Catheter Course Research Articles

Complications Related to the Securement Device in Peripheral Intravenous Catheters: A Randomized Study.

Studies have not demonstrated the effectiveness of the different types of dressings in reducing the rate of complications. The purpose of this study was to determine which type of dressing is most beneficial in reducing the rate of complications. A total of 281 patients requiring a peripheral intravenous catheter were randomized to receive partially reinforced dressings or fully reinforced dressings (dressings with integral catheter securement). Patients were followed throughout their entire catheter course, and complications included infection, occlusion, phlebitis, accidental dislodgement, extravasation, and medical adhesive-related skin injury. Catheter outcome data were compared to determine whether statistically significant differences existed between the 2 groups. The groups had equivalent demographic characteristics and catheter indications. The average securement time with partially reinforced dressings was 2.72days, and that for fully reinforced dressings was 2.64days. However, catheters secured with fully reinforced dressings were associated with fewer total complications, such as infectious phlebitis (P =.043) and accidental dislodgement (P =.03). The fully reinforced securement device significantly reduced the rate of complications related to accidental dislodgement of the device and cases of infectious phlebitis. The use of fully reinforced dressings could reduce catheter-associated complications and improve the quality of patient care.

Retroflexed catheter course reduces the risk of right free wall accessory pathway recurrence.

Accessory atrioventricular pathways (APs) may mediate atrioventricular reciprocating tachycardia and, in some cases, have the potential to conduct atrial tachycardia rapidly, which can be life threatening. While catheter ablation can be curative, ablation of right free wall APs is associated with a high rate of recurrence, likely secondary to reduced catheter stability along the right free wall atrioventricular groove. We sought to identify characteristics associated with a lower rate of recurrence and hypothesized ablation lesions placed on the ventricular side of the atrioventricular groove using a retroflexed catheter approach would decrease rates of recurrence. Retrospective chart review of patients who underwent catheter ablation of a right free wall AP from January 1, 2008 through June 1, 2021 with >2 months follow up. Cox proportional hazards regression was used to identify relationships between predictor variables and AP recurrence. We identified 95 patients who underwent ablation of 98 right free wall APs. Median age was 13.1 years and median weight at ablation was 52.3 kg. Overall, 23/98 (23%) APs recurred. Use of a retroflexed catheter course approaching the atrioventricular groove from the ventricular aspect was associated with reduced risk of AP recurrence with (univariable hazard ratio of 0.10 [95% confidence interval: 0.01-0.78]), which remained significant in multiple two variable Cox proportional hazards models. Use of a retroflexed catheter course is associated with a reduced likelihood of AP recurrence. This approach results in improved catheter stability and should be considered for ablation of right free wall APs.

Extra cardiac perforation following failed percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy (PTMC) is the procedure of choice for select patients with mitral valve disease who have favorable valve architecture and meet the requirements for balloon valve dilatation. Complications following PTMC are rare (<3%). A 56-year-old woman with rheumatic valvular heart disease, severe mitral stenosis and moderate mitral regurgitation in atrial fibrillation underwent elective PTMC. She developed an extra-cardiac perforation during PTMC because of abnormal catheter course, and underwent emergency mitral valve replacement with extra-cardiac perforation repair. Catheter-related complications following PTMC are rare but not unheard of. Prompt management of immediate complications result in favorable outcomes.

Unusual Course of a Pulmonary Artery Catheter Due to Absence of Right Superior Vena Cava.

The persistent left superior vena cava may complicate the placement of vascular access. It rarely occurs with an absence of the right superior vena cava. We present a chest X-ray of a patient with this rare anomaly that was demonstrated incidentally with an unusual course of a pulmonary artery catheter course.

Physical Simulation of Transcatheter Edge-to-Edge Repair Using Image-Derived 3D Printed Heart Models

BackgroundTranscatheter edge-to-edge valve repair (TEER) is a complex procedure requiring delivery and alignment of the device to the target valve, which can be challenging in atypical or surgically palliated anatomy. We demonstrate application of virtual and physical simulation to plan optimal TEER access and catheter path in normal and congenitally abnormal cardiac anatomy. MethodsThree heart models were created from 3-dimensional (3D) images and 3D printed, including 2 with congenital heart disease. TEER catheter course was simulated both virtually and physically using a commercial TEER system. ResultsWe demonstrate application of modeling in 3 patients, including 2 with congenital heart disease and a Fontan circulation. Access site and pathway to device delivery were simulated by members of a multidisciplinary valve team. Virtual and physical simulations were compared. ConclusionsVirtual and physical simulation of TEER using 3D printed heart models is feasible and may be beneficial for planning and simulation, particularly in patients with complex anatomy. Future work is required to demonstrate application in the clinical setting.

Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks.

Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.

Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes.

This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT). Although catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure. An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT. Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range: 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11). T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.

An Unusual Association of lEft-Sided Inferior Vena Cava with Slow-Fast Atrioventricular Reentrant Tachycardia

We report an extremely rare association of left-sided inferior vena cava (IVC) in a 38-year-old female presenting with recurrent palpitation for the past 2 years with typical slow-fast atrioventricular reentrant tachycardia (AVNRT). We delineated the course of the left-sided IVC with pigtail injection and catheter course to the right atrium and successfully modified the slow pathway with conventional catheters with difficulty in ablation catheter maneuvering and his catheter stability was an issue. Our case is the first description of an unusual association of isolated left-sided IVC in a patient with typical AVNRT.

High-Resolution MRI for Evaluation of Ventriculostomy Tubes: Assessment of Positioning and Proximal Patency.

Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated breath-hold examination sequences, in the evaluation of ventriculostomy catheters. We performed a retrospective review of 23 clinical MR imaging cases of shunted hydrocephalus spanning a 3-year period, all depicting ventriculostomy catheters. The MR imaging examinations included isotropic CISS and volumetric interpolated breath-hold examination sequences performed with and without contrast. These were independently evaluated by 2 neuroradiologists with respect to the catheter course, side hole position, relationship of the side holes to the ventricles, patency, and the presence or absence of intraluminal debris. The catheter tip was best seen on isotropic CISS sequences reformatted in an oblique plane, and side holes were visualized as CSF signal defects along the catheter wall in 10/23 (43%) cases. The relationship of the catheter side holes to the ventricles was seen in 47% of cases and was best visualized on the coronal CISS sequences. Catheter patency was confirmed in 12/23 (52%) cases, while the other 48% were notable for T2 hypointense filling defects compatible with luminal obstruction. Enhancement of some of these filling defects on imaging is suggestive of choroid plexus ingrowth rather than debris. High-resolution 3D MR imaging using isotropic CISS sequences allows systematic evaluation of catheter positioning, patency, and potential etiologic differentiation of filling defects when shunt dysfunction is suspected.

Imaging evaluation of catheter integrity prevent potentially fatal complication of pinch-off syndrome: illustration of two cases.

Peripherally inserted central catheters (PICC) and implantable venous access devices with an attached catheter such as a Port-A-Cath are common types of central venous catheters (CVC) that are used to deliver chemotherapy and other medications. Subclavian vein (SVC) access for CVC, although widely practiced, presents risks for catheter complications such as the compression of the catheter in the space anterior to the first rib and posterior to the clavicle (1). This compression is rated on a scale of grades 0 to 3 pinch-off syndrome (POS). Grade 0 exhibits a regular catheter course without luminal narrowing; grade 1 exhibits an altered catheter course without luminal narrowing; grade 2 exhibits luminal narrowing; and grade 3 exhibits catheter fracture (2). POS may present with pain or swelling of the shoulder region but patients may also be asymptomatic (3). Additionally, POS can be an incidental finding seen on a chest X-ray (4). Regardless, clinicians should suspect a possible POS if there is patient-reported pain or an abnormal catheter pathway seen on a chest X-ray. Further investigation via radiographic or fluoroscopic evaluation is warranted. Early detection of POS requires only catheter replacement but failure to intervene may result in life-threatening complications caused by catheter fragmentation. In such cases, pieces of the catheter may break off to cause ventricular tachycardia, vessel embolization, and cardiac perforation (5-7). In this report, we discuss two cases of grade 3 POS that were detected based on clinical and radiographic signs.

Intraoperative Hybrid Stenting of Recurrent Coarctation and Arch Hypoplasia with Large Stents in Patients with Univentricular Hearts

Objective: Obstruction of the reconstructed aortic arch, tubular hypoplasia and recurrent coarctation (RC) is an important risk factor after the Norwood procedure or similar surgery. Balloon angioplasty (BA) may be effective but pressure gradient relief is often incomplete, with a high incidence of restenosis usually within the first year. Percutaneous interventions may have an increased risk due to limited vascular access or a very tortuous catheter course. Combining operative and interventional approaches (hybrid procedures) with direct puncture of the heart or the great vessels may facilitate implantation of even large devices. For the past two years we have adopted the concept of intraoperative hybrid stenting of RC and arch hypoplasia with large stents in patients with univentricular hearts as standard care procedure.

Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children

Background/PurposeOptimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children. MethodsWe performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA). ResultsTwo derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA+7cm, and for the right subclavian vein approach it was 5*BSA+6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children. ConclusionThe optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.

P73 The creation of a simulated pan-deanery medical thoracoscopy and indwelling pleural catheter course

IntroductionMedical thoracoscopy (MT) and indwelling pleural catheter (IPC) insertion are becoming increasingly utilised for the purposes of diagnostic and therapeutic intervention in pleural disease. We are at the cusp of...

“Extracaval Shepherd's Crook” Sign

Inaccurate positioning is a well-known and documented complication of central venous catheterization. Inadvertent placement of a central venous catheter into the right internal thoracic vein has been reported in the literature; however, the characteristic radiographic appearance for this complication has yet to be described. We report 3 cases that demonstrate central venous catheters improperly terminating in the right internal jugular vein. Characteristic radiographic findings of this altered catheter course are described. Recognition of these characteristic findings should prompt consideration for line repositioning or replacement.

Aberrant course of the umbilical vein in a newborn with Cornelia de Lange syndrome

Congenital anomalies of the umbilical vein are rare. We describe an aberrant course of the umbilical vein discovered by identifying an unusual umbilical venous catheter course on abdominal radiography in a patient with Cornelia de Lange syndrome. The umbilical vein bypassed the liver to insert directly into a right pelvic vein. Use of the lateral abdominal radiograph and sonography were helpful in determining the catheter location after identifying the unusual course of the catheter on the frontal radiograph.

Hybrid procedures can reduce the risk of congenital cardiovascular surgery

Objective: Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course. In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices.

Hybrid procedures can reduce the risk of congenital cardiovascular surgery

Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter course. In these cases, combining operative and interventional approaches with direct puncture of the heart or the great vessels may facilitate implantation of even large devices. Furthermore, in some situations, cardiopulmonary bypass or circulatory arrest can be omitted when doing a hybrid procedure. Between January 2000 and April 2007 17 patients were operated in a hybrid fashion. Age ranged from 14 days to 45 years. Operative procedures consisted of implantation of an atrial septal defect occluder via direct puncture of the right atrium (n=4), closure of a ventricular septal defect via direct puncture of the right ventricle (n=1), implantation of isthmus stents via the ascending aorta (n=5), redilation of an isthmus stent (n=1), redilation of a ductal stent (n=1), angioplasty of a pulmonary artery stenosis (n=1), interventional occlusion of an intrahepatic porto-caval shunt (n=1), stent implantation into the right pulmonary artery (n=1) and into the right ventricular outflow tract (n=1) under direct vision as well as atrioseptoplasty combined with a bilateral pulmonary artery banding in one newborn with a single ventricle and very low birth weight (n=1). The planned intervention could be performed in all cases under the assistance of intraoperative fluoroscopy, transesophageal or epicardial echocardiography, or under direct vision. In all cases, the primary hemodynamic objectives were achieved. In selected patients, the combination of a surgical procedure and a percutaneous intervention may help to reduce both operative and interventional risks. This concept may enable new treatment options, especially in patients with complex congenital heart defects or complex vascular situations.

A novel, simplified pediatric syringopleural shunt

The diversion of fluid from an intramedullary syrinx cavity is an option for the treatment of syringomyelia. The authors have modified the technique of shunting syrinx fluid to the pleural space with the aid of a simple short tube and a single incision; this is a one-stage operation in pediatric patients. The advantages of this technique include the use of familiar standard neurosurgical techniques, the availability of shunt components, a short, direct catheter course, the minimization of a siphoning effect secondary to improved catheter tip placement, and the use of pleural rather than peritoneal space. In this small series the technique of syringopleural shunting has proved simple, safe, and well tolerated by pediatric patients.

Fístula broncovascular: complicação de cateter venoso central percutâneo em neonato

To present a case of central venous line misplacement with vasculo-pulmonary fistula and severe respiratory consequences in a newborn. To review the literature concerning respiratory and non-respiratory complications related to the introduction of percutaneously placed central venous lines in children. Evaluative and diagnostic data were described after patient chart review. A premature newborn was admitted in a NICU after delivery for treatment of low-grade hyaline membrane disease and infection manifested afterwards. In the day after the introduction of the percutaneously placed central venous catheter, in order to provide parenteral nutrition, respiratory distress began with rapid progression. Mechanical ventilation was demanded to establish proper gas exchange. The complication was revealed after checking the catheter course using radiographic contrast. Complications associated with central venous catheter insertion are not rare and infection is the most frequent one. It is essential that the caretakers be aware of the many less frequent ones like vascular thrombosis and catheter misplacement with organ injury and extravascular fluids collections. Only one description related to this kind of complication verified in our patient was found in newborns. This singular characteristic may have resulted in embarrassment for rapid diagnosis. Care related aspects, after catheter insertion, that could make easier the prompt recognition of these complications are emphasized.

Sutureless Securement Device Reduces Complications of Peripherally Inserted Central Venous Catheters

This study was conducted to evaluate the performance of a sutureless adhesive-backed device, StatLock, for securement of peripherally inserted central venous catheters (PICCs). Earlier studies have demonstrated that StatLock significantly reduces catheter-related complications when compared to tape. The purpose of this study was to determine whether a sutureless securement device offers an advantage over suture in preventing catheter-related complications. 170 patients requiring PICCs, which were randomized to suture (n = 85) or StatLock (n = 85) securement were prospectively studied. Patients were followed throughout their entire catheter course, and PICC-related complications including dislodgment, infection, occlusion, leakage, and central venous thrombosis were documented. Catheter outcome data were compared to determine if statistically significant differences existed between the suture and StatLock groups. The groups had equivalent demographic characteristics and catheter indications. Average securement time with StatLock was significantly shorter (4.7 minutes vs 2.7 minutes;P <.001). Although StatLock was associated with fewer total complications (42 vs 61), this difference did not achieve significance. However, there were significantly fewer PICC-related bloodstream infections in the StatLock group (2 vs 10; P =.032). One securement-related needle-stick injury was documented during suturing of a PICC. The sutureless anchor pad was beneficial for both patients and health care providers. Further investigation to determine how StatLock helps reduce catheter-related blood stream infections is necessary.