 patients with a history of chronic venous insufficiency (CVI) from 1995 to 1999 were studied. FVP parameters studied included ambulatory venous pressure (AVP), percent decrease in FVP with manual calf compression (%drop), ratio of increase in FVP over 4 seconds after release of compression (4SR%), and time to 90% recovery of FVP were measured. APG parameters studied included functional venous volume, 90% refilling time (VFT90), venous filling index, ejection fraction, and residual volume fraction. Venous filling index and 90% refilling time were significantly decreased in limbs with stasis syndrome compared with the control group. AVP, %drop, and 4SR% also showed significantly decrease in limbs with stasis syndrome compared with those without it. AVP, %drop, and 4SR% were significantly different for the primary group compared with the secondary group, whereas no differences were found with regard to any APG parameter. APG enables prediction of the presence of CVI, whereas FVP measurements are more useful for evaluation of clinical severity of CVI.

CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography.

PubMed

Kranz, Peter G; Amrhein, Timothy J; Gray, Linda

2017-12-01

The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM). Visibility of the CSF venous fistula on CTM and a modified conventional myelography technique we refer to as dynamic myelography was also compared. Twenty-two cases of CSF venous fistula were identified. The fistulas were located between T4 and L1. Ninety percent occurred without a concurrent epidural CSF leak. In most cases (82%), the CSF venous fistula originated from a nerve root sleeve diverticulum. On CTM, the abnormal veins associated with the CSF venous fistula were seen in a paravertebral location in 45% of cases, centrally within the epidural venous plexus in 32%, and lateral to the spine in 23%. Differences in attenuation between the fistula veins and the control veins was highly statistically significant (p < 0.0001), with a threshold of 70 HU perfectly discriminating fistulas from normal veins in our series. When both CTM and dynamic myelography were performed, the fistula was identified on both modalities in 88% of cases. CSF venous fistulas are an important cause of SIH that can be detected on both CTM and dynamic myelograph y and may occur without an epidural CSF leak. Familiarity with the imaging characteristics of these lesions is critical to providing appropriate treatment to patients with SIH.

Warfarin-induced Venous Limb Gangrene

PubMed Central

Grim Hostetler, Sarah; Sopkovich, Jennifer; Dean, Steven

2012-01-01

Warfarin is a commonly used anticoagulant that has been associated with several significant cutaneous side effects, most notably warfarin-induced skin necrosis. A lesser known adverse reaction to warfarin is warfarin-induced venous limb gangrene. Both cutaneous adverse effects share the same pathophysiology, but are clinically quite different. The majority of cases of warfarin-induced venous limb gangrene has been in patients with cancer or heparin-induced thrombocytopenia. However, other hypercoagulable disease states, such as the antiphospholipid antibody syndrome, can be associated with venous limb gangrene. In order to increase recognition of this important condition, the authors report a case of warfarin-induced venous limb gangrene in a patient with presumed antiphospholipid antibody syndrome and review the literature on warfarin-induced venous limb gangrene. PMID:23198012

The Barriers and Facilitators to Transfer of Ultrasound-Guided Central Venous Line Skills From Simulation to Practice: Exploring Perceptions of Learners and Supervisors.

PubMed

Mema, Briseida; Harris, Ilene

2016-01-01

PHENOMENON: Ultrasound-guided central venous line insertion is currently the standard of care. Randomized controlled trials and systematic reviews show that simulation is superior to apprenticeship training. The purpose of this study is to explore, from the perspectives of participants in a simulation-training program, the factors that help or hinder the transfer of skills from simulation to practice. Purposeful sampling was used to select and study the experience and perspective of novice fellows after they had completed simulation training and then performed ultrasound-guided central venous line in practice. Seven novice pediatric intensive care unit fellows and six supervising faculty in a university-affiliated academic center in a large urban city were recruited between September 2012 and January 2013. We conducted a qualitative study using semistructured interviews as our data source, employing a constructivist, grounded theory methodology. Both curricular and real-life factors influence the transfer of skills from simulation to practice and the overall performance of trainees. Clear instructions, the opportunity to practice to mastery, one-on-one observation with feedback, supervision, and further real-life experiences were perceived as factors that facilitated the transfer of skills. Concern for patient welfare, live trouble shooting, complexity of the intensive care unit environment, and the procedure itself were perceived as real-life factors that hindered the transfer of skills. Insights: As more studies confirm the superiority of simulation training versus apprenticeship training for initial student learning, the faculty should gain insight into factors that facilitate and hinder the transfer of skills from simulation to bedside settings and impact learners' performances. As simulation further augments clinical learning, efforts should be made to modify the curricular and bedside factors that facilitate transfer of skills from simulation to practice

Risk factors for acute adverse events during ultrasound-guided central venous cannulation in the emergency department.

PubMed

Theodoro, Daniel; Krauss, Missy; Kollef, Marin; Evanoff, Bradley

2010-10-01

Ultrasound (US) greatly facilitates cannulation of the internal jugular vein. Despite the ability to visualize the needle and anatomy, adverse events still occur. The authors hypothesized that the technique has limitations among certain patients and clinical scenarios. The purpose of this study was to identify characteristics of adverse events surrounding US-guided central venous cannulation (CVC). The authors assembled a prospective observational cohort of emergency department (ED) patients undergoing consecutive internal jugular CVC with US. The primary outcome of interest was a composite of acute mechanical adverse events including hematoma, arterial cannulation, pneumothorax, and unsuccessful placement. Physicians performing the CVC recorded anatomical site, reason for insertion, and acute complications. The patients with catheters were followed until the catheters were removed based on radiographic evidence or hospital nursing records. ED charts and pharmacy records contributed variables of interest. A self-reported online survey provided physician experience information. Logistic regression was used to calculate the odds of an adverse outcome.   Physicians attempted 289 CVCs on 282 patients. An adverse outcome occurred in 57 attempts (19.7%, 95% confidence interval [CI] = 15.5 to 24.7), the most common being 31 unsuccessful placements (11%, 95% CI = 7.7 to 14.8). Patients with a history of end-stage renal disease (odds ratio [OR] = 3.54, 95% CI = 1.59 to 7.89), and central lines placed by operators with intermediate experience (OR = 2.26, 95% CI = 1.19 to 4.32), were most likely to encounter adverse events. Previously cited predictors such as body mass index (BMI), coagulopathy, and pulmonary hyperinflation were not significant in our final model. Acute adverse events occurred in approximately one-fifth of US-guided internal jugular central line attempts. The study identified both patient (history of end-stage renal disease) and physician (intermediate

Comparative study on fixation of central venous catheter by suture versus adhesive device.

PubMed

Molina-Mazón, C S; Martín-Cerezo, X; Domene-Nieves de la Vega, G; Asensio-Flores, S; Adamuz-Tomás, J

2018-03-27

To assess the efficacy of a central venous catheter adhesive fixation device (CVC) to prevent associated complications. To establish the need for dressing changes, number of days' catheterization and reasons for catheter removal in both study groups. To assess the degree of satisfaction of personnel with the adhesive system. A, randomized, prospective and open pilot study, of parallel groups, with comparative evaluation between CVC fixation with suture and with an adhesive safety system. The study was performed in the Coronary Unit of the Universitari de Bellvitge Hospital, between April and November 2016. The population studied were patients with a CVC. The results were analyzed using SPSS Statistics software. The study was approved by the Clinical Research Ethics Committee. 100 patients (47 adhesive system and 53 suture) were analyzed. Both groups were homogeneous in terms of demographic variables, anticoagulation and days of catheterization. The frequency of complications in the adhesive system group was 21.3%, while in the suture group it was 47.2% (P=.01). The suture group had a higher frequency of local signs of infection (p=.006), catheter displacement (p=.005), and catheter-associated bacteraemia (P=.05). The use of adhesive fixation was associated with a lower requirement for dressing changes due to bleeding (P=.006). Ninety-six point seven percent of the staff recommended using the adhesive safety system. The catheters fixed with adhesive systems had fewer infectious complications and less displacement. Copyright © 2018 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Brachial arteriovenous fistula as a complication of placement of a peripherally inserted central venous catheter: a case report and review of the literature.

PubMed

Tran, Hoang S; Burrows, Brian J; Zang, William A; Han, David C

2006-09-01

Peripherally inserted central venous catheter (PICC) lines have become a frequently used method of intravenous access for long-term administration of antibiotics, chemotherapy, and parenteral nutrition. Catheter-related complications involving the arterial tree are rare. We report a case of a 25-year-old woman with a history of difficult PICC line placement that presented with an arteriovenous fistula in the left arm. Duplex ultrasound confirmed the diagnosis of a brachial artery-to-brachial vein arteriovenous fistula (AVF), and the patient underwent surgical repair. To our knowledge, this is the first reported case of an AVF resulting from PICC line placement. Correction of AVF is indicated to alleviate symptoms as well as to prevent future complications.

Assessment of cerebral venous sinus thrombosis using T2*-weighted gradient echo magnetic resonance imaging sequences

PubMed Central

Bidar, Fatemeh; Faeghi, Fariborz; Ghorbani, Askar

2016-01-01

Background: The purpose of this study is to demonstrate the advantages of gradient echo (GRE) sequences in the detection and characterization of cerebral venous sinus thrombosis compared to conventional magnetic resonance sequences. Methods: A total of 17 patients with cerebral venous thrombosis (CVT) were evaluated using different magnetic resonance imaging (MRI) sequences. The MRI sequences included T1-weighted spin echo (SE) imaging, T*2-weighted turbo SE (TSE), fluid attenuated inversion recovery (FLAIR), T*2-weighted conventional GRE, and diffusion weighted imaging (DWI). MR venography (MRV) images were obtained as the golden standard. Results: Venous sinus thrombosis was best detectable in T*2-weighted conventional GRE sequences in all patients except in one case. Venous thrombosis was undetectable in DWI. T*2-weighted GRE sequences were superior to T*2-weighted TSE, T1-weighted SE, and FLAIR. Enhanced MRV was successful in displaying the location of thrombosis. Conclusion: T*2-weighted conventional GRE sequences are probably the best method for the assessment of cerebral venous sinus thrombosis. The mentioned method is non-invasive; therefore, it can be employed in the clinical evaluation of cerebral venous sinus thrombosis. PMID:27326365

Comparison of Oseltamivir and Oseltamivir Carboxylate Concentrations in Venous Plasma, Venous Blood, and Capillary Blood in Healthy Volunteers

PubMed Central

Instiaty, Insti; Lindegardh, Niklas; Jittmala, Podjanee; Hanpithakpong, Warunee; Blessborn, Daniel; Pukrittayakamee, Sasithon; White, Nicholas J.

2013-01-01

Oseltamivir and oseltamivir carboxylate concentrations were measured in venous plasma, venous blood, and capillary blood taken simultaneously from 24 healthy volunteers. Median (range) venous-blood-to-plasma ratios were 1.42 (0.920 to 1.97) for oseltamivir and 0.673 (0.564 to 0.814) for oseltamivir carboxylate. Capillary blood/venous plasma ratios were 1.32 (0.737 to 3.16) for oseltamivir and 0.685 (0.502 to 1.34) for oseltamivir carboxylate. Oseltamivir concentrations in venous and capillary blood were similar. Oseltamivir carboxylate showed a time-dependent distribution between venous and capillary blood. PMID:23507284

Micrococcus-associated central venous catheter infection in patients with pulmonary arterial hypertension.

PubMed

Oudiz, Ronald J; Widlitz, Allison; Beckmann, X Joy; Camanga, Daisy; Alfie, Jose; Brundage, Bruce H; Barst, Robyn J

2004-07-01

To determine the incidence of catheter-related infection in patients with pulmonary arterial hypertension (PAH) receiving epoprostenol (EPO), and to note an etiologic role for Micrococcus spp, which is rarely reported as a pathogen in the medical literature. Observational study. Two PAH specialty treatment centers, Harbor-UCLA Medical Center (Torrance, CA), and the College of Physicians and Surgeons, Columbia University (New York, NY). A total of 192 patients with PAH receiving continuous therapy with IV EPO. From 1987 to 2000, 192 patients with PAH received infusions of EPO via central venous catheter. Catheter care included regular dressing changes with dry gauze using a sterile procedure, without the use of flushes. Patients were asked to report on known infections and treatments, and symptoms. All infections were verified by a telephone call to the patient, care provider, and microbiology laboratory whenever possible. There were 335,285 catheter days (mean +/- SD, 1,325 +/- 974 catheter days). There were 88 clinical catheter infections with 51 blood culture-positive infections, necessitating catheter removal in 38 instances. The following pathogens were isolated: Staphylococcus aureus (25); Micrococcus spp (14); mixed flora (3); coagulase-negative Staphylococcus spp (2); Corynebacterium spp (2); Serratia marcessens (1); Enterobacter spp (1); Pseudomonas aeruginosa (1); enterococci (1); and unidentified Gram-positive cocci (1). The catheter infection rate was 0.26 per 1,000 catheter days. The use of long-term therapy with continuous EPO appears to be associated with a low incidence of catheter-related infections. Micrococcus spp were the second most common etiologic agent. Caregivers managing patients with PAH must be aware of the risk of catheter infection, as it may contribute to the morbidity and mortality associated with the use of EPO. When isolated, Micrococcus spp should not be viewed as a contaminant, but rather as a true pathogen that may require

A delayed diagnosis of a retained guidewire during central venous catheterisation: a case report and review of the literature

PubMed Central

Gunduz, Yasemin; Vatan, Mehmet Bulent; Osken, Altug; Cakar, Mehmet Akif

2012-01-01

Central venous catheterisation allows delivery of medications, intravenous fluids, parenteral nutrition, haemodialysis and monitoring of haemodynamic variables. Various complications may occur during and after the procedure. However, the complete guidewire retention has rarely been reported. In this report, we have presented a complete guidewire retention as a result of inadvertent catheter insertion. After 17 months of the first operation performed upon the diagnosis of Fournier's gangrene, the patient was admitted to the cardiology polyclinic with a recurrent chest pain. Echocardiography showed a wire-shaped foreign body within the right part of the heart, and a fluoroscopic examination showed a guidewire reaching from the superior vena cava to the right external iliac vein. In retrospect, the wire was already visible on the postoperative chest x-rays and CT taken while the patient was still in intensive care unit, but its presence was overlooked at that time. The guidewire was retrieved completely during a surgery. PMID:23166171

Personalized Learning in Medical Education: Designing a User Interface for a Dynamic Haptic Robotic Trainer for Central Venous Catheterization

PubMed Central

Yovanoff, Mary; Pepley, David; Mirkin, Katelin; Moore, Jason; Han, David; Miller, Scarlett

2017-01-01

While Virtual Reality (VR) has emerged as a viable method for training new medical residents, it has not yet reached all areas of training. One area lacking such development is surgical residency programs where there are large learning curves associated with skill development. In order to address this gap, a Dynamic Haptic Robotic Trainer (DHRT) was developed to help train surgical residents in the placement of ultrasound guided Internal Jugular Central Venous Catheters and to incorporate personalized learning. In order to accomplish this, a 2-part study was conducted to: (1) systematically analyze the feedback given to 18 third year medical students by trained professionals to identify the items necessary for a personalized learning system and (2) develop and experimentally test the usability of the personalized learning interface within the DHRT system. The results can be used to inform the design of VR and personalized learning systems within the medical community. PMID:29123361

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.

Factors Associated with Continuous Low Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide

PubMed Central

Onyeama, Sara-Jane N; Hanson, Sheila J; Dasgupta, Mahua; Hoffmann, Raymond G; Faustino, Edward Vincent S

2016-01-01

Objective To identify patient, hospital and central venous catheter (CVC) factors that may influence the use of low dose heparin infusion (LDHI) for CVC patency in critically ill-children. Design Secondary analysis of an international multicenter observational study. Setting 59 Pediatric Intensive Care Units (PICUs) over four study dates in 2012, involving 7 countries. Patients Children less than 18 years of age with a CVC, admitted to a participating unit and enrolled in the completed PROTRACT study were included. All overflow patients were excluded. Interventions None. Measurements and Main Results Of the 2,484 patients in the PROTRACT study, 1,312 patients had a CVC. 507 of those patients used LDHI. The frequency of LDHI was compared across various patient, hospital and CVC factors using chi-squared, Mann-Whitney and Fisher's exact tests. In the multivariate analysis, age was not a significant factor for LDHI use. Patients with pulmonary hypertension had decreased LDHI use while those with active surgical or trauma diagnoses had increased LDHI use. All central CVC insertion sites were more likely to use LDHI when compared to peripherally inserted CVCs. The Asia-Pacific region showed increased LDHI use, along with community hospitals and smaller ICUs (<10 beds). Conclusion Patient, CVC, and hospital factors are associated with the use of LDHI in critically ill children. Further study is needed to evaluate the efficacy and persistence of LDHI use. PMID:27362853

A content validated questionnaire for assessment of self reported venous blood sampling practices

PubMed Central

2012-01-01

Background Venous blood sampling is a common procedure in health care. It is strictly regulated by national and international guidelines. Deviations from guidelines due to human mistakes can cause patient harm. Validated questionnaires for health care personnel can be used to assess preventable "near misses"--i.e. potential errors and nonconformities during venous blood sampling practices that could transform into adverse events. However, no validated questionnaire that assesses nonconformities in venous blood sampling has previously been presented. The aim was to test a recently developed questionnaire in self reported venous blood sampling practices for validity and reliability. Findings We developed a questionnaire to assess deviations from best practices during venous blood sampling. The questionnaire contained questions about patient identification, test request management, test tube labeling, test tube handling, information search procedures and frequencies of error reporting. For content validity, the questionnaire was confirmed by experts on questionnaires and venous blood sampling. For reliability, test-retest statistics were used on the questionnaire answered twice. The final venous blood sampling questionnaire included 19 questions out of which 9 had in total 34 underlying items. It was found to have content validity. The test-retest analysis demonstrated that the items were generally stable. In total, 82% of the items fulfilled the reliability acceptance criteria. Conclusions The questionnaire could be used for assessment of "near miss" practices that could jeopardize patient safety and gives several benefits instead of assessing rare adverse events only. The higher frequencies of "near miss" practices allows for quantitative analysis of the effect of corrective interventions and to benchmark preanalytical quality not only at the laboratory/hospital level but also at the health care unit/hospital ward. PMID:22260505

Notes From the Field: Direct Observation Versus Rating by Videos for the Assessment of Central Venous Catheterization Skills.

PubMed

Ma, Irene W Y; Zalunardo, Nadia; Brindle, Mary E; Hatala, Rose; McLaughlin, Kevin

2015-09-01

Blinded assessments of technical skills using video-recordings may offer more objective assessments than direct observations. This study seeks to compare these two modalities. Two trained assessors independently assessed 18 central venous catheterization performances by direct observation and video-recorded assessments using two tools. Although sound quality was deemed adequate in all videos, portions of the video for wire handling and drape handling were frequently out of view (n = 13, 72% for wire-handling; n = 17, 94% for drape-handling). There were no differences in summary global rating scores, checklist scores, or pass/fail decisions for either modality (p > 0.05). Inter-rater reliability was acceptable for both modalities. Of the 26 discrepancies identified between direct observation and video-recorded assessments, three discrepancies (12%) were due to inattention during video review, while one (4%) discrepancy was due to inattention during direct observation. In conclusion, although scores did not differ between the two assessment modalities, techniques of video-recording may significantly impact individual items of assessments. © The Author(s) 2014.

Clinical outcomes of totally implantable venous access port placement via the axillary vein in patients with head and neck malignancy.

PubMed

Hong, Sun; Seo, Tae-Seok; Song, Myung Gyu; Seol, Hae-Young; Suh, Sang Il; Ryoo, In-Seon

2018-06-01

To evaluate the clinical outcomes and complications of totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy. A total of 176 totally implantable venous access ports were placed via the axillary vein in 171 patients with head and neck malignancy between May 2012 and June 2015. The patients included 133 men and 38 women, and the mean age was 58.8 years (range: 19-84 years). Medical records were retrospectively reviewed. This study included a total of 93,237 totally implantable venous access port catheter-days (median 478 catheter-days, range: 13-1380 catheter-days). Of the 176 implanted totally implantable venous access port, complications developed in nine cases (5.1%), with the overall incidence of 0.097 events/1000 catheter-days. The complications were three central line-associated blood-stream infection cases, one case of keloid scar at the needling access site, and five cases of central vein stenosis or thrombosis on neck computed tomography images. The 133 cases for which neck computed tomography images were available had a total of 59,777 totally implantable venous access port catheter-days (median 399 catheter-days, range: 38-1207 catheter-days). On neck computed tomography evaluation, the incidence of central vein stenosis or thrombosis was 0.083 events/1000 catheter-days. Thrombosis developed in four cases, yielding an incidence of 0.067 events/1000 catheter-days. All four patients presented with thrombus in the axillary or subclavian vein. Stenosis occurred in one case yielding an incidence of 0.017 events/1000 catheter-days. One case was catheter-related brachiocephalic vein stenosis, and the other case was subclavian vein stenosis due to extrinsic compression by tumor progression. Of the nine complication cases, six underwent port removal. These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and

Need for tissue plasminogen activator for central venous catheter dysfunction is significantly associated with thrombosis in pediatric cancer patients.

PubMed

MacLean, Jessica; MacDonald, Tamara; Digout, Carol; Smith, Nadine; Rigby, Krista; Kulkarni, Ketan

2018-06-01

Central venous catheter (CVC) dysfunction is a common complication among pediatric cancer patients. Tissue plasminogen activator (tPA) is administered to resolve CVC dysfunction. The present study was designed to determine risk factors associated with requirement of tPA for CVC dysfunction and to assess the clinical impact of CVC dysfunction in terms of CVC loss and venous thrombotic events (VTE). Case records of all pediatric patients with cancer from the Maritimes, Canada were reviewed following ethics approval. Data regarding demographics, clinical diagnosis, CVC dysfunction, characteristics of CVCs, and VTE were pooled from multiple data sources. Seven hundred and forty-one patients required ≥1 CVC. 26.3% of patients required tPA for ≥1 episodes of CVC dysfunction. Requirement of one or more doses of tPA for episodes of CVC dysfunction increased the odds of VTE by two times (95% confidence interval, 1.1-3.6). Patients that required ≥1 doses of tPA required significantly more CVCs (2.05 ± 1.29 per individual patient, 55% of the patients needed >1 CVCs) as compared to the remainder (1.52 ± 0.95 per individual patient, 32% needed >1 CVCs) (P = 0.0001). Multivariate analysis revealed age > 10 years, diagnosis of sarcoma, and tunneled line were independently associated with tPA requirement. We determined independent risk factors associated with requirement of tPA for CVC dysfunction. Requirement of tPA for CVC dysfunction was associated with significantly increased risk of VTE and requirement of more CVCs. These observations can assist in identification of patients at increased risk of CVC dysfunction and inform approaches to reduce CVC loss and VTE. © 2018 Wiley Periodicals, Inc.

Reduction in central venous pressure enhances erythropoietin synthesis: role of volume-regulating hormones.

PubMed

Montero, D; Rauber, S; Goetze, J P; Lundby, C

2016-10-01

Erythropoiesis is a tightly controlled biological event, but its regulation under non-hypoxic conditions, however, remains unresolved. We examined whether acute changes in central venous blood pressure (CVP) elicited by whole-body tilting affect erythropoietin (EPO) concentration according to volume-regulating hormones. Plasma EPO, angiotensin II (ANGII), aldosterone, pro-atrial natriuretic peptide (proANP) and copeptin concentrations were measured at supine rest and up to 3 h during 30° head-up (HUT) and head-down tilt (HDT) in ten healthy male volunteers. Plasma albumin concentration was used to correct for changes in plasma volume and CVP was estimated through the internal jugular vein (IJV) aspect ratio with ultrasonography. From supine rest, the IJV aspect ratio was decreased and increased throughout HUT and HDT respectively. Plasma EPO concentration increased during HUT (13%; P = 0.001, P for linear component = 0.017), independent of changes in albumin concentration. Moreover, ANGII and copeptin concentrations increased during HUT, while proANP decreased. The increase in EPO concentration during HUT disappeared when adjusted for changes in copeptin. During HDT, EPO, ANGII and copeptin concentrations remained unaffected while proANP increased. In regression analyses, EPO was positively associated with copeptin (β = 0.55; 95% CI = 0.18, 0.93; P = 0.004) irrespective of changes in other hormones and albumin concentration. Reduction in CVP prompts an increase in plasma EPO concentration independent of hemoconcentration and hence suggests CVP per se as an acute regulator of EPO synthesis. This effect may be explained by changes in volume-regulating hormones. © 2016 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

Enhanced Venous Thrombus Resolution in Plasminogen Activator Inhibitor Type-2 Deficient Mice

PubMed Central

Siefert, Suzanne A; Chabasse, Christine; Mukhopadhyay, Subhradip; Hoofnagle, Mark H; Strickland, Dudley K; Sarkar, Rajabrata; Antalis, Toni M

2014-01-01

Background The resolution of deep vein thrombosis (DVT) requires an inflammatory response and mobilization of proteases, such as urokinase-type plasminogen activator (uPA) and matrix metalloproteinases (MMPs), to degrade the thrombus and remodel the injured vein wall. PAI-2 is a serine protease inhibitor (serpin) with unique immunosuppressive and cell survival properties that was originally identified as an inhibitor of uPA. Objective To investigate the role of PAI-2 in venous thrombus formation and resolution. Methods Venous thrombus resolution was compared in wild type C57BL/6, PAI-2 -/- and PAI-1 -/- mice using the stasis model of DVT. Formed thrombi were harvested, thrombus weights were recorded, and tissue was analyzed for uPA, and MMP activities, PAI-1 expression, and the nature of inflammatory cell infiltration. Results We found that absence of PAI-2 enhanced venous thrombus resolution, while thrombus formation was unaffected. Enhanced venous thrombus resolution in PAI-2 -/- mice was associated with increased uPA activity and reduced levels of PAI-1, with no significant effect on MMP-2 and -9 activities. PAI-1 deficiency resulted in an increase in thrombus resolution similar to PAI-2 deficiency, but additionally reduced venous thrombus formation and altered MMP activity. PAI-2 deficient thrombi had increased levels of the neutrophil chemoattractant, CXCL2, which was associated with early enhanced neutrophil recruitment. Conclusions These data identify PAI-2 as a novel regulator of venous thrombus resolution, which modulates several pathways involving both inflammatory and uPA activity mechanisms, distinct from PAI-1. Further examination of these pathways may lead to potential therapeutic prospects in accelerating thrombus resolution. PMID:25041188

[Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol].

PubMed

Ferrete-Morales, C; Vázquez-Pérez, M A; Sánchez-Berna, M; Gilabert-Cerro, I; Corzo-Delgado, J E; Pineda-Vergara, J A; Vergara-López, S; Gómez-Mateos, J

2010-01-01

To assess the impact on the incidence of PPIVC by implementing a catheter management protocol and to determine risk factors for PPIVC development in hospitalized patients. A total of 3978 episodes of venous catheterization were prospectively included from September 2002 to December 2007. A catheter management protocol was implemented during this period of time. The incidence and variables associated to the occurrence of PPIVC were determined. The incidence of PPIVC from 2002 to 2007 was 4.8%, 4.3%, 3.6%, 2.5%, 1.3% and 1.8% (p<0.001). Perfusion of amiodarone [adjusted OR (AOR) 25.97; 95% CI=7.29-92.55, p=0.0001] and cefotaxime (AOR 2.90; 95% CI=1.29-6.52, p=0.01) and the shift when the catheters were placed (AOR for morning vs. night shift 0.60; 95% CI=0.35-1.02, p=0.063) were independently associated to the development of PPIVC. A history of phlebitis was the only factor independently associated to phlebitis due to peripherally inserted central venous catheters (AOR 3.24; CI at 95% CI= 1.05-9.98, p=0.04). A catheter management protocol decreases the incidence of PPIVC in hospitalized patients. The risk of PPIVC increases for peripherally inserted central venous catheters when the patients have a history of phlebitis and for peripheral venous catheters when amiodarone or cefotaxime are infused. Catheterization of peripheral veins performed during morning shifts is associated with a lower incidence of PPIVC when compared with night shift catheterizations.

Role of Color Flow Ultrasound in Detection of Deep Venous Thrombosis

ERIC Educational Resources Information Center

Mohammed, Shelan Hakeem; AL-Najjar, Salwa A.

2016-01-01

Background: Deep vein thrombosis (DVT) of lower limbs is one of the most causes for the majority of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and squeal of…

Agreement of arterial sodium and arterial potassium levels with venous sodium and venous potassium in patients admitted to intensive care unit.

PubMed

Nanda, Sunil Kumar; Ray, Lopamudra; Dinakaran, Asha

2015-02-01

Electrolyte abnormalities are one of the common causes of morbidity and mortality in critically ill patients. The turnaround time for electrolyte reporting should be as low as possible. Electrolytes are measured conventionally in serum obtained from venous blood by electrolyte analyser which takes 20 to 30 min. Point of care analysers are now available where in electrolytes can be measured in arterial blood within 5 min. This study was done to study the agreement of arterial sodium and arterial potassium with venous sodium and venous potassium levels. Venous sodium and venous potassium levels and arterial sodium and arterial potassium levels were analysed on 206 patient samples admitted to Intensive Care Unit (ICU). The venous values were compared with the arterial values for correlation. Venous sodium was compared with arterial sodium by spearman correlation. Venous potassium was compared with arterial potassium by pearson correlation. The mean value of arterial sodium was 134 and venous sodium was 137. The mean value of arterial potassium was 3.6 and venous potassium was 4.1. The correlation coefficient obtained for sodium was 0.787 and correlation coefficient obtained for potassium was 0.701. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters. Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.

Central Vein Dilatation Prior to Concomitant Port Implantation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krombach, Gabriele A., E-mail: krombach@rad.rwth-aachen.de; Plumhans, Cedric; Goerg, Fabian

2010-04-15

Implantation of subcutaneous port systems is routinely performed in patients requiring repeated long-term infusion therapy. Ultrasound- and fluoroscopy-guided implantation under local anesthesia is broadly established in interventional radiology and has decreased the rate of complications compared to the surgical approach. In addition, interventional radiology offers the unique possibility of simultaneous management of venous occlusion. We present a technique for recanalization of central venous occlusion and angioplasty combined with port placement in a single intervention which we performed in two patients. Surgical port placement was impossible owing to occlusion of the superior vena cava following placement of a cardiac pacemaker andmore » occlusion of multiple central veins due to paraneoplastic coagulopathy, respectively. In both cases the affected vessel segments were dilated with balloon catheters and the port systems were placed thereafter. After successful dilatation, the venous access was secured with a 25-cm-long, 8-Fr introducer sheath, a subcutaneous pocket prepared, and the port catheter tunneled to the venipuncture site. The port catheter was introduced through the sheath with the proximal end connected to a 5-Fr catheter. This catheter was pulled through the tunnel in order to preserve the tunnel and, at the same time, allow safe removal of the long sheath over the wire. The port system functioned well in both cases. The combination of recanalization and port placement in a single intervention is a straightforward alternative for patients with central venous occlusion that can only be offered by interventional radiology.« less

Combined oral contraceptives: venous thrombosis.

PubMed

de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

2014-03-03

Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. We selected studies including healthy women taking COC with VT as outcome. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene

Value of the portal venous phase in evaluation of treated hepatocellular carcinoma following transcatheter arterial chemoembolisation.

PubMed

Lam, A; Fernando, D; Sirlin, C C; Nayyar, M; Goodwin, S C; Imagawa, D K; Lall, C

2017-11-01

To evaluate the utility of the portal venous phase on multiphasic computed tomography (CT) after treatment of hepatocellular carcinoma (HCC) with trans-arterial chemoembolisation (TACE). This was a retrospective review of patients who underwent TACE for HCC between 1 April 2012 and 21 December 2014, with appropriate multiphasic, pre- and post-procedural CT examinations. The maximum non-contrast, arterial phase, and portal venous phase attenuation values of the tumour and tumour bed were evaluated within a region of interest (ROI), with values adjusted against background hepatic parenchyma. Linear regression analyses were performed for both the arterial and venous phases, to assess the level of enhancement and to determine if the venous phase had additional value in this setting. A total of 86 cases from 51 patients were reviewed. All pre-procedural CT examinations of lesions demonstrated arterial phase enhancement with portal venous and delayed phase washout compatible with HCC. The post-procedural CT examinations following TACE revealed expected decreased arterial enhancement. Sixty-five cases (76%) showed persistent non-enhancement on the portal venous phase following embolisation therapy. A total of 21 cases (24%), however, demonstrated progressive portal venous hyper enhancement. Linear regression analysis demonstrated a statistical significance between the difference in maximal arterial and portal venous enhancement in these cases. Following TACE, the treated lesion may demonstrate portal venous phase hyper-enhancement within the tumour bed. As such, full attention should be given to these images for comprehensive evaluation of tumour response following treatment. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Tendon vibration attenuates superficial venous vessel response of the resting limb during static arm exercise.

PubMed

Ooue, Anna; Sato, Kohei; Hirasawa, Ai; Sadamoto, Tomoko

2012-11-07

The superficial vein of the resting limb constricts sympathetically during exercise. Central command is the one of the neural mechanisms that controls the cardiovascular response to exercise. However, it is not clear whether central command contributes to venous vessel response during exercise. Tendon vibration during static elbow flexion causes primary muscle spindle afferents, such that a lower central command is required to achieve a given force without altering muscle force. The purpose of this study was therefore to investigate whether a reduction in central command during static exercise with tendon vibration influences the superficial venous vessel response in the resting limb. Eleven subjects performed static elbow flexion at 35% of maximal voluntary contraction with (EX + VIB) and without (EX) vibration of the biceps brachii tendon. The heart rate, mean arterial pressure, and rating of perceived exertion (RPE) in overall and exercising muscle were measured. The cross-sectional area (CSAvein) and blood velocity of the basilic vein in the resting upper arm were assessed by ultrasound, and blood flow (BFvein) was calculated using both variables. Muscle tension during exercise was similar between EX and EX + VIB. However, RPEs at EX + VIB were lower than those at EX (P <0.05). Increases in heart rate and mean arterial pressure during exercise at EX + VIB were also lower than those at EX (P <0.05). CSAvein in the resting limb at EX decreased during exercise from baseline (P <0.05), but CSAvein at EX + VIB did not change during exercise. CSAvein during exercise at EX was smaller than that at EX + VIB (P <0.05). However, BFvein did not change during the protocol under either condition. The decreases in circulatory response and RPEs during EX + VIB, despite identical muscle tension, showed that activation of central command was less during EX + VIB than during EX. Abolishment of the decrease in CSAvein during exercise at EX + VIB may thus have been caused by a

Venous pump of the calf: a study of venous and muscular pressures.

PubMed

Alimi, Y S; Barthelemy, P; Juhan, C

1994-11-01

Little data are available concerning the relation between the muscular pumping mechanism and the variation of superficial and deep venous pressure during normal action of the calf pump; therefore we undertook this study to determine the pressure values in three compartments of the calf and in the deep and the superficial venous system and to establish correlation between muscular and venous pressure. Nine healthy young women with a mean age of 23 years (range 19 to 28 years) were examined. In the same calf, a muscular catheter was placed in the deep posterior compartment (DPC), in the superficial posterior compartment (SPC), and in the anterior tibial compartment (ATC), and a vascular catheter was placed in the popliteal vein and in the greater saphenous vein (GSV). The five lines of pressure were simultaneously recorded in the following situations: at rest, during Valsalva maneuver, foot flexion, and foot extension. The situation was studied with the patient in the following positions: decubitus, sitting, standing, and squatting. A final continuous recording was carried out after the patient had been walking for 5 minutes. Mean values with standard errors of muscular and venous pressure were established in each situation. At rest and during Valsalva maneuver, the muscular pressures did not vary, whereas venous pressures increased significantly when the patient was sitting and standing. On the other hand, squatting was associated with a rise in the muscular and vein pressures. Foot flexion entailed a significant increase in the ATC pressure and a rise in the GSV pressure, whereas foot extension caused the DPC pressure to rise without venous pressure modifications. Walking was associated with an alternating increase in the DPC, SPC, GSV and popliteal vein pressures when the foot was compressed to floor followed by a significant decrease when the foot pressure was released. The variations in the deep and superficial venous pressures when the patient is sitting and

Thrombophilia in children with venous thromboembolic disease.

PubMed

Revel-Vilk, Shoshana; Kenet, Gili

2006-01-01

Venous thromboembolic events (VTEs) in children are usually associated with underlying clinical conditions such as central venous line, cancer and cardiac diseases. The objective of this review is to present the importance of thrombophilia to the occurrence of childhood VTE. The reported prevalence of thrombophilia in children with VTE varies extremely between 10% and 78% in different registries. The variation in the reported prevalence most probably reflects differences in the clinical characteristics of the children studied and differences in study designs. The initial management of children with thrombophilia and VTE is similar to those individuals who do not have a specific inherited thrombophilic risk factor, except in the rare events of homozygous deficiencies of prothrombotic coagulation proteins. The impact of thrombophilic markers on long-term therapy and outcome of children with VTE has not been completely clarified. According to the current guidelines for thrombophilia, all children with VTE should be tested for a full panel of genetic and acquired prothrombotic traits. However, re-evaluation of co-morbid risk factors other than thrombophilic markers and careful consideration of the prognostic value of thrombophilic markers might help to change future attitude from the rigidity of current guidelines to more rational schemes.

Venous ulcer review

PubMed Central

Bevis, Paul; Earnshaw, Jonothan

2011-01-01

Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

Increased rate of venous thrombosis may be associated with inpatient dihydroergotamine treatment.

PubMed

Tso, Amy R; Patniyot, Irene R; Gelfand, Amy A; Goadsby, Peter J

2017-07-18

To review whether the incidence of catheter-associated venous thromboses was higher in patients receiving IV dihydroergotamine compared to lidocaine. We retrospectively reviewed all admissions at the University of California, San Francisco Headache Center from February 25, 2008, through October 31, 2014, for age, sex, diagnosis, aura, treatment dose, type of IV line used, days with line, superficial (SVT) or deep venous thrombosis (DVT), and pulmonary embolism (PE). A peripherally inserted central catheter (PICC) or midline catheter was placed in 315 of 589 (53%) admissions. Mean age was 38 years with a range of 6 to 79 years; 121 patients (21%) were ≤18 years old. Seventy-four percent (433 of 589) of patients were female. Of 263 dihydroergotamine admissions using a PICC or midline catheter, 19 (7.2%) had either an SVT or DVT or a PE; 2 patients were diagnosed with both DVT and PE. Of 52 lidocaine admissions using a PICC or midline catheter, none had a thrombotic event ( p = 0.05, Fisher exact test). Age, sex, aura, total dihydroergotamine dose, and number of days with line were not significant predictors of venous thrombosis. IV dihydroergotamine treatment may be associated with an increased risk of catheter-associated venous thrombosis. A low threshold for diagnostic ultrasound investigation is appropriate because anticoagulation therapy was frequently required. © 2017 American Academy of Neurology.

The effect of vein repair on the risk of venous thromboembolic events: a review of more than 100 traumatic military venous injuries.

PubMed

Quan, Reagan W; Gillespie, David L; Stuart, Rory P; Chang, Audrey S; Whittaker, David R; Fox, Charles J

2008-03-01

The management of venous trauma remains controversial. Critics of venous repair have cited an increased incidence of associated venous thromboembolic events with this management. We analyzed the current treatment of wartime venous injuries in United States military personnel in an effort to answer this question. From December 1, 2001, to October 31, 2005, all United States casualties with named venous injuries were evaluated. A retrospective review of a clinical database was performed on demographics, mechanism of injury, associated injuries, treatment, outcomes, and venous thromboembolic events. Data were analyzed using the Fisher exact test, analysis of variance, and logarithmic transformation. During this 5-year period, 82 patients sustained 103 named venous injuries due to combat operations. All patients were male, with an average age of 27.9 years (range, 20.3-58.3 years). Blast injuries accounted for 54 venous injuries (65.9%), gunshot wounds for 25 (30.5%), and motor vehicle accidents for 3 (3.6%). The venous injury was isolated in 28 patients (34.1%), and 16 (19.5%) had multiple venous injuries. The venous injury in two patients was associated with acute phlegmasia, with fractures in 33 (40.2%), and 22 (28.1%) sustained neurologic deficits. Venous injuries were treated by ligation in 65 patients (63.1%) and by open surgical repair in 38 (36.9%). Postoperative extremity edema occurred in all patients irrespective of method of management. Thrombosis after venous repair occurred in six of the 38 cases (15.8%). Pulmonary emboli developed in three patients, one after open repair and two after ligation (P > .99). In the largest review of military venous trauma in more than three decades, we found no difference in the incidence of venous thromboembolic complications between venous injuries managed by open repair vs ligation. Blast injuries of the extremities have caused most of the venous injuries. Ligation is the most common modality of treatment in combat zones

Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres' formula or a radiological landmark-based approach: a prospective randomized single-centre study.

PubMed

Ahn, J H; Kim, I S; Yang, J H; Lee, I G; Seo, D H; Kim, S P

2017-02-01

The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography. Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (n=93) or the R group (n=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA-SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view. The distance from the skin insertion point to the RA-SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; r=0.821, P<0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; r=0.517, P<0.001], with z=3.96 (P<0.001). More tips were correctly positioned in the R group than in the P group (74 vs 93%, P=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable. Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula. Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp KCT0001937. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Project work: formation of health-care personnel for self-care of tunnelled central venous catheters in hemodialysis patients of the territory].

PubMed

Morale, Walter; Patanè, D; Incardona, C; Seminara, G; Malfa, P; L'Anfusa, G; Calcara, G; Bisceglie, P; Puliatti, D; Di Landro, D

2013-01-01

Scientific data from current literature demonstrate an incidence of bacteraemia due to tunnelled central venous catheter (tCVC) use accounting for 1.6 / 1000 days per tCVC, with a range of 1.5 to 1.8. In Sicily no data on the incidence of tCVC- related bacteraemia are available. In our hospital, tCVC infection occurs 2.4 times in 1000 days during CVC use. A retrospective analysis carried out from 2006 to 2012 was performed on 650 patients with tunnelled catheters. Of the subjects who received tCVC in our hospital, 90% were destined to undergo haemodialysis in a private health care environment outside our hospital. In order to improve the aforementioned infection outcome, we planned and implemented a specific work project. The work project (WP) was subdivided into two steps: 1) The first step was further subdivided into two sub-phases. The first was principally concerned with the implementation of educational courses, conducted directly on the ward and aimed at the implementation of meticulous nursing regimes for the care of tCVC by our health care nurse. The courses were entitled Management of Vascular Access: from doing - to teaching to do!. These educational courses were organized by the Nephrology Department, which takes care of the management and handling of the major complications of tCVCs for the maintenance of haemodialysis. After this first step, the nurses who had participated became the promoters of the second part of the course, which concerned the development of know-how within an outpatient clinic, which deals exclusively with the nursing management of tCVCs. 2) The title of the second phase was Therapeutic Education: self-Care and understanding and managing your venous access at home. The aim of this step was the integration of correct in-hospital care with that available in outsourced private institutions, via the involvement of the patient in the management of their own central venous access. During our training project, a more detailed analysis of

Estimating duration of central venous catheter at time of insertion: Clinician judgment and clinical predictors.

PubMed

Holmberg, Mathias J; Andersen, Lars W; Graver, Amanda; Wright, Sharon B; Yassa, David; Howell, Michael D; Donnino, Michael W; Cocchi, Michael N

2015-12-01

The aim of this study was to investigate whether clinicians can estimate the length of time a central venous catheter (CVC) will remain in place and to identify variables that may predict CVC duration. We conducted a prospective study of patients admitted to the intensive care unit over a 1-year period. Clinicians estimated the anticipated CVC duration at time of insertion. We collected demographics, medical history, type of intensive care unit, anatomical site of CVC placement, vital signs, laboratory values, Sequential Organ Failure Assessment score, mechanical ventilation, and use of vasopressors. Pearson correlation coefficient was used to assess the correlation between estimated and actual CVC time. We performed multivariable logistic regression to identify predictors of long duration (>5 days). We enrolled 200 patients; median age was 65 years (quartiles 52, 75); 91 (46%) were female; and mortality was 24%. Correlation between estimated and actual CVC time was low (r=0.26; r2=0.07; P<.001). Mechanical ventilation (odds ratio, 2.20; 95% confidence interval, 1.22-3.97; P=.009) at time of insertion and a medical history of cancer (odds ratio, 0.35; 95% confidence interval, 0.16-0.75; P=.007) were significantly associated with long duration. Our results suggest a low correlation between clinician prediction and actual CVC duration. We did not find any strong predictors of long CVC duration identifiable at the time of insertion. Copyright © 2015 Elsevier Inc. All rights reserved.

A survey of the European Venous Forum on education and training in venous surgery and phlebology in Europe.

PubMed

Spanos, K; De Maeseneer, M; Nicolaides, A; Giannoukas, A D

2015-04-01

Venous training in Europe is lacking a formal curriculum among various specialties related to management of venous diseases. We conducted a survey in order to have a snapshot on the actual education and training level among physicians practicing currently venous surgery and phlebology in Europe. From April 7, 2014 to June 11, 2014 a survey was carried out using the Survey Monkey system, including 11 main questions covering all the domains of training and education in venous surgery and phlebology. The questionnaire was sent to all physicians included in the current mailing list of the European Venous Forum (EVF) and the Mediterranean League of Angiology and Vascular Surgery. Two questions were particularly addressed to those physicians who had attended the EVF hands-on workshop (HOW) at least once. The response rate was 24% (97/400) and 51.5% of them were practicing in a hospital service. Most responders were vascular surgeons (67.7%), followed by angiologists (19.4%). Only half of the responders felt as being competent to manage the whole spectrum of venous diseases successfully after completion of their training, while a few were able to perform endovenous ablations and even less more advanced venous interventions. Formal training in Duplex ultrasound was undertaken only in 55.2%. The majority suggested that a venous training program should be a separate part of their specialty rotation and should be organized at a national or European level, or even by a specific scientific society. Over 95% of those physicians who already participated in the EVF HOW considered the knowledge they acquired there as useful for their practice. There is currently an important need for more specialized venous training for all physicians involved in the diagnosis and management of venous diseases. Therefore all local, national and international initiatives should be encouraged to improve education in this field.

Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis

PubMed Central

Bird, Steven T.; Hartzema, Abraham G.; Brophy, James M.; Etminan, Mahyar; Delaney, Joseph A.C.

2013-01-01

Background: There is an increased risk of venous thromboembolism among women taking oral contraceptives. However, whether there is an additional risk among women with polycystic ovary syndrome (PCOS) is unknown. Methods: We developed a population-based cohort from the IMS LifeLink Health Plan Claims Database, which includes managed care organizations in the United States. Women aged 18–46 years taking combined oral contraceptives and who had a claim for PCOS (n = 43 506) were matched, based on a propensity score, to control women (n = 43 506) taking oral contraceptives. Venous thromboembolism was defined using administrative coding and use of anticoagulation. We used Cox proportional hazards models to assess the relative risk (RR) of venous thromboembolism among users of combined oral contraceptives with and without PCOS. Results: The incidence of venous thromboembolism among women with PCOS was 23.7/10 000 person-years, while that for matched controls was 10.9/10 000 person-years. Women with PCOS taking combined oral contraceptives had an RR for venous thromboembolism of 2.14 (95% confidence interval [CI] 1.41–3.24) compared with other contraceptive users. The incidence of venous thromboembolism was 6.3/10 000 person-years among women with PCOS not taking oral contraceptives; the incidence was 4.1/10 000 person-years among matched controls. The RR of venous thromboembolism among women with PCOS not taking oral contraceptives was 1.55 (95% CI 1.10–2.19). Interpretation: We found a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives. Physicians should consider the increased risk of venous thromboembolism when prescribing contraceptive therapy to women with PCOS. PMID:23209115

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

PubMed Central

Yi, Jian-hua; Liu, Hua-bo; Zhang, Mao; Wu, Jun-song; Yang, Jian-xin; Chen, Jin-ming; Xu, Shan-xiang; Wang, Jian-an

2012-01-01

Objective: To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter (CVC), compared with using a conventional chest tube. Methods: A prospective controlled study with the Ethics Committee approval was undertaken. A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs (n=214) or conventional chest tubes (n=193). The Seldinger technique was used for drainage by CVC, and the conventional technique for drainage by chest tube. If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days, the treatment was considered successful. The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0. A P value of less than 0.05 was taken as indicating statistical significance. Results: Compared with the chest tube group, the operation time, fraction of analgesic treatment, time of surgical wound healing, and infection rate of surgical wounds were significantly decreased (P<0.05) in the CVC group. There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications (P>0.05), or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully (P>0.05). Conclusions: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube. PMID:22205619

Complications of intra-cardial placement of silastic central venous catheter in pediatric patients.

PubMed

Soong, W J; Jeng, M J; Hwang, B

1996-01-01

A three-year prospective study was undertaken to determine the incidence and early complications from intra-cardiac placement of percutaneous central venous catheter (CVC). CVC was inserted by using "Catheter-through-needle" technique, and the insertion length was measured by body surface landmark. CVC course and tip location were routinely checked by roentgenography. Echocardiography was performed in case of arrhythmia. After analysis of 784 CVCs, 104 (13.3%) were proved to be intra-cardial, as located by either roentgenography or echocardiography. However, catheters passed via the upper trunk (14.5%) were significantly (p < 0.05) more intra-cardially located than those via the lower trunk (4.8%). Catheters which passed via the right upper trunk veins (basilic, cephalic, or external jugular veins) were also more intra-cardially located than those via their left veins counterparts, but the finding was not statistically significant (p > 0.05). The mean body weight (3.1 +/- 2.4 kg) in the intra-cardial placement group was significantly (p < 0.05) less than that in the non-intracardial placement group (7.9 +/- 4.5 kg). In intra-cardial placement patients, 32 cases (30.8%) had episode(s) of cardiac arrhythmia including 31 premature ventricular depolarization and 1 supra-ventricular tachycardia. All cases showed the presence of intra-ventricular catheter. All arrhythmias ceased abruptly after the catheters were pulled from the hearts. No other early complications were observed. the incidence of the intracardiac placement of CVC is high, especially in small infants or when the insertion via the upper trunk. Short term intra-cardiac catheter placement has a benign clinical course except that the intraventricular catheter may cause arrhythmia. However, this kind of arrhythmia can be resolved spontaneously by withdrawing the catheter.

Management of Central Venous Access Device-Associated Skin Impairment: An Evidence-Based Algorithm.

PubMed

Broadhurst, Daphne; Moureau, Nancy; Ullman, Amanda J

Patients relying on central venous access devices (CVADs) for treatment are frequently complex. Many have multiple comorbid conditions, including renal impairment, nutritional deficiencies, hematologic disorders, or cancer. These conditions can impair the skin surrounding the CVAD insertion site, resulting in an increased likelihood of skin damage when standard CVAD management practices are employed. Supported by the World Congress of Vascular Access (WoCoVA), developed an evidence- and consensus-based algorithm to improve CVAD-associated skin impairment (CASI) identification and diagnosis, guide clinical decision-making, and improve clinician confidence in managing CASI. A scoping review of relevant literature surrounding CASI management was undertaken March 2014, and results were distributed to an international advisory panel. A CASI algorithm was developed by an international advisory panel of clinicians with expertise in wounds, vascular access, pediatrics, geriatric care, home care, intensive care, infection control and acute care, using a 2-phase, modified Delphi technique. The algorithm focuses on identification and treatment of skin injury, exit site infection, noninfectious exudate, and skin irritation/contact dermatitis. It comprised 3 domains: assessment, skin protection, and patient comfort. External validation of the algorithm was achieved by prospective pre- and posttest design, using clinical scenarios and self-reported clinician confidence (Likert scale), and incorporating algorithm feasibility and face validity endpoints. The CASI algorithm was found to significantly increase participants' confidence in the assessment and management of skin injury (P = .002), skin irritation/contact dermatitis (P = .001), and noninfectious exudate (P < .01). A majority of participants reported the algorithm as easy to understand (24/25; 96%), containing all necessary information (24/25; 96%). Twenty-four of 25 (96%) stated that they would recommend the tool to

Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Akahane, Akio, E-mail: a.akahane@gmail.com; Sone, Miyuki; Ehara, Shigeru

2011-12-15

Purpose: This study was designed to compare central venous ports (CVP) from two different routes of venous access-the subclavian vein and arm vein-in terms of safety for patients with head and neck cancer (HNC). Methods: Patients with HNC who underwent image-guided implantations of CVPs were retrospectively evaluated. All CVPs were implanted under local anesthesia. Primary outcome measurements were rates and types of adverse events (AEs). Secondary outcomes included technical success and rate and reason of CVP removal. Results: A total of 162 patients (subclavian port group, 47; arm port group, 115) were included in this study. Technical success was achievedmore » in all patients. The median follow-up period was 94 (range, 1-891) days. Two patients in the subclavian port group experienced periprocedural complications. Postprocedural AEs were observed in 8.5 and 22.6% of the subclavian port and arm port group patients, respectively (P = 0.044). Phlebitis and system occlusions were observed only in the arm port group. The rate of infection was not significantly different between the two groups. The CVP was removed in 34 and 39.1% of the subclavian port and arm port patients, respectively. Conclusions: Both subclavian and arm CVPs are feasible in patients with HNC. AEs were more frequent in the arm port group; thus, the arm port is not recommended as the first choice for patients with HNC. However, further experience is needed to improve the placement technique and the maintenance of CVPs and a prospective analysis is warranted.« less

A crossover randomized prospective pilot study evaluating a central venous catheter team in reducing catheter-related bloodstream infections in pediatric oncology patients.

PubMed

Secola, Rita; Azen, Colleen; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Sposto, Richard; Doering, Lynn

2012-01-01

Treatment for most children with cancer includes the use of a central venous catheter (CVC). CVCs provide reliable venous access for delivery of chemotherapy and supportive care. This advantage is mitigated by an increased risk of bloodstream infections (BSIs). Despite the ubiquitous use of CVCs, few prospective studies have been conducted to address infection prevention strategies in pediatric oncology patients. Prospective, crossover pilot study of a CVC team intervention versus standard care. Two inpatient oncology units in a metropolitan children's hospital. A total of 41 patients/135 admissions for the experimental unit (EU) and 41/129 admissions for the control unit (CU). Patients received a CVC blood draw bundle procedure by a CVC registered nurse (RN) team member (experimental intervention: EU) for 6 months and by the assigned bedside RN (standard care: CU) for 6 months. Feasibility of implementing a CVC RN team; a significant difference in CVC-related BSIs between the team intervention versus standard care and risk factors associated in the development of CVC-related BSIs were determined. There were 7 CVC-related BSIs/1238 catheter days in the EU group (5.7/1000 catheter days) versus 3 CVC-related BSIs/1419 catheter days in the CU group (2.1/1000 catheter days; P = .97). Selected risk factors were not significantly associated with the development of a CVC-related BSI. A CVC team in the care of pediatric oncology patients is feasible; however, a larger cohort will be required to adequately determine the effectiveness of the team reducing CVC-related BSIs.

Deep Venous Thrombosis: An Interventionalist's Approach

PubMed Central

Jenkins, J. Stephen; Michael, Paul

2014-01-01

Background Deep venous thrombosis (DVT) of the lower extremity has traditionally been anatomically categorized into proximal DVT (thrombosis involving the popliteal vein and above) and distal DVT (isolated calf vein thrombosis). Proximal DVT involving the common femoral and/or iliac veins, referred to as iliofemoral DVT (IFDVT), represents a disease process with a worse prognosis and higher risk for poor clinical outcomes compared to proximal DVT not involving the common femoral or iliac draining veins. Methods This review discusses therapeutic options for treatment of lower extremity IFDVT, including adjuvant anticoagulation and catheter-based invasive therapies; literature supporting current acute interventional techniques; and the recommendations from the recently published American Heart Association guidelines. Results Patients with IFDVT represent an opportune subset of patients for acute interventional management with currently available techniques. This subset of patients with proximal DVT has a worse prognosis, is less well studied, and benefits more from acute intervention compared to patients with proximal DVT or distal DVT. Conclusion Invasive catheter-based therapies that remove thrombus and correct venous outflow obstructions improve outcomes and morbidity in patients with IFDVT. Future trials that address IFDVT specifically will improve our understanding and the proper management of this higher-risk subset of patients with DVT. PMID:25598728

Clinical features of venous insufficiency and the risk of venous thrombosis in older people.

PubMed

Engbers, Marissa J; Karasu, Alev; Blom, Jeanet W; Cushman, Mary; Rosendaal, Frits R; van Hylckama Vlieg, Astrid

2015-11-01

Venous thrombosis is common in older age, with an incidence of 0·5-1% per year in those aged >70 years. Stasis of blood flow is an important contributor to the development of thrombosis and may be due to venous insufficiency in the legs. The risk of thrombosis associated with clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, obtained with a standardized interview was assessed in the Age and Thrombosis Acquired and Genetic risk factors in the Elderly (AT-AGE) study. The AT-AGE study is a case-control study in individuals aged 70 years and older (401 cases with a first-time venous thrombosis and 431 control subjects). We calculated odds ratios (ORs) and corresponding 95% confidence intervals (CI) adjusted for age, sex and study centre. Varicose veins and leg ulcer were associated with a 1·6-fold (95% CI 1·2-2·3) and 3·3-fold increased risk of thrombosis (95% CI 1·6-6·7), respectively, while the risk was increased 3·0-fold (95% CI 2·1-4·5) in the presence of leg oedema. The risk of thrombosis was highest when all three risk factors occurred simultaneously (OR: 10·5; 95% CI 1·3-86·1). In conclusion, clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, are risk factors for venous thrombosis in older people. © 2015 John Wiley & Sons Ltd.

Comparison of delayed complications of central venous catheters placed surgically or radiologically in pediatric oncology patients.

PubMed

Basford, Tavis J; Poenaru, Dan; Silva, Mariana

2003-05-01

Pediatric central venous catheters (CVCs) traditionally have been placed surgically, guided by anatomic landmarks. Increasingly, interventional radiology services are inserting CVCs using ultrasound image guidance. This study compares the frequency of delayed complications in CVCs placed surgically or radiologically in a pediatric oncology population. Data on CVCs placed in one academic institution over 10 years were collected and analyzed retrospectively. Main outcomes assessed were infectious complications, mechanical complications, and premature catheter removal. Ninety-eight CVCs-comprising 52 external tunneled catheters (ETCs) and 46 subcutaneous ports-were assessed in 67 patients. Median patient age was 6.1 years for children with external catheters and 7.8 years for those with ports. Both infectious and mechanical complications were significantly more common among surgically placed ETCs than those placed radiologically (P <.05). Complications per 1,000 catheter days and premature removal showed a trend toward greater frequency among surgical ETCs, although this did not reach statistical significance. No consistent trends were seen in complications among ports. Pediatric patients with CVCs, especially those with external catheters, experience frequent delayed complications. Patients with radiologically inserted ETCs may encounter fewer complications than those with surgically placed ones. This corroborates previous reports in the literature suggesting image-guided CVC placement as a preferable alternative to traditional techniques. Copyright 2003 Elsevier Inc. All rights reserved.

Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors.

PubMed

Touré, Abdoulaye; Vanhems, Philippe; Lombard-Bohas, Catherine; Cassier, Philippe; Péré-Vergé, Denis; Souquet, Jean-Christophe; Ecochard, René; Chambrier, Cécile

2012-12-01

Central venous access port-related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Current concepts in repair of extremity venous injury.

PubMed

Williams, Timothy K; Clouse, W Darrin

2016-04-01

Extremity venous injury management remains controversial. The purpose of this communication is to offer perspective as well as experiential and technical insight into extremity venous injury repair. Available literature is reviewed and discussed. Historical context is provided. Indication, the decision process for repair, including technical conduct, is delineated. In particular, the authors' experiences in both civilian and wartime injury are used for perspective. Extremity venous injury repair was championed within data from the Vietnam Vascular Registry. However, patterns of extremity venous injury differ between combat and civilian settings. Since Vietnam, civilian descriptive series opine the benefits and potential complications associated with both venous injury repair and ligation. These surround extremity edema, chronic venous insufficiency, thromboembolism, and limb loss. Whereas no clear superiority in either approach has been identified to date, there appears to be no increased risk of pulmonary embolism or chronic venous changes with repair. Newer data from the wars in Iraq and Afghanistan and meta-analysis have reinforced this and also have suggested limb salvage benefit for extremity venous repair in combined arterial and venous injuries in modern settings. The patient's physiologic state and associated injury drive five triage categories suggesting vein injury management. Vein repair thrombosis occurs in a significant proportion, yet many recanalize and possibly have a positive impact on limb venous return. Further, early decompression favors reduced blood loss, acute edema, and inflammation, supporting collateral development. Large soft tissue injury minimizing collateral capacity increases the importance of repair. Constructs of repair are varied with modest differences in patency. Venous shunting is feasible, but specific roles remain nebulous. An aggressive posture toward extremity venous injury repair seems justified today because of the likely

Relationship between neighborhood socioeconomic status and venous thromboembolism: results from a population-based study.

PubMed

Kort, D; van Rein, N; van der Meer, F J M; Vermaas, H W; Wiersma, N; Cannegieter, S C; Lijfering, W M

2017-12-01

Essentials Literature on socioeconomic status (SES) and incidence of venous thromboembolism (VTE) is scarce. We assessed neighborhood SES with VTE risk in a population of over 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. These findings are helpful to inform policy and resource allocation in health systems. Background The association between socioeconomic status and arterial cardiovascular disease is well established. However, despite its high burden of disability-adjusted life years, little research has been carried out to determine whether socioeconomic status is associated with venous thromboembolism. Objective To determine if neighborhood socioeconomic status is associated with venous thromboembolism in a population-based study from the Netherlands. Methods We identified all patients aged 15 years and older with a first event of venous thromboembolism from inhabitants who lived in the urban districts of The Hague, Leiden and Utrecht in the Netherlands in 2008-2012. Neighborhood socioeconomic status was based on the status score, which combines educational level, income and unemployment on a four-digit postal code level. Incidence rate ratios of venous thromboembolism were calculated for different levels of neighborhood socioeconomic status, with adjustments for age and sex. Results A total of 7373 patients with a first venous thromboembolism (median age 61 years; 50% deep vein thrombosis) were identified among more than 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. In the two highest status score groups (i.e. the 95-99th and > 99th percentile), the adjusted incidence rate ratios were 0.91 (95% confidence interval [CI], 0.84-1.00) and 0.80 (95% CI, 0.69-0.93), respectively, compared with the reference status score group (i.e. 30-70th percentile). Conclusions High neighborhood socioeconomic status is associated with a lower risk of first venous thromboembolism. © 2017

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... (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 venous...

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... (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 venous...

21 CFR 870.1140 - Venous blood pressure manometer.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 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 venous...

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 venous...

Longitudinal Volume Quantification of Deep Medullary Veins in Patients with Cerebral Venous Sinus Thrombosis : Venous Volume Assessment in Cerebral Venous Sinus Thrombosis Using SWI.

PubMed

Dempfle, A K; Harloff, A; Schuchardt, F; Bäuerle, J; Yang, S; Urbach, H; Egger, K

2017-06-06

Susceptibility-weighted imaging (SWI) visualizes small cerebral veins with high sensitivity and could, thus, enable quantification of hemodynamics of deep medullary veins. We aimed to evaluate volume changes of deep medullary veins in patients with acute cerebral venous sinus thrombosis (CVST) over time in comparison to healthy controls. All magnetic resonance imaging (MRI) experiments were executed at 3 T using a 32-channel head coil. Based on SWI and semiautomatic postprocessing (statistical parametric mapping [SPM8] and ANTs), the volume of deep medullary veins was quantified in 14 patients with acute CVST at baseline and the 6‑month follow-up, as well as in 13 healthy controls undergoing repeated MRI examination with an interscan interval of at least 1 month. Deep medullary venous volume change over time was significantly different between healthy controls and patient groups (p < 0.001). Patients with superior sagittal sinus thrombosis (SSST) showed a significant decline from baseline to follow-up measurements (9.8 ± 4.9 ml versus 7.5 ± 4.2 ml; p = 0.02), whereas in patients with transverse sinus thrombosis (TST) and healthy controls no significant volume changes were observable. Venous volume quantification was feasible and reproducible both in healthy volunteers and in patients. The decrease of venous volume in patients over time represents improvement of venous drainage, reduction of congestion, and normalization of microcirculation due to treatment. Thus, quantification of venous microcirculation could be valuable for estimation of prognosis and guidance of CVST therapy in the future.

Vacuum-assisted venous return reduces blood usage.

PubMed

Banbury, Michael K; White, Jennifer A; Blackstone, Eugene H; Cosgrove, Delos M

2003-09-01

To determine whether vacuum-assisted venous return has clinical advantages over conventional gravity drainage apart from allowing the use of smaller cannulas and shorter tubing. A total of 150 valve operations were performed at our institution between February and July 1999 using vacuum-assisted venous return with small venous cannulas connected to short tubing. These were compared with (1) 83 valve operations performed between April 1997 and January 1998 using the initial version of vacuum-assisted venous return, and (2) 124 valve operations performed between January and April of 1997 using conventional gravity drainage. Priming volume, hematocrit value, red blood cell usage, and total blood product usage were compared multivariably. These comparisons were covariate and propensity adjusted for dissimilarities between the groups and confirmed by propensity-matched pairs analysis. Priming volume was 1.4 +/- 0.4 L for small-cannula vacuum-assisted venous return, 1.7 +/- 0.4 L for initial vacuum-assisted venous return, and 2.0 +/- 0.4 L for gravity drainage (P <.0001). Smaller priming resulted in higher hematocrit values both at the beginning of cardiopulmonary bypass (27% +/- 5% compared with 26% +/- 4% and 25% +/- 4%, respectively, P <.0001) and at the end (30% +/- 4% compared with 28% +/- 4% and 27% +/- 4%, respectively, P <.0001). Red cell transfusions were used in 17% of the patients having small-cannula vacuum-assisted venous return, 27% of the initial patients having vacuum-assisted venous return, and 37% of the patients having gravity drainage (P =.001); total blood product usage was 19%, 27%, and 39%, respectively (P =.002). Although ministernotomy also was associated with reduced blood product usage (P <.004), propensity matching on type of sternotomy confirmed the association of vacuum-assisted venous return with lowered blood product usage. Vacuum-assisted venous return results in (1) higher hematocrit values during cardiopulmonary bypass and (2) decreased

Intraatrial baffle repair of anomalous systemic venous return without hepatic venous drainage in heterotaxy syndrome.

PubMed

Turkoz, Riza; Ayabakan, Canan; Vuran, Can; Omay, Oğuz

2010-08-01

A 7-month-old boy with heterotaxy syndrome had partial atrioventricular septal defect and interrupted inferior vena cava with hemiazygos continuation to a left superior vena cava. The left side of the common atrium receiving all the venous drainage was in connection with the left ventricle and the aorta. The small atrium and the proximity of the pulmonary and hepatic vein orifices precluded complete baffling. This report describes an intraatrial baffle repair of anomalous systemic venous return without hepatic venous drainage. This resulted in good oxygenation postoperatively, with oxygen saturation ranging from 93% to 98%.

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 < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency.

PubMed

Jones, Roy Wesley; Parkerson, Godfrey Ross; Ottinger, Mary; Rodriguez, Eduardo; Park, Brian

2017-01-01

We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

Oxytocin Reduces Background Anxiety in a Fear-Potentiated Startle Paradigm: Peripheral vs Central Administration

PubMed Central

Ayers, Luke W; Missig, Galen; Schulkin, Jay; Rosen, Jeffrey B

2011-01-01

Oxytocin is known to have anti-anxiety and anti-stress effects. Using a fear-potentiated startle paradigm in rats, we previously demonstrated that subcutaneously administered oxytocin suppressed acoustic startle following fear conditioning compared with startle before fear conditioning (termed background anxiety), but did not have an effect on cue-specific fear-potentiated startle. The findings suggest oxytocin reduces background anxiety, an anxious state not directly related to cue-specific fear, but sustained beyond the immediate threat. The goal of the present study was to compare the effects of centrally and peripherally administered oxytocin on background anxiety and cue-specific fear. Male rats were given oxytocin either subcutaneously (SC) or intracerebroventricularly (ICV) into the lateral ventricles before fear-potentiated startle testing. Oxytocin doses of 0.01 and 0.1 μg/kg SC reduced background anxiety. ICV administration of oxytocin at doses from 0.002 to 20 μg oxytocin had no effect on background anxiety or cue-specific fear-potentiated startle. The 20 μg ICV dose of oxytocin did reduce acoustic startle in non-fear conditioned rats. These studies indicate that oxytocin is potent and effective in reducing background anxiety when delivered peripherally, but not when delivered into the cerebroventricular system. Oxytocin given systemically may have anti-anxiety properties that are particularly germane to the hypervigilance and exaggerated startle typically seen in many anxiety and mental health disorder patients. PMID:21796104

Anomalous pulmonary venous connection: An underestimated entity.

PubMed

Magalhães, Sara P; Moreno, Nuno; Loureiro, Marília; França, Manuela; Reis, Fernanda; Alvares, Sílvia; Ribeiro, Manuel

2016-12-01

Anomalous pulmonary venous connection is an uncommon congenital anomaly in which all (total form) or some (partial form) pulmonary veins drain into a systemic vein or into the right atrium rather than into the left atrium. The authors present one case of total anomalous pulmonary venous connection and two cases of partial anomalous pulmonary venous connection, one of supracardiac drainage into the brachiocephalic vein, and the other of infracardiac anomalous venous drainage (scimitar syndrome). Through the presentation of these cases, this article aims to review the main pulmonary venous developmental defects, highlighting the role of imaging techniques in the assessment of these anomalies. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

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

PubMed

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

2010-04-01

A 33-year-old woman with a history of gestational trophoblastic disease presented for investigation of a right atrial mass. She had been receiving chemotherapy administered via a Port-a-Cath system for 2 months prior to presentation. On transesophageal echocardiography and magnetic resonance imaging, she was found to have a mass attached to the right atrial free wall, with a segment projecting across a patent foramen ovale. Because of the risk for an embolic event, the mass was surgically removed and the patent foramen ovale repaired. Pathology showed an organized thrombus. This case emphasizes the need for high suspicion for thrombus when a right atrial mass is found in a patient with a hypercoagulable state due to underlying malignancy who has a central venous catheter. Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Venous thromboembolism: a UK perspective.

PubMed

Kakkar, Ajay

2009-07-01

Venous thromboembolism remains a significant cause of morbidity and mortality in the UK, and its dangers, particularly in hospitalized patients, have long been recognized. Recent measures to tackle this problem and new treatments should alleviate the burden of venous thromboembolism for patients, their families and hospital services.

Mixed venous oxygen saturation monitoring revisited: thoughts for critical care nursing practice.

PubMed

Christensen, Martin

2012-05-01

Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO(2)). The aim of this paper is to put forward the notion that SvO(2) provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO(2). SvO(2) monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO(2) monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO(2)) might be an attractive alternative to SvO(2) because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO(2) is less accurate than SvO(2) and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO(2) and SvO(2) and this is dependent on the presenting disease, in some cases SvO(2) will be significantly lower than ScvO(2). Whilst newer technologies have been developed to

Venous thromboembolism and arterial complications.

PubMed

Prandoni, Paolo; Piovella, Chiara; Pesavento, Raffaele

2012-04-01

An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, smoking, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cumulative Evidence of Randomized Controlled and Observational Studies on Catheter-Related Infection Risk of Central Venous Catheter Insertion Site in ICU Patients: A Pairwise and Network Meta-Analysis.

PubMed

Arvaniti, Kostoula; Lathyris, Dimitrios; Blot, Stijn; Apostolidou-Kiouti, Fani; Koulenti, Despoina; Haidich, Anna-Bettina

2017-04-01

Selection of central venous catheter insertion site in ICU patients could help reduce catheter-related infections. Although subclavian was considered the most appropriate site, its preferential use in ICU patients is not generalized and questioned by contradicted meta-analysis results. In addition, conflicting data exist on alternative site selection whenever subclavian is contraindicated. To compare catheter-related bloodstream infection and colonization risk between the three sites (subclavian, internal jugular, and femoral) in adult ICU patients. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, CINAHL, and ClinicalTrials.gov. Eligible studies were randomized controlled trials and observational ones. Extracted data were analyzed by pairwise and network meta-analysis. Twenty studies were included; 11 were observational, seven were randomized controlled trials for other outcomes, and two were randomized controlled trials for sites. We evaluated 18,554 central venous catheters: 9,331 from observational studies, 5,482 from randomized controlled trials for other outcomes, and 3,741 from randomized controlled trials for sites. Colonization risk was higher for internal jugular (relative risk, 2.25 [95% CI, 1.84-2.75]; I = 0%) and femoral (relative risk, 2.92 [95% CI, 2.11-4.04]; I = 24%), compared with subclavian. Catheter-related bloodstream infection risk was comparable for internal jugular and subclavian, higher for femoral than subclavian (relative risk, 2.44 [95% CI, 1.25-4.75]; I = 61%), and lower for internal jugular than femoral (relative risk, 0.55 [95% CI, 0.34-0.89]; I = 61%). When observational studies that did not control for baseline characteristics were excluded, catheter-related bloodstream infection risk was comparable between the sites. In ICU patients, internal jugular and subclavian may, similarly, decrease catheter-related bloodstream infection risk, when compared with femoral. Subclavian could be suggested as the most

Venous trauma in the Lebanon War--2006.

PubMed

Nitecki, Samy S; Karram, Tony; Hoffman, Aaron; Bass, Arie

2007-10-01

Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can

Octenidine hydrochloride for the care of central venous catheter insertion sites in severely immunocompromised patients.

PubMed

Tietz, Andreas; Frei, Reno; Dangel, Marc; Bolliger, Dora; Passweg, Jakob R; Gratwohl, Alois; Widmer, Andreas E

2005-08-01

To determine the efficacy and tolerability of octenidine hydrochloride, a non-alcoholic skin antiseptic, for the care of central venous catheter (CVC) insertion sites. Prospective, observational study. Bone marrow transplantation unit of a university hospital. All consecutive patients with a nontunneled CVC were enrolled prospectively after informed consent. Octenidine hydrochloride (0.1%) was applied for disinfection at the CVC insertion site during dressing changes. The following cultures were performed weekly as well as at the occurrence of any systemic inflammatory response syndrome criteria: cultures of the skin surrounding the CVC entry site, cultures of the three-way hub connected to the CVC, blood cultures, and cultures of the CVC tip on removal. Enhanced microbiological methods (skin swabs of a 24-cm2 standardized area, roll plate, and sonication of catheter tips) were applied. One hundred thirty-five CVCs were inserted in 62 patients during the study period and remained for a mean period of 19.1 days, corresponding to 2,462 catheter-days. Bacterial density at the insertion site declined substantially over time, and most cultures became negative 2 weeks after insertion. Only 6 patients had a documented catheter-related bloodstream infection. The incidence density was 2.39 catheter infections per 1,000 catheter-days. No side effects were noted with application of the antiseptic. Disinfection with a skin antiseptic that contains octenidine hydrochloride is highly active and well tolerated. It leads to a decrease in skin colonization over time and may be a new option for CVC care.

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

PubMed Central

ARIBAŞ, BILGIN KADRI; ARDA, KEMAL; ARIBAŞ, ÖZGE; ÇILEDAĞ, NAZAN; YOLOĞLU, ZEYNEL; AKTAŞ, ELIF; SEBER, TURGUT; KAVAK, ŞEYHMUS; COŞAR, YUSUF; KAYGUSUZ, HIDIR; TEKIN, EKREM

2012-01-01

The purpose of the present study was to examine whether patency times, including complications of subcutaneous venous chest port insertion using ultrasonography (US) guidance, differ between jugular and subclavian venous access. Between December 2008 and July 2010, subcutaneous venous chest ports were placed in 347 patients by an experienced team. All single-lumen port catheters were placed into jugular and subclavian veins under US and fluoroscopy guidance. Patency times and complication rates of ports via these routes were compared and the variables were age, gender, access, site of malignancy and coagulation parameters. The success of the jugular and subclavian groups was compared by univariate Kaplan-Meier survival analysis and the multivariable Cox regression test. A total of 15 patients underwent port removal due to complications. As a rate per 100 catheter days, ports were explanted in 7 (0.0092) due to thrombosis, 4 (0.0053) for catheter malposition, one each (0.0013) of port reservoir flip-over, bleeding, port pocket infection, skin necrosis and incision dehiscence, for a total of 15 patients (0.0197). Patency times were not different in the jugular and subclavian veins. Factors were not significant, with the exception of platelet count. There was no significant difference in patency times, including complications, between jugular vein access and subclavian vein access using US. This should be considered when selecting the access method. PMID:23170125

Identifying and reducing the incidence of post discharge Venous Thromboembolism (VTE) in orthopaedic patients: a systematic review.

PubMed

McLiesh, Paul; Wiechula, Rick

2012-01-01

BACKGROUND: The risk of venous thromboembolism for orthopaedic patients is often high due to the length of surgery, damage from trauma to bone and soft tissues and lengthy periods of immobility or reduced mobility. Although venous thromboembolism occurs mainly in inpatients a significant number of patients develop venous thromboembolism post discharge OBJECTIVES: To synthesise the best available evidence on strategies that effectively reduce post discharge venous thromboembolism in orthopaedic patients. INCLUSION CRITERIA: Patients regardless of age, gender or co-morbidities that have been admitted with an acute orthopaedic injury (unplanned) or a planned orthopaedic surgery/procedure and then followed up after discharge. Only papers describing the incidence and prophylaxis treatment used in non-Asian patients were considered for inclusion. Any interventions of combinations of chemoprophylaxis and/or mechanical prophylaxis to prevent venous thromboembolism incidence extending beyond hospital admission. Outcomes included diagnosis of venous thromboembolism following an orthopaedic admission/surgery for up to 6 months post discharge and the incidence of any significant bleeding or death related to venous thromboembolism or haemorrhage.The review considered any randomised controlled trials; in the absence of RCTs other research designs, such as non-randomised controlled trials and before and after studies, were considered SEARCH STRATEGY: Search strategy considered only papers in English from 2000 to March 2012. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION: Data was extracted from the studies using the standardised Johanna Briggs Institute data extraction form. DATA SYNTHESIS: Of the included studies none matched methodology, treatment or comparator that allowed meta-analysis. The results were therefore presented in a narrative form and were

Surgical management of venous malformations.

PubMed

Loose, D A

2007-01-01

Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

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

Safety, dose, and timing of reteplase in treating occluded central venous catheters in children with cancer.

PubMed

Terrill, Kelly R; Lemons, Richard S; Goldsby, Robert E

2003-11-01

Recombinant tissue plasminogen activator, alteplase, began to be commonly used to restore the patency of occluded central venous catheters (CVCs) as urokinase production was halted in the late 1990s. However, alteplase often requires an extended dwell time to restore patency to occluded CVCs. In adults, reteplase, a newer thrombolytic agent, has been reported to restore patency to CVCs in 30 minutes. The authors prospectively evaluated the safety and efficacy of reteplase in restoring patency to occluded CVCs in children with cancer. This was a dose escalation trial. The dose of reteplase was initiated at 0.1 units and increased by increments of 0.1 units to a maximum dose of 0.4 units. Each dose was tested on at least three participants. Time to patency after reteplase administration was recorded by nurses caring for the patients. Attempts to access the line occurred every 15 minutes for 1 hour. CVCs that remained occluded after 1 hour were treated with alteplase. Reteplase was administered to 15 clotted CVCs. Twelve of the 15 were cleared with an average dwell time of 38 minutes. The time to patency did not appear to correlate with the dose. No adverse events were reported. Reteplase can restore patency to occluded CVCs in a pediatric population. Reteplase appears to have comparable efficacy with alteplase, but reteplase may require shorter dwell times. A prospective, randomized, clinical trial is warranted to determine whether reteplase is as effective as alteplase in restoring patency to occluded CVCs.

Horner's syndrome in patients admitted to the intensive care unit that have undergone central venous catheterization: a prospective study.

PubMed

Butty, Z; Gopwani, J; Mehta, S; Margolin, E

2016-01-01

PurposeCentral venous catheterization (CVC) is estimated to be performed in millions of patients per year. Swan-Ganz catheters used for CVC are most often inserted into the internal jugular vein and during this procedure they may come into contact with the sympathetic chain. This study aims to determine the incidence of Horner's syndrome in patients admitted to intensive care unit that have undergone internal jugular CVC insertion during their admission and to determine whether ultrasonography-assisted insertion has decreased the frequency of this complication.Patients and methodsA total of 100 prospective patients admitted to the ICU were examined for the presence of anisocoria and ptosis after undergoing recent CVC. Presence of Horner's syndrome was confirmed by testing with 0.5% apraclonidine and looking for the reversal of anisocoria.ResultsFrequency of Horner's syndrome after CVC was 2% in a sample of 100 prospectively examined patients.ConclusionHorner's syndrome remains a relatively rare but definitive complication of CVC. ICU physicians should be educated about its existence and prevalence and ophthalmologists should inquire about any history of ICU admission necessitating CVC insertion in any patient presenting with Horner's syndrome.

Cannulation for veno-venous extracorporeal membrane oxygenation

PubMed Central

2018-01-01

Extracorporeal membrane oxygenation (ECMO) is described as a modified, smaller cardiopulmonary bypass circuit. The veno-venous (VV) ECMO circuit drains venous blood, oxygenate the blood, and pump the blood back into the same venous compartment. Draining and reinfusing in the same compartment means there are a risk of recirculation. The draining position within the venous system, ECMO pump flow, return flow position within the venous system and the patients cardiac output (CO) all have an impact on recirculation. Using two single lumen cannulas or one dual lumen cannula, but also the design of the venous cannula, can have an impact on where within the venous system the cannula is draining blood and will affect the efficiency of the ECMO circuit. VV ECMO can be performed with different cannulation strategies. The use of two single lumen cannulas draining in inferior vena cava (IVC) and reinfusing in superior vena cava (SVC) or draining in SVC and reinfusing in IVC, or one dual lumen cannula inserted in right jugular vein is all possible cannulation strategies. Independent of cannulation strategy there will be a risk of recirculation. Efficiency can be reasonable in either strategy if the cannulas are carefully positioned and monitored during the dynamic procedure of pulmonary disease. The disadvantage draining from IVC only occurs when there is a need for converting from VV to veno-arterial (VA) ECMO, reinfusing in the femoral artery. Then draining from SVC is the most efficient strategy, draining low saturated venous blood, and also means low risk of dual circulation. PMID:29732177

International Meeting on Simulation in Healthcare 2007

DTIC Science & Technology

2007-03-01

Research Abstract : 32  Simulation­based Training in Ultrasound Assisted  Central   Venous   Catheterization .  Pamela Andreatta 1 , Rajani Mangrulkar 2...vascular access skill training for  central   venous   catheterization , and basic and difficult airway management skill training with infant/pediatric/adult task...Office of Clinical  Affairs, University of Michigan Health System Background: More than 5 million central venous catheters (CVCs) are inserted in the

The possibility for use of venous flaps in plastic surgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.

2015-11-17

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 nomore » 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.« less

Normal venous anatomy and physiology of the lower extremity.

PubMed

Notowitz, L B

1993-06-01

Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days.

PubMed

Biffi, R; de Braud, F; Orsi, F; Pozzi, S; Mauri, S; Goldhirsch, A; Nolè, F; Andreoni, B

1998-07-01

A few data are available from analyses of the complications and costs of central venous access ports for chemotherapy. This prospective study deals with the complications and global costs of central venous ports connected to a Groshong catheter for deliverance of long-term chemotherapy. Patients with a variety of solid neoplastic diseases requiring chemotherapy who were undergoing placement of implantable ports over a 30-month period (1 October 1994 to 31 March 1997) have been prospectively studied. Follow-up continued until the device was removed or the study was closed (30 September 1997); patients with uneventful implant experience and subsequent follow-ups of less than 180 days were not considered for this study. A single port, constructed of titanium and silicone rubber (Dome Port, Bard Inc., Salt Lake City, USA), was used, connected to an 8 F silastic Groshong catheter tubing (Bard Inc., Salt Lake City, USA). Two-hundred ninety-six devices were placed in the operating room under fluoroscopic control even in the patients treated and monitored in a day-hospital setting: 37 of them were in an angiographic suite. A central venous access form was filled in by the operator after the procedure and all ports were followed prospectively for device-related and overall complications. The average purchase cost of the device was obtained from the hospital charges, based on the costs applied during the 30-month period of the study. Insertion and maintenance costs were estimated by obtaining the charges for an average TIAP implant and its subsequent use; the costs of complication management were assessed analytically. The total cost of each device was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. The cost of removing the TIAP was also included in the economic analysis when required by the treatment of the complication. Three hundred thirty-three devices, for a total of 79,178 days in

Venous Shunt Versus Venous Ligation for Vascular Damage Control: The Immunohistochemical Evidence.

PubMed

Góes Junior, Adenauer Marinho de Oliveira; Abib, Simone de Campos Vieira; Alves, Maria Teresa de Seixas; Ferreira, Paulo Sérgio Venerando da Silva; Andrade, Mariseth Carvalho de

2017-05-01

To evaluate the expression of immunohistochemical markers of tissue ischemia (iNOS, eNOS, and HSP70) in a vascular damage control experimental model to determine if a venous temporary vascular shunt insertion leads to a better limb perfusion when compared with the ligature of the injured vein. Experimental study in male Sus Scrofa weighting 40 Kg. Animals were distributed into 5 groups: group 1 animals were submitted to right external iliac artery (EIA) shunting and right external iliac vein (EIV) ligation; group 2 animals were submitted to right EIA shunting and right EIV shunting; group 3 animals were submitted to right EIV ligation; group 4 animals were submitted to right EIV shunting; group 5 animals were not submitted to vascular shunting or venous ligation. Transonic Systems flowmeters were used to measure vascular flow on right and left external iliac vessels, and i-STAT (Abbot) portable blood analyzer was used for EIVs blood biochemical analysis. An initial baseline register of invasive arterial pressure, iliac vessels flow, and venous blood analysis was performed. Arterial pressure and iliac vessels flow were taken immediately after right iliac vessels shunting or ligation. Then, hemorrhagic shock was induced by continuous 20 mL/min blood withdraw from the external right jugular vein whereas arterial blood pressure and iliac vessels flow registers were taken every 10 min, and blood samples from EIVs were obtained every 30 min until the vascular flow through right EIA (or through the shunt inserted into the right EIV for group 4 animals) became inexistent or until the animal's death. After the end of the experiments, bilateral hind limb's biopsies were obtained for immunohistochemical analysis. Using image editing and analysis software, the expression of iNOS, eNOS, and HSP70 (3 well-known ischemic associated immunohistochemical markers) was assessed. The mean expression of each marker in the right hind limb was compared between groups. For statistical

Efficacy and safety of venous angioplasty of the extracranial veins for multiple sclerosis. Brave dreams study (brain venous drainage exploited against multiple sclerosis): study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with a disabling progressive course. Chronic cerebrospinal venous insufficiency (CCSVI) has recently been described as a vascular condition characterized by restricted venous outflow from the brain, mainly due to blockages of the internal jugular and azygos veins. Despite a wide variability among studies, it has been found to be associated with MS. Data from a few small case series suggest possible improvement of the clinical course and quality of life by performing percutaneous balloon angioplasty (PTA) of the stenotic veins. Study design and methods This is a multicenter, randomized, parallel group, blinded, sham-controlled trial to assess the efficacy and safety of PTA. Participants with relapsing remitting MS or secondary progressive MS and a sonographic diagnosis of CCSVI will be enrolled after providing their informed consent. Each participant will be centrally randomized to receive catheter venography and PTA or catheter venography and sham PTA. Two primary end points with respect to efficacy at 12 months are (1) a combined end point obtained through the integration of five functional indicators, walking, balance, manual dexterity, bladder control, and visual acuity, objectively measured by instruments; and (2) number of new brain lesions measured by T2-weighted MRI sequences. Secondary end points include annual relapse rate, change in Expanded Disability Status Scale score, proportion of patients with zero, one or two, or more than two relapses; fatigue; anxiety and depression; general cognitive state; memory/attention/calculus; impact of bladder incontinence; and adverse events. Six hundred seventy-nine patients will be recruited. The follow-up is scheduled at 12 months. Patients, treating neurologists, trained outcome assessors, and the statistician in charge of data analysis will be masked to the assigned treatment. Discussion The study will

Venous leg ulcers

PubMed Central

2011-01-01

Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids

Catheter-Salvage in Home Infusion Patients with Central Line-Associated Bloodstream Infection

PubMed Central

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

2014-01-01

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

Microsurgical anatomy of the central lobe.

PubMed

Frigeri, Thomas; Paglioli, Eliseu; de Oliveira, Evandro; Rhoton, Albert L

2015-03-01

The central lobe consists of the pre- and postcentral gyri on the lateral surface and the paracentral lobule on the medial surface and corresponds to the sensorimotor cortex. The objective of the present study was to define the neural features, craniometric relationships, arterial supply, and venous drainage of the central lobe. Cadaveric hemispheres dissected using microsurgical techniques provided the material for this study. The coronal suture is closer to the precentral gyrus and central sulcus at its lower rather than at its upper end, but they are closest at a point near where the superior temporal line crosses the coronal suture. The arterial supply of the lower two-thirds of the lateral surface of the central lobe was from the central, precentral, and anterior parietal branches that arose predominantly from the superior trunk of the middle cerebral artery. The medial surface and the superior third of the lateral surface were supplied by the posterior interior frontal, paracentral, and superior parietal branches of the pericallosal and callosomarginal arteries. The venous drainage of the superior two-thirds of the lateral surface and the central lobe on the medial surface was predominantly through the superior sagittal sinus, and the inferior third of the lateral surface was predominantly through the superficial sylvian veins to the sphenoparietal sinus or the vein of Labbé to the transverse sinus. The pre- and postcentral gyri and paracentral lobule have a morphological and functional anatomy that differentiates them from the remainder of their respective lobes and are considered by many as a single lobe. An understanding of the anatomical relationships of the central lobe can be useful in preoperative planning and in establishing reliable intraoperative landmarks.

Peripherally inserted central venous catheter-associated complications exert negative effects on body weight gain in neonatal intensive care units.

PubMed

Wen, Jie; Yu, Qun; Chen, Haiyan; Chen, Niannian; Huang, Shourong; Cai, Wei

2017-01-01

The placement of a peripherally inserted central venous catheter (PICC) is an essential procedure in neonatal intensive care units (NICU). The aim of this study was to determine the risk of PICC complications in NICU, and further identify the effects of PICC complications on body weight gain in premature infants. A total of 304 premature infants who had a PICC inserted in NICU were enrolled in this study. The weight-for-age z-score (WAZ) at the time of PICC insertion and removal were calculated, and changes of WAZ in different groups were compared using a t-test. Risk factors for PICC complications were assessed using the chi-squared test and multiple logistic regression analysis. Thirty (9.97%) PICCs were removed due to complications. Of them, 14 PICCs were removed because of non-infectious complications and 16 PICCs were removed for central-line-associated bloodstream infections (CLABSIs). Multiple logistic regression analysis showed that premature infants with birth weight >1,500 g were less likely to have PICC complications than infants with birth weight <=1,500 g (OR, 0.29; 95% CI: 0.10-0.82; p=0.020). In addition, the changes in WAZ between PICC insertion and removal were significantly different in both infectious (-0.144±0.122, p<0.005) and non-infectious (-0.65±0.528, p<0.001) complications groups, compared with the no complications group (0.291±0.552). Findings from this study suggest that birth weight is a risk factor for PICC-associated complications in the NICU, and both infectious and non-infectious PICC complications are associated with poor body weight gain in premature infants.

[Risk Factors for Oxaliplatin-Induced Phlebitis and Venous Pain, and Evaluation of the Preventive Effect of Preheating with a Hot Compress for Administration of Oxaliplatin].

PubMed

Nakauchi, Kana; Kawazoe, Hitoshi; Miyajima, Risa; Waizumi, Chieko; Rokkaku, Yuki; Tsuneoka, Kikue; Higuchi, Noriko; Fujiwara, Mitsuko; Kojima, Yoh; Yakushijin, Yoshihiro

2015-11-01

Venous pain induced by oxaliplatin(L-OHP)is a clinical issue related to adherence to the Cape OX regimen. To prevent LOHP- induced venous pain, we provided nursing care to outpatients who were administered a preheated L -OHP diluted solution using a hot compress. We retrospectively evaluated the risk factors for colorectal cancer patients who had L -OHP induced phlebitis and venous pain. Furthermore, the preventive effect of nursing care was compared between inpatients and outpatients from January 2010 to March 2012. At the L-OHP administration site, any symptoms were defined as phlebitis, whereas pain was defined as venous pain. A total of 132 treatment courses among 31 patients were evaluated. Multivariate logistic regression analysis revealed that both phlebitis and venous pain were significantly more common in female patients (adjusted odds ratio, 2.357; 95%CI: 1.053-5.418; and adjusted odds ratio, 5.754; 95%CI: 2.119-18.567, respectively). The prevalence of phlebitis and venous pain did not differ between inpatients and outpatients (phlebitis, 61.3% vs 67.7%; venous pain, 29.0%vs 19.4%). These results suggest that administration of L-OHP via a central venous route should be considered in female patients.

Cerebral venous blood oxygenation monitoring during hyperventilation in healthy volunteers with a novel optoacoustic system

NASA Astrophysics Data System (ADS)

Petrov, Andrey; Prough, Donald S.; Petrov, Irene Y.; Petrov, Yuriy; Deyo, Donald J.; Henkel, Sheryl N.; Seeton, Roger; Esenaliev, Rinat O.

2013-03-01

Monitoring of cerebral venous oxygenation is useful to facilitate management of patients with severe or moderate traumatic brain injury (TBI). Prompt recognition of low cerebral venous oxygenation is a key to avoiding secondary brain injury associated with brain hypoxia. In specialized clinical research centers, jugular venous bulb catheters have been used for cerebral venous oxygenation monitoring and have demonstrated that oxygen saturation < 50% (normal range is 55-75%) correlates with poor clinical outcome. We developed an optoacoustic technique for noninvasive monitoring of cerebral venous oxygenation. Recently, we designed and built a novel, medical grade optoacoustic system operating in the near-infrared spectral range for continuous, real-time oxygenation monitoring in the superior sagittal sinus (SSS), a large central cerebral vein. In this work, we designed and built a novel SSS optoacoustic probe and developed a new algorithm for SSS oxygenation measurement. The SSS signals were measured in healthy volunteers during voluntary hyperventilation, which induced changes in SSS oxygenation. Simultaneously, we measured exhaled carbon dioxide concentration (EtCO2) using capnography. Good temporal correlation between decreases in optoacoustically measured SSS oxygenation and decreases in EtCO2 was obtained. Decreases in EtCO2 from normal values (35-45 mmHg) to 20-25 mmHg resulted in SSS oxygenation decreases by 3-10%. Intersubject variability of the responses may relate to nonspecific brain activation associated with voluntary hyperventilation. The obtained data demonstrate the capability of the optoacoustic system to detect in real time minor changes in the SSS blood oxygenation.

Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens.

PubMed

Marcos, Miguel; Soriano, Alex; Iñurrieta, Amaia; Martínez, José A; Romero, Alberto; Cobos, Nazaret; Hernández, Cristina; Almela, Manel; Marco, Francesc; Mensa, Josep

2011-09-01

Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs. A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis. Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives. Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.

Acute venous sinus thrombosis after chickenpox infection.

PubMed

Sardana, Vijay; Mittal, Lal Chand; Meena, S R; Sharma, Deepti; Khandelwal, Girish

2014-08-01

Chickenpox is one of the classic childhood diseases. Recently chicken pox has been reported in adults with more severe systemic and neurological complications. Cerebral venous thrombosis (CVT) is a life threatening disorder if not treated in time. We report a patient with post varicella CVT as a rare complication of primary Varicella zoster virus. Vasculitic arterial infarction is known while venous stroke has rarely been reported with Varicella-zoster virus infection. Here, we report an immunocompetent 30 yr old male who developed chickenpox after contact with his daughter two month back. He presented with acute neurological deficit, one week after onset of skin lesion. MR venography revealed non-visualisation of left transverse sinus and left sigmoid sinus suggestive of venous sinus thrombosis. Varicella infection is rarely associated with venous sinus thrombosis. Possibly hypercoagulable state produced by the infection or direct invasion of virus in venous endothelial wall with subsequent damage to endothelium leading to thrombosis could be the cause.

Surgical management of anomalous pulmonary venous connection to the superior vena cava - early results

PubMed Central

Chandra, Dinesh; Gupta, Anubhav; Nath, Ranjit K.; kazmi, Aamir; Grover, Vijay; Gupta, Vijay K.

2013-01-01

Background The anatomical variability in patients with anomalous pulmonary venous connection to superior vena cava presents a surgical challenge. The problem is further compounded by the common occurrence of postoperative complications like arrhythmias and obstruction of the superior vena cava or pulmonary veins. We present our experience of managing this subset using the two patch and Warden's techniques. Patients and methods Between June 2011 and September 2012, 7 patients with APVC to the SVC were operated in our institute. After delineating the anatomy, five of them had a two patch repair and two were managed with Warden's technique. Results There was no in-hospital mortality or early mortality over a mean follow-up of 9.66 ± 3.88 months (range 6–15 months). All the patients on follow-up had unobstructed pulmonary venous and SVC drainage on echocardiography and all of them were in normal sinus rhythm. Conclusions Anomalous pulmonary venous connection to superior vena cava is a challenging subset of patients in whom the surgical management needs to be individualized. The detailed anatomy must be delineated using echocardiography with or without CT angiography before deciding the surgical plan. This entity can be repaired with excellent immediate and early results. However, these patients must be closely followed up for complications like systemic and pulmonary venous obstruction and sinus node dysfunction. PMID:24206880

Neutrophil extracellular traps form predominantly during the organizing stage of human venous thromboembolism development

PubMed Central

Savchenko, A. S.; Martinod, K.; Seidman, M. A.; Wong, S. L.; Borissoff, J. I.; Piazza, G.; Libby, P.; Goldhaber, S. Z.; Mitchell, R. N.; Wagner, D. D.

2014-01-01

Background A growing health problem, venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), requires refined diagnostic and therapeutic approaches. Neutrophils contribute to thrombus initiation and development in experimental DVT. Recent animal studies recognized neutrophil extracellular traps (NETs) as an important scaffold supporting thrombus stability. However, the hypothesis that human venous thrombi involve NETs has not undergone rigorous testing. Objective To explore the cellular composition and the presence of NETs within human venous thrombi at different stages of development. Patients and Methods We examined sixteen thrombi obtained from 11 patients during surgery or at autopsy using histomorphological, immunohistochemical and immunofluorescence analyses. Results We classified thrombus regions as unorganized, organizing, and organized according to their morphological characteristics. We then evaluated them focusing on neutrophil and platelet deposition as well as micro-vascularization of the thrombus body. We observed evidence of NET accumulation, including the presence of citrullinated histone H3 (H3Cit)-positive cells. NETs, defined as extracellular diffuse H3Cit areas associated with myeloperoxidase and DNA, localized predominantly during the phase of organization in human venous thrombi. Conclusions NETs are present in organizing thrombi in patients with VTE. They are associated with thrombus maturation in humans. Dissolution of NETs might thus facilitate thrombolysis. This finding provides new insights into the clinical development and pathology of thrombosis and provides new perspectives for therapeutic advances. PMID:24674135

History of venous leg ulcers.

PubMed

Gianfaldoni, S; Wollina, U; Lotti, J; Gianfaldoni, R; Lotti, T; Fioranelli, M; Roccia, M G

To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure!

PubMed

Redaelli, Sara; Zanella, Alberto; Milan, Manuela; Isgrò, Stefano; Lucchini, Alberto; Pesenti, Antonio; Patroniti, Nicolò

2016-12-01

Daily nursing in critical care patients may alter vital parameters, especially in the most critically ill patients. The aim of our study was to evaluate feasibility and safety of daily nursing on patients undergoing venous-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure. Daily nursing was performed following defined phases (sponge bath, elevation with scooping stretcher, change position of endotracheal tube, dressing replacement). We recorded physiological and ECMO parameters before and during daily nursing in 5 patients for several days (total: 25 daily nursing) and adverse events: desaturation, hypertension, reduction of mixed venous oxygen saturation, arterial oxygen saturation or ECMO blood flow and elevation in minute ventilation. Sedative drug dosage and additional bolus were recorded. Daily nursing was performed in 92 % of cases (23/25), with a minimum of two adverse events per daily nursing. Hypertension and tachycardia were mostly recorded at the beginning, while desaturation, reduction in mixed venous oxygen saturation and blood flow were recorded during elevation with scooping stretcher. Increase in minute ventilation was frequent in spontaneous breathing patients. Additional bolus of sedation was required before and/or during nursing. Daily nursing significantly alters physiologic parameters; thus, it should be performed only when physicians are readily available to treat adverse events.

Going with the flow or swimming against the tide: should children with central venous catheters swim?

PubMed

Miller, Jessica; Dalton, Meghan K; Duggan, Christopher; Lam, Shirley; Iglesias, Julie; Jaksic, Tom; Gura, Kathleen M

2014-02-01

Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.

Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position?

PubMed

Wirsing, Melanie; Schummer, Claudia; Neumann, Rotraud; Steenbeck, Jörg; Schmidt, Peter; Schummer, Wolfram

2008-09-01

Traditionally, the positioning of central venous catheters (CVCs) outside the right atrium (RA) in patients receiving intensive care is determined by surrogate landmarks on bedside chest radiographs (CXRs). The validity of this method was examined by comparing readings of radiologists with the results of transesophageal echocardiography (TEE). Prospective study at university hospital. Two hundred thirteen adults scheduled for cardiothoracic surgery were randomized to right or left internal jugular vein catheterization under ECG guidance. One senior radiologist and two radiologists in training independently read the CXRs, and determined whether the CVC tip ended in the RA and measured the vertical distance from the CVC tip to the carina (TC-distance). Two hundred twelve CVC tips could be identified by TEE. Only left-sided CVCs (n = 5) ended in the upper RA (2.4%). Three of those patients were shorter than 160 cm. Specificity was 94% for senior radiologist, 44% for the first radiologist in training, and 60% for the second radiologist in training. The TC-distance of intraatrial catheters was 39, 55, 59, 80, and 83 mm, respectively. Thus, a TC-distance < or = 55 mm ensured extraatrial tip position in four of five intraatrial CVCs (80%, p = 0.002). The TC-distance of extraatrial catheters ranged from - 26 to 102 mm. Reading of a bedside CXR alone is not very accurate to identify intraatrial CVC tip position. TC-distance is a helpful marker, and its specificity is as good as that of an experienced radiologist if a cutoff value of 55 mm is chosen.

Sodium citrate 4% versus heparin as a lock solution in hemodialysis patients with central venous catheters.

PubMed

Yon, Calantha K; Low, Chai L

2013-01-15

The effects of heparin versus sodium citrate 4% as a lock solution on catheter-related infections (CRIs), catheter patency, and hospitalizations in long-term hemodialysis patients with central venous catheters (CVCs) were compared. Data for patients receiving heparin lock solutions were collected from July 2008 to July 2009. Data on patients receiving sodium citrate 4% lock solution were collected from September 2009 through December 2010. Patients who were receiving the heparin lock solution who continued to have a CVC in September 2009 were transitioned from heparin to sodium citrate catheter 4% lock solution. New patients with CVCs placed after September 2009 received sodium citrate 4% without a period of using heparin lock solution. Pertinent information on patient medical history, bleeding or clotting events, infections, and hospitalization was collected. Data were collected retrospectively for the heparin group and prospectively for the sodium citrate group. Data were collected from 360 patient-months among 60 patients during the heparin treatment period and from 451 patient-months among 58 patients during the sodium citrate period. Thirty-three patients were common to both study groups. There were significantly more CRIs and CRIs per 1000 catheter-days in the heparin than the sodium citrate treatment group. Secondary outcomes of hospitalizations and catheter thrombosis were comparable. CRIs and thrombosis led to significantly more catheter exchanges or removals in the heparin group than the sodium citrate group. In patients with long-term hemodialysis catheters, a lock solution of sodium citrate 4% was associated with fewer CRIs and similar effectiveness when compared with heparin 5000 units/mL.

High dose urokinase for restoration of patency of occluded permanent central venous catheters in hemodialysis patients.

PubMed

Shavit, L; Lifschitz, M; Plaksin, J; Grenader, T; Slotki, I

2010-10-01

Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes. Technical success was defined as restoring blood pump speed to at least 250 ml/min. We determined the average time from catheter placement to first clot event (primary patency PP), recurrent clot event after urokinase treatment (secondary patency SP), catheter salvage rate and cause for removal. 37 catheters developed total thrombosis and urokinase was used to restore patency one or more times (total 47 treatments). Catheter salvage rate was 97 %. The average time of PP was 152 ± 56 days (7 - 784 days). Nine patients (30%) developed recurrent occlusion and the average time of SP was 64 ± 34 days (2 - 364 days). One catheter was removed because of dysfunction due to thrombosis. Other catheters were removed due to infection, fistula maturation or fell out spontaneously. Hemodialysis was performed immediately after treatment with blood speed of 250 ml/min in all patients. Our protocol is highly effective, short, and allows to restore patency of totally occluded central venous catheters with minimal disruption of the dialysis session.

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

Intracranial developmental venous anomaly: is it asymptomatic?

PubMed

Puente, A Bolívar; de Asís Bravo Rodríguez, F; Bravo Rey, I; Romero, E Roldán

2018-03-16

Intracranial developmental venous anomalies are the most common vascular malformation. In the immense majority of cases, these anomalies are asymptomatic and discovered incidentally, and they are considered benign. Very exceptionally, however, they can cause neurological symptoms. In this article, we present three cases of patients with developmental venous anomalies that presented with different symptoms owing to complications derived from altered venous drainage. These anomalies were located in the left insula, right temporal lobe, and cerebellum. The exceptionality of the cases presented as well as of the images associated, which show the mechanism through which the symptoms developed, lies in the low incidence of symptomatic developmental venous anomalies reported in the literature. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency.

PubMed

Ercan, Sabriye; Çetin, Cem; Yavuz, Turhan; Demir, Hilmi M; Atalay, Yurdagül B

2018-05-01

Objective The aim of this study was to observe the change of the ankle joint range of motion, the muscle strength values measured with an isokinetic dynamometer, pain scores, quality of life scale, and venous return time in chronic venous insufficiency diagnosed patients by prospective follow-up after 12-week exercise program including isokinetic exercises. Methods The patient group of this study comprised 27 patients (23 female, 4 male) who were diagnosed with chronic venous insufficiency. An exercise program including isokinetic exercise for the calf muscle was given to patients three days per week for 12 weeks. At the end of 12 weeks, five of the patients left the study due to inadequate compliance with the exercise program. As a result, control data of 22 patients were included. Ankle joint range of active motion, isokinetic muscle strength, pain, quality of life, and photoplethysmography measurements were assessed before starting and after the exercise program. Results Evaluating changes of the starting and control data depending on time showed that all isokinetic muscle strength measurement parameters, range of motion, and overall quality of life values of patients improved. Venous return time values have also increased significantly ( p < 0.05). Conclusion In conclusion, increase in muscle strength has been provided with exercise therapy in patients with chronic venous insufficiency. It has been determined that the increase in muscle strength affected the venous pump and this ensured improvement in venous function and range of motion of the ankle. In addition, it has been detected that pain reduced and quality of life improved after the exercise program.

Detection of deep venous thrombophlebitis by gallium 67 scintigraphy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, J.H.

1981-07-01

Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.

Detection of deep venous thrombophlebitis by Gallium 67 scintigraphy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, J.H.

1981-07-01

Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.

A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency.

PubMed

Aguilar-Ferrándiz, M Encarnación; Castro-Sánchez, Adelaida María; Matarán-Peñarrocha, Guillermo A; Guisado-Barrilao, Rafael; García-Ríos, M Carmen; Moreno-Lorenzo, Carmen

2014-01-01

To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency. A double-blinded randomized clinical trial. Clinical setting. One hundred and twenty postmenopausal women with mild-moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping. MAIN OUTCOMES VARIABLES: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment. The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness (F = 22.99, p = 0.002), claudication (F = 8.57, p = 0.004), swelling (F = 22.58, p = 0.001), muscle cramps (F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity (F = 18.47, p = 0.001), physical function (F = 9.15, p = 0.003) and body pain (F = 3.36, p = 0.043). Both groups reported significant reduction in pain. Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

A study to evaluate patterns of superficial venous reflux in patients with primary chronic venous disease.

PubMed

Qureshi, Mahim I; Gohel, Manj; Wing, Louise; MacDonald, Andrew; Lim, Chung S; Ellis, Mary; Franklin, Ian J; Davies, Alun H

2015-08-01

This study assessed patterns of superficial reflux in patients with primary chronic venous disease. Retrospective review of all patient venous duplex ultrasonography reports at one institution between 2000 and 2009. Legs with secondary, deep or no superficial reflux were excluded. In total, 8654 limbs were scanned; 2559 legs from 2053 patients (mean age 52.3 years) were included for analysis. Great saphenous vein reflux predominated (68%), followed by combined great saphenous vein/small saphenous vein reflux (20%) and small saphenous vein reflux (7%). The majority of legs with competent saphenofemoral junction had below-knee great saphenous vein reflux (53%); incompetent saphenofemoral junction was associated with combined above and below-knee great saphenous vein reflux (72%). Isolated small saphenous vein reflux was associated with saphenopopliteal junction incompetence (61%), although the majority of all small saphenous vein reflux limbs had a competent saphenopopliteal junction (57%). Superficial venous reflux does not necessarily originate from a saphenous junction. Large prospective studies with interval duplex ultrasonography are required to unravel the natural history of primary chronic venous disease. © The Author(s) 2014.

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

PubMed

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

2016-12-01

Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Protective Effects of Micronized Purified Flavonoid Fraction (MPFF) on a Novel Experimental Model of Chronic Venous Hypertension.

PubMed

das Graças C de Souza, Maria; Cyrino, Fatima Zga; de Carvalho, Jorge J; Blanc-Guillemaud, Vanessa; Bouskela, Eliete

2018-05-01

To assess protective effects of micronized purified flavonoid fraction (MPFF) on microcirculation in an original chronic model of hind limb venous hypertension with low blood flow in small animals. Vein ligatures were performed on male hamsters, as follows: A-right femoral vein; A + B-right femoral vein and its right branch; A + C-right femoral vein and its left branch; A + B + C-right femoral and its right and left branches; D-external right iliac vein. In sham operated groups, similar vascular dissections were performed without ligatures. Superficial (epigastric) and central (jugular) venous pressure evaluations were made during a 10 week period. Hamsters subjected to A + B + C and D ligatures were selected for leukocyte rolling and sticking, functional capillary density (FCD), and venular and arteriolar diameter observations. D ligature was selected to evaluate pharmacological treatment efficacy. MPFF (100 mg/kg), concomitant active flavonoids of MPFF (diosmetin, hesperidin, linarin, and isorhoifolin) (10 mg/kg), diosmin (100 mg/kg) or drug vehicle were administered orally during 2 weeks before vein ligature and 6 weeks thereafter. A, A + B and A + C models maintained venous return through collaterals. From the 2 nd to the 10 th weeks after vein ligatures, A + B + C and D models elicited a progressive increase of superficial venous pressure (3.83 ± 0.65 vs. 8.56 ± 0.72 mmHg, p < .001 and 4.13 ± 0.65 vs. 9.35 ± 0.65 mmHg, p < .001, respectively) with significant changes to the microcirculation. As D model significantly increased superficial venous pressure without affecting central venous pressure, it was used to evaluate the long-term effects of treatment. Compared with vehicle, MPFF, concomitant active flavonoids of MPFF, and diosmin, significantly decreased leukocyte-endothelium interaction and prevented FCD reduction. Only MPFF significantly prevented venular enlargement as observed in the vehicle treated group. MPFF

Prophylactic antibiotics for preventing early Gram-positive central venous catheter infections in oncology patients, a Cochrane systematic review.

PubMed

van de Wetering, M D; van Woensel, J B M; Kremer, L C M; Caron, H N

2005-05-01

Long-term tunnelled central venous catheters (TCVC) are increasingly used in oncology patients. Infections are a frequent complication of TCVC, mostly caused by Gram-positive bacteria. The objective of this review is to evaluate the efficacy of antibiotics in the prevention of early Gram-positive TCVC infections, in oncology patients. We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register up to July 2003. We selected randomised controlled trials (RCT) evaluating prophylactic antibiotics prior to insertion of the TCVC, and the combination of an antibiotic and heparin to flush the TCVC, in paediatric and adult oncology patients. The primary outcome was documented Gram-positive bacteraemia in patients with a TCVC. All trials identified were assessed and the data extracted independently by two reviewers. There were nine trials included. Four trials reported on vancomycin/teicoplanin prior to insertion of the TCVC compared to no antibiotics. There was no reduction in the number of Gram-positive TCVC infections with an Odds ratio of 0.42 (95% confidence interval 0.13-1.31). Five trials studied flushing of the TCVC with a vancomycin/heparin solution compared to heparin flushing only. This method decreased the number of TCVC infections significantly with an Odds ratio of 0.43 (95% CI 0.21-0.87). Flushing the TCVC with a vancomycin/heparin solution reduced the incidence of Gram-positive infections.

Three-dimensional venous anatomy of the dermis observed using stereography

PubMed Central

Imanishi, Nobuaki; Kishi, Kazuo; Chang, Hak; Nakajima, Hideo; Aiso, Sadakazu

2008-01-01

Veins of the dermis have been investigated mainly by histological methods in the fields of anatomy and histology, and a large number of schemata of the veins have been depicted in a variety of textbooks. However, the schemata are usually two-dimensional and it is therefore difficult to envisage the actual vasculature of the dermal veins. In this study, we performed a stereographic study of the skin of three fresh cadavers that had been injected with radio-opaque dye, which was dispersed throughout the entire body. A venous network consisting of venous polygons of various sizes existed just under the dermis or in the deep zone of the dermis, which is generally called the subdermal venous plexus. There were many small vessels towards the inside of each venous polygon, and most of them ascended, branching off stereoscopically. Those branches anastomosed with each other, and they formed the dermal and subpapillary venous plexuses. However, there was little vascular connection between dermal venous plexuses of different venous polygons. The characteristic structure of the dermal venous plexus has been considered to bring about venous congestion of the skin in various clinical situations. PMID:18422525

A mixed-reality part-task trainer for subclavian venous access.

PubMed

Robinson, Albert R; Gravenstein, Nikolaus; Cooper, Lou Ann; Lizdas, David; Luria, Isaac; Lampotang, Samsun

2014-02-01

Mixed-reality (MR) procedural simulators combine virtual and physical components and visualization software that can be used for debriefing and offer an alternative to learn subclavian central venous access (SCVA). We present a SCVA MR simulator, a part-task trainer, which can assist in the training of medical personnel. Sixty-five participants were involved in the following: (1) a simulation trial 1; (2) a teaching intervention followed by trial 2 (with the simulator's visualization software); and (3) trial 3, a final simulation assessment. The main test parameters were time to complete SCVA and the SCVA score, a composite of efficiency and safety metrics generated by the simulator's scoring algorithm. Residents and faculty completed questionnaires presimulation and postsimulation that assessed their confidence in obtaining access and learner satisfaction questions, for example, realism of the simulator. The average SCVA score was improved by 24.5 (n=65). Repeated-measures analysis of variance showed significant reductions in average time (F=31.94, P<0.0001), number of attempts (F=10.56, P<0.0001), and score (F=18.59, P<0.0001). After the teaching intervention and practice with the MR simulator, the results no longer showed a difference in performance between the faculty and residents. On a 5-point scale (5=strongly agree), participants agreed that the SCVA simulator was realistic (M=4.3) and strongly agreed that it should be used as an educational tool (M=4.9). An SCVA mixed simulator offers a realistic representation of subclavian central venous access and offers new debriefing capabilities.

Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study.

PubMed

Rogers, Mary A M; Blumberg, Neil; Bernstein, Steven J; Flanders, Scott A; Chopra, Vineet

2016-12-01

Mechanisms of red blood cell delivery and their contribution to the incidence of venous thromboembolism are not well understood in the clinical setting. We assessed whether red blood cell transfusion through peripherally inserted central catheters (PICCs) affects the risk of venous thromboembolism compared with transfusion through non-PICC devices. We implemented a prospective study between Jan 1, 2013, and Sept 12, 2015, in patients (age ≥18 years) admitted to a general medicine ward or intensive care unit who received a PICC for any reason during clinical care in 47 hospitals in Michigan, USA, with a maximum follow-up of 70 days. The exposure of interest was route of red blood cell transfusion. The primary outcome was symptomatic, radiographically confirmed, deep-vein thrombosis in the arm or leg or pulmonary embolism. We used Cox proportional hazards regression for analyses. Venous thromboembolism developed in 482 (5%) of 10 604 patients with PICCs. Of 788 patients who received a red blood cell transfusion through a multi-lumen PICC, 61 had venous thromboembolism. The adjusted hazard ratio (HR) for venous thromboembolism in all patients whose transfusions were administered through a multi-lumen PICC was 1·96 (95% CI 1·47-2·61; p<0·0001) compared with patients not receiving a transfusion, and was 1·79 (1·09-2·95; p=0·022) compared with patients transfused through a peripheral intravenous line. Compared with delivery through a peripheral intravenous line, venous thromboembolism risk was not elevated if transfusions were delivered through a single-lumen PICC (HR 0·98, 95% CI 0·44-2·14; p=0·95) or central venous catheter (1·50, 0·77-2·91; p=0·23). For every red blood cell unit transfused through a PICC, there was a significantly increased risk of venous thromboembolism (adjusted HR 1·24, 95% CI 1·01-1·52; p=0·037). Patients who received a transfusion through a PICC in the left arm were significantly more likely to develop a deep

A Contemporary Assessment of Mechanical Complication Rates and Trainee Perceptions of Central Venous Catheter Insertion.

PubMed

Heidemann, Lauren; Nathani, Niket; Sagana, Rommel; Chopra, Veneet; Heung, Michael

2017-08-01

Limited data exist regarding rates of mechanical complications of ultrasound-guided, nontunneled central venous catheters (CVC). Similarly, trainee perceptions surrounding CVC complications are largely unknown. To evaluate contemporary CVC mechanical complication rates, associated risk factors, and trainee perspectives. A single-center retrospective review of CVC procedures between June 1, 2014, and May 1, 2015. Electronic survey distributed to internal medicine trainees. Intensive care units and the emergency department at an academic hospital. Electronic health records of patients with CVC procedures were reviewed for complications. Demographic and procedural characteristics were compared for complicated vs uncomplicated procedures. Student t tests and chi-square tests were used to compare continuous and categorical variables, respectively. Of the 730 reviewed records, 14 serious mechanical complications occurred due to pneumothorax (n = 5), bleeding (n = 3), vascular injury (n = 3), stroke (n = 1), and death (n = 2). Risk factors for complicated vs uncomplicated CVC placement included subclavian location (21.4% vs 7.8%, = 0.001), number of attempts (2.2 vs 1.5, = 0.02), unsuccessful CVC (21.4% vs. 4.3%, = 0.001), attending supervision (61.5% vs 34.7%, = 0.04), low body mass index (mean 25.7 kg/ m² vs 31.5 kg/m², = 0.001), anticoagulation (28.6% vs 20.6%, = 0.048), and ventilation (78.5% vs 66.5%, = 0.001). Survey data suggested deficiencies in managing unsuccessful CVC procedures; specifically, only 35% (N = 21/60) of trainees regularly perform chest x-rays after failed CVC attempt. We observed a 1.9% rate of mechanical complications associated with CVC placement. Our study confirms historical data that unsuccessful CVC attempts are an important risk factor for complications. Education regarding unsuccessful CVC placement may improve patient safety. © 2017 Society of Hospital Medicine

Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review.

PubMed

Rahn, David D; Mamik, Mamta M; Sanses, Tatiana V D; Matteson, Kristen A; Aschkenazi, Sarit O; Washington, Blair B; Steinberg, Adam C; Harvie, Heidi S; Lukban, James C; Uhlig, Katrin; Balk, Ethan M; Sung, Vivian W

2011-11-01

To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines. MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery populations. Interventions and comparators included graduated compression stockings, intermittent pneumatic compression, unfractionated heparin, and low molecular weight heparin; placebo and routine postoperative care were allowed as comparators. One thousand two hundred sixty-six articles were screened, and 14 randomized controlled trials (five benign gynecologic, nine gynecologic oncology) met eligibility criteria. In addition, nine prospective or retrospective studies with at least 150 women were identified and provided data on venous thromboembolism risk stratification, gynecologic laparoscopy, and urogynecologic populations. Two reviewers independently screened articles with discrepancies adjudicated by a third. Eligible randomized controlled trials were extracted for these characteristics: study, participant, surgery, intervention, comparator, and outcomes data, including venous thromboembolism incidence and bleeding complications. Studies were individually and collectively assessed for methodologic quality and strength of evidence. Overall incidence of clinical venous thromboembolism was 0-2% in the benign gynecologic population. With use of intermittent pneumatic compression for benign major procedures, venous thromboembolism incidence was less than 1%. No venous thromboembolisms were identified in prospective studies of benign laparoscopic procedures. Overall quality of evidence in the benign gynecologic literature was poor. Gynecologic-oncology randomized controlled trials reported venous thromboembolism incidence (including "silent" venous thromboembolisms) of 0-14.8% with prophylaxis and up to 34.6% without prophylaxis. Fair quality of evidence supports that