Catheter Malfunction Research Articles

Complications associated with pulsed field ablation versus radiofrequency catheter ablation of atrial fibrillation

BackgroundThe first commercial systems for pulsed field ablation(PFA) were recently approved by the Food and Drug Administration(FDA), but their safety profile in nationwide practice remains underexplored. ObjectiveThis study aimed to describe reported adverse events with PFA systems after their market release and to compare the relative proportion of complications associated with PFA versus radiofrequency(RF) ablation catheters. MethodsWe conducted a search of the Manufacturer and User Facility Device Experience database for adverse event reports involving FDA-approved PFA and RF catheters between January 1, 2024, to July 31, 2024. ResultsA total of 1,237 reports detailing clinical complications (N=156 for PFA and N=315 for RF) or catheter malfunctions (N=336 for PFA and N=430 for RF) were analyzed. The most common adverse events reported for PFA were pericardial effusion, vasovagal response, and hemolysis, and for RFA were pericardial effusion, ischemic stroke, and esophageal damage. The proportion of reported adverse events that were deaths was lower among PFA compared to RF (2.6% vs. 8.9%, P=0.010). Hemolysis (9.0% vs. 0%), coronary events (5.8% vs. 0.6%), and vasovagal responses (14.1% vs. 0%) were reported more frequently after PFA (all P<0.001). In contrast, esophageal damage (0% vs. 4.1%, P<0.001) and pulmonary vein stenosis (0% vs. 1.9%, P=0.184) were not reported with PFA, only with RF. Regarding catheter malfunctions, mechanical problems were reported in greater proportion after PFA compared with RF (87.2% vs. 17.2%, P<0.001). ConclusionThe reported complications associated with PFA and RF ablation differ significantly. Close attention to PFA-specific complications is essential for ensuring the safe use of PFA and for mitigating risk.

Efficacy of urokinase in maintaining patency of hemodialysis catheters: Ameta-analysis.

Catheter malfunctions are associated with reduced blood flow and interrupted dialysis during hemodialysis. This meta-analysis aimed to determine whether the use of urokinase to lock hemodialysis catheters can maintain their patency and prevent catheter-related bloodstream infections (CRBSIs). The PubMed, Cochrane Library, Web of Science, Embase, and Chinese medical databases were searched for controlled trials of hemodialysis catheter locking using urokinase from database inception until July 15, 2021. The primary outcome was catheter malfunction, and the secondary outcomes were the peak catheter blood flow rate (Qb) and CRBSIs. Across 16 trials, 1,041 patients were randomized to receive either urokinase/urokinase mixture (treated) or heparin (control) locks once or thrice a week. Locking with urokinase alone or in combination with another substance significantly prevented catheter malfunction. The effect on Qb was significant, with that in the treated group being better than in the control group. Similarly, the incidence of CRBSIs in the treated group was lower. Urokinase locking maintains catheter patency more effectively than heparin. Prophylactic locking with urokinase or urokinase mixtures reduces incidences of catheter malfunction, which ensures the smooth progression of hemodialysis and reduces patient medical costs. The results of this study have important clinical implications and will provide guidance to medical practitioners globally.

Salvaging intraluminal peritoneal dialysis catheter obstruction from blood clot with a targeted thrombolytic agent: an innovation.

Peritoneal dialysis (PD) catheter malfunction commonly leads to the removal of the catheter and eventually to a transfer to hemodialysis. The most common cause is intraluminal obstruction caused by blood and fibrin clots. Recommended interventions include irrigation of the catheter with heparinized saline; if this method fails, thrombolytic agents may be used. Mechanical methods such as intraluminal brushing are also utilized, typically after medical treatment fails. Here, we present a case of a patient who developed an intraluminal blood clot that persisted despite attempts with intraluminal thrombolytic drugs and intraluminal brushing. To salvage the catheter, targeted thrombolysis was performed using an endoscopic retrograde cholangiopancreatography (ERCP) guidewire to reinforce the coiled PD catheter and puncture the clots. Additionally, a Swing Tip cannula was employed for direct injection of the thrombolytic agent. These interventions successfully preserved the catheter, resolving the clot and ensuring continued functionality.

Detection and position evaluation of chest percutaneous drainage catheter on chest radiographs using deep learning.

This study aimed to develop an algorithm for the automatic detecting chest percutaneous catheter drainage (PCD) and evaluating catheter positions on chest radiographs using deep learning. This retrospective study included 1,217 chest radiographs (proper positioned: 937; malpositioned: 280) from a total of 960 patients underwent chest PCD from October 2017 to February 2023. The tip location of the chest PCD was annotated using bounding boxes and classified as proper positioned and malpositioned. The radiographs were randomly allocated into the training, validation sets (total: 1,094 radiographs; proper positioned: 853 radiographs; malpositioned: 241 radiographs), and test datasets (total: 123 radiographs; proper positioned: 84 radiographs; malpositioned: 39 radiographs). The selected AI model was used to detect the catheter tip of chest PCD and evaluate the catheter's position using the test dataset to distinguish between properly positioned and malpositioned cases. Its performance in detecting the catheter and assessing its position on chest radiographs was evaluated by per radiographs and per instances. The association between the position and function of the catheter during chest PCD was evaluated. In per chest radiographs, the selected model's accuracy was 0.88. The sensitivity and specificity were 0.86 and 0.92, respectively. In per instance, the selected model's the mean Average Precision 50 (mAP50) was 0.86. The precision and recall were 0.90 and 0.79 respectively. Regarding the association between the position and function of the catheter during chest PCD, its sensitivity and specificity were 0.93 and 0.95, respectively. The artificial intelligence model for the automatic detection and evaluation of catheter position during chest PCD on chest radiographs demonstrated acceptable diagnostic performance and could assist radiologists and clinicians in the early detection of catheter malposition and malfunction during chest percutaneous catheter drainage.

Interventional nephrology in peritoneal dialysis: Best practice report of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology.

The procedure of peritoneal dialysis (PD) catheter placement is of utmost importance for a good outcome of peritoneal dialysis. Currently, catheters are mainly placed by surgeons and interventional nephrologists. Still, there is a lack of trained personnel in many dialysis units, which can impair the efficiency of PD units and reduce the patients' possibility to enter a PD programme. The Italian Society of Nephrology has endorsed a practical core curriculum for interventional nephrology in PD available on the Society website, which is here reported for the wider nephrology community. The topics addressed are the hernias of the abdominal wall, catheter placement with standard surgical open technique, basic video-laparoscopy, advanced video-laparoscopy, video-laparoscopic cholecystectomy and catheter placement, cuff-shaving and video-laparoscopy in catheter malfunction.

Focal alveolar hemorrhage following guide-wire progression into the pulmonary arterial circulation during fibrin sheath angioplasty and catheter exchange: Case report.

Central venous catheters are a frequently used vascular access for hemodialysis. Fibrin sheath formation is a common complication and is associated with catheter malfunction. Although fibrin sheath angioplasty with catheter exchange is a frequently employed procedure, it can be associated with mechanical complications. An important technical step in this procedure is progression of the guide-wire into the inferior vena cava. Focal alveolar hemorrhage is a very rare complication of this procedure. We report a case of a 70-year old patient on dual antiplatelet therapy who underwent fibrin sheath angioplasty with guide-wire catheter exchange and experienced focal alveolar hemorrhage presenting as hemoptysis and acute type 1 respiratory failure. Progression of the guide-wire into the pulmonary circulation and antithrombotic therapy played a significant role in the development of this complication. This report aims to call attention to a poorly described and potentially serious yet avoidable complication of fibrin sheath angioplasty with guide-wire catheter exchange.

Establishing an animal model for peritoneal catheter malfunction caused by omental wrapping using negative pressure suction: in vitro and in vivo exploration

Background This study aims to establish a simplified and effective animal model of catheter malfunction caused by omental wrapped using negative pressure suction. Method The peritoneal dialysis catheter outlet was linked to a negative-pressure (0-75mmHg) suction pump to intensify the negative pressure. Different negative pressures were tested for model construction in vitro. In vivo, a model of peritoneal catheter malfunction caused by omental wrapped was constructed in five beagles after catheter placement. Catheter drainage conditions and related complications were monitored before and after the model establishment. Results In the vitro experiment, the overall success rate of constructed models was 90% (36/40). The total malfunction rate was higher in 62.5 mmHg (10/10) and 75 mmHg (10/10) than in 12.5 mmHg (8/10) and 37.5 mmHg (8/10). The outflow velocity of dialysate at 62.5 mmHg was significantly lower than that at 12.5 mmHg and 37.5 mmHg, without a statistically significant difference compared to 75 mmHg. In the in vivo experiment, catheter outflow velocity increased, and residual fluid volume decreased after omental wrapped (99.6 ± 6.7 ml/min vs. 32.6 ± 4.6 ml/min at initial five minutes, p < 0.0001; 69.2 ± 16.3 ml vs. 581.0 ± 109.4 ml, p < 0.001). And the outflow velocity was finally below 2 ml/min. No severe related complications (such as infection, organ damage, or bleeding) were observed through laparoscopic examination and dialysate tests seven days post-operation. Conclusion Utilizing negative pressure suction to increase negative pressure around catheter tip is a simple, safe, and effective method for establishing an animal model of omental wrapped leading to catheter malfunction.

Stripping the catheter: A new device for an old technique.

Fibroblastic sleeve is a common pathophysiological phenomenon characterized by the formation of a mixed fibrous-collagen tissue encasing the outside of venous access devices. Although it nearly always presents asymptomatically, this catheter-related complication represents one of the leading culprits of venous catheters malfunction. Several techniques have been described for the management of dysfunctional catheters secondary to fibroblastic sleeve, including medical therapy, catheter exchange, balloon angioplasty, and percutaneous stripping. However, there is no common consensus for the treatment management in patients who present contraindications to surgical port removal. This report illustrates the case of a port catheter malfunction due to a fibroblastic sleeve in an oncological patient with a high risk of bleeding. This was effectively treated with a minimally invasive stripping technique using an off-label device for mechanical thrombectomy, namely the ClotTriever system (Inari Medical, Irvine, CA).

Uncovering the rate and risk factors of intrathecal baclofen pump-associated complications in the adult population.

The aim of this study was 1) to describe the rate of intrathecal baclofen (ITB)-associated complications at a large tertiary center, and 2) to evaluate the impact of patient-related factors on the likelihood of developing such complications. A retrospective single-center study was carried out. A total of 301 eligible patients were included in the analysis. Univariate regression models were used to evaluate the impact of age, sex, diagnosis, ambulation status, modified Ashworth scale score, body mass index, diabetes status, and pain level on the likelihood of developing a device-related infection, pump malfunction, catheter malfunction, and other clinically significant complications. Overall, 27% of patients experienced an ITB-related complication. The most common complications included infection (6%, 18/301), pump malfunction (7.3%, 22/301), and catheter malfunction (14%, 42/301). The univariate analyses revealed that the patient's ambulatory status had a significant impact on the likelihood of developing a catheter-related malfunction. Furthermore, a trend toward significance was identified between patients' preoperative body mass index and device-related infection. Finally, the risk of suffering any ITB-related complications was statistically correlated with the number of years that had passed since the initial pump implantation. The authors' analysis reveals a previously underrecognized association between ambulatory status at the time of ITB pump implantation and the incidence of catheter-related complications, and confirms the impact of time since surgery on the risk of developing any ITB-related complication. The patient's age, sex, diagnosis, diabetes status, or pain level at baseline were not associated with the risk of complications. Collectively, these insights contribute novel information to the existing literature, providing practical value for physicians in guiding patient selection for ITB therapy.

Spinal catheter revision in pediatric intrathecal baclofen pumps: risk factors and postoperative outcomes.

Intrathecal baclofen (ITB) pumps are commonly used in pediatric patients with cerebral palsy (CP) and medically refractory spasticity. However, catheter malfunction and associated risk factors are not well understood. The aim of this study was to examine potential risk factors for spinal catheter malfunction and characterize postoperative follow-up to understand the clinical consequences. Patients who received ITB pump replacement or revision at Boston Children's Hospital between 2010 and 2023 were retrospectively reviewed. The spinal catheter revision cohort (SCRC) included patients whose spinal catheter was occluded requiring lumbar catheter revision. The second cohort included abdominal pump replacements only (APRC). Between-group comparisons and multivariable regression identified factors associated with catheter revision and postoperative outcomes. Forty-one (33.6%) patients underwent spinal catheter revision and were compared with 81 patients (66.4%) who underwent abdominal pump replacement only. Younger age at surgery and an elevated preoperative lower-extremity modified Ashworth scale grade were associated with spinal catheter revision (p < 0.05). Catheter model type, tip location, and history of spinal fusion were not associated with obstruction. Postoperatively, SCRC patients experienced a higher rate of infection (17.1%) relative to APRC patients (0%) within 30 days from their ITB pump replacement procedure (p < 0.05) and greater likelihood of subsequent ITB system removal compared with the APRC (24.4% vs 7.4%, p < 0.05). Although not differing preoperatively, SCRC patients had lower postoperative ITB doses when compared with the APRC group (median dose 143 vs 350 µg/day, p < 0.05) at hospital discharge and remained statistically different at the 6-month and 1-year follow-ups (p < 0.05). There were no postoperative differences in baclofen overdose, withdrawal, or median number of hospital readmissions within 30 days. Overall, 31.7% of spinal catheter revisions were unanticipated by the clinical team at time of surgery. Younger age at surgery and increased preoperative lower-extremity tone may be risk factors for catheter obstruction, resulting in a higher rate of postoperative infection and subsequent ITB pump removal compared with pump replacement alone. Spinal catheter occlusion can complicate revision or replacement procedures, especially when unanticipated. Routine clinical assessment may be inadequate for diagnosing insidious catheter malfunction. Catheter occlusion deserves further study, and routine assessment of catheter patency may be warranted to prevent suboptimal tone therapy.

Ultrasound-guided Axillary Artery Catheter Placement and Associated Complications in Critically Ill Patients.

Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve.

Nursing management of catheter-related non-infectious complications of PD: Your questions answered.

A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.

Cavoatrial junction stenting in vascular hemodialysis catheter malfunction.

In patients undergoing hemodialytic treatment via intravascular catheters, stenosis or occlusion of central veins is common. Despite an extensive characterization of Superior Vena Cava Syndrome (SVCS) no data is available about CavoAtrial Junction (CAJ) stenosis. We report the case of two patients with a story of multiple catheter failures due to thrombosis or infection. Computed tomography (CT) showed radiological signs of CAJ stenosis confirmed at the following venography. In absence of other feasible options to place a vascular access, the two underwent stenting with Gore Viabahn VBX balloon expandable endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ, USA) of the CAJ stenosis. Completion venography showed complete resolution of the stenosis in both patients. No complications occurred during the procedures. At a mean follow-up of 878 ± 559 days no signs of in-stent restenosis or recoil were found. The present cases emphasize the feasibility and safety of CAJ stenting, underlining the importance of preserving CAJ and upper veins patency in hemodialysis access.

Adverse Events from Fluoroscopic versus Portable Placement of Peripherally Inserted Central Catheters and Central Venous Catheters in Pediatric Patients

PurposeTo compare the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients. Materials and MethodsThis is a single-center, retrospective review of 346 upper-extremity PICC placements (286 fluoroscopic and 60 portable; mean age, 9.83 years [SD ± 5.58]; 49.1% female) and 138 tunneled femoral CVC placements (56 fluoroscopic and 82 portable; mean age, 0.23 years [SD ± 0.36]; 57.0% female). Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists. ResultsFluoroscopic PICC placements had a lower procedure time (43.9 vs 57.9 minutes; P < .001), radiation dosage (342 vs 590 mGy·cm2; P < .001), incidence of technical failure (0% vs 3.3%; P = .029), and incidence of catheter malfunction (1.7% vs 12.1%; P < .001) compared with portable PICC placements. Fluoroscopic CVC placements had a lower procedure time (42.6 vs 54.8 minutes; P < .001) and radiation dosage (63.8 vs 405 mGy·cm2; P < .001) compared with portable CVC placements. No technical failures were found in either CVC groups and the difference was nonsignificant for catheter malfunction (0% vs 7.3%; P = .081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line–associated bloodstream infection compared with portable placements (0.71 vs 2.22 cases per 1,000 line-days; P = .046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared with portable placements (3.2% vs 14.8%; P < .001). Portable procedure setting was the only significant factor associated with adverse events (odds ratio, 33.77; 95% CI, 4.56–757.01). ConclusionsFluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared with portable placements in pediatric patients.

Different outcomes between downward and lateral peritoneal dialysis catheter exit-site directions

BackgroundThe International Society for Peritoneal Dialysis guidelines suggest lateral or downward exit positions for peritoneal dialysis (PD) catheter. In cases with straight inter-cuff design (used in Thailand), downward exit may lead to more complications due to catheter memory force. We compared lateral (lateral group) and downward (downward group) exits in PD patients.MethodsWe retrospectively studied end-stage kidney disease patients with PD catheters from 2011 to 2021 at Chao Phraya Abhaibhubejhr Hospital, Thailand. We analysed catheter malfunction, exit-site infection (ESI) and patient survival.ResultsA total of 425 patients, aged 11–87 years (57% female and 59% with diabetes mellitus). 326 had downward exits, and 99 had lateral exits. Both groups had similar 2-years patient survival (p = 0.592), 1-year survival catheter dysfunction requiring removal (p = 0.146) and First-year ESI (p = 0.432). In the lateral exit group, the percent of catheter dysfunction requiring removal was slightly lower (1.01 vs. 3.99, p = 0.204) while the percent of patient with ESI at first year was slightly higher (8.08 vs. 6.13, p = 0.494) compared to downward exit group.ConclusionsLateral exit and downward exit with a straight inter-cuff design have similar outcome of catheter survival/function, exit site infection and patient survival. Lateral exit site is a good option in context of a straight inter-cuff design.

Comparison of immediate-start peritoneal dialysis without break-in period and conventional-start peritoneal dialysis: a two-center retrospective audit.

Immediate-start peritoneal dialysis (PD) has emerged as a strategy for patients in need of urgent dialysis. However, the ideal timing for initiating this procedure remains uncertain. In this study, we aimed to compare complications and outcomes between immediate-start PD and conventional-start PD. We performed a two-center retrospective cohort study between 1 January 2015 and 31 May 2020. Patients who underwent PD were divided into immediate-start PD (without break-in period) and conventional-start PD group (break-in period within at least 14days). The primary outcomes were the incidence of the mechanical complications and infectious complication. The secondary outcomes were technique failure and patient survival. A total of 209 patients (106 in the immediate-start PD group and 103 in the conventional-start PD group) were included. Immediate-start PD had significantly lower catheter malfunction or migration rate compare with conventional-start PD (2.8% vs. 15.5%, p = 0.003) but comparable rates of dialysate leaks, pleuroperitoneal leaks, and hemoperitoneum. Infectious complications (exit-site infection and peritonitis) were similar between groups. Technique survival was comparable (7.5% vs. 4.8%, p = 0.22), while immediate-start PD exhibited lower mortality rates (0.9% vs. 13.6%, p = 0.001). Immediate-start PD appears to be a viable option for patients in need of urgent dialysis, with reduced catheter complications and comparable infectious complications and technique survival when compared to conventional-start PD.

7. ANALYSIS OF THE RESULTS OF LAPAROSCOPIC TUNNELLED PERITONEAL DIALYSIS CATHETER PLACEMENT

Abstract Introduction Peritoneal dialysis is a type of renal replacement therapy that improves quality of life and empowers patients with advanced chronic kidney disease. The best method of peritoneal dialysis catheter (PDC) placement remains to be defined. Methods Retrospective observational study from October 2019 to March 2023, aiming to analyse the results of this new technique for PDC placement in our centre. Results The study consisted of 45 patients, 66.7% of whom were men. The study comprised 45 patients, with 66.7% being men. The mean age was 57 years, and the mean BMI was 27.9 kg/m2, with 82.8% of the patients classified as ASA III. In 66.7% of cases, it was the first catheter to be placed. Of the surgeries conducted, 41 involved initial placements, and 4 involved laparoscopic repositioning, the latter following a previously unsuccessful Alpha manoeuvre. In 6 cases, an associated surgery was performed. The mean duration of surgery was 34 minutes, with a median length of stay of 24 hours. In 3 patients, catheter malfunction occurred, with 2 requiring laparoscopic repositioning and the remaining one laparoscopic replacement. Additionally, 3 other patients experienced infectious complications, which were treated conservatively. No major complications or laparoscopy conversions were noted. The mean follow-up from surgery was 15.4 months, with 42.2% of PDCs being removed after a mean of 11.5 months, and renal transplantation being the most common reason for removal (79%). Conclusion In our centre, tunnelled PDC placement has proven to be safe and effective, with a low percentage of infections, relocations or replacements, and it is considered the technique of choice for patients capable of undergoing surgery under general anaesthesia.

Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients.

Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications. One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group. A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, p = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, p = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%. We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.

Use of a lockable pigtail catheter (Cook Dawson‐Mueller Multipurpose Drainage Catheter) for nephrostomy reduces the risk of slippage of the catheter

AbstractObjectiveThis study compared the outcomes of using Mac‐Loc catheters and non–Mac‐Loc catheters for percutaneous nephrostomy (PCN). Mac‐Loc catheters have a locking mechanism that forms a curl at the tip by pulling a suture and securing it in place.MethodologyThis retrospective study compared the outcomes of consecutive patients who received PCN with catheters equipped with Mac‐Loc versus those with catheters without Mac‐Loc. Catheter failure was the primary endpoint of the study and was defined as all cases of catheter malfunction after PCN. A propensity score was calculated from covariates based on clinical variables, and patients in each group were matched 1:1 based on the propensity score.ResultsDuring the follow‐up period, a total of 289 cases underwent PCN, 72 with catheters equipped with Mac‐Loc and 217 without Mac‐Loc. Failure of the catheter occurred in 63 cases (22%). There were 44 cases (70%) of slippage, 18 cases (29%) of obstruction, and 1 case (2%) of catheter rupture. After propensity score matching, catheter failure–free survival was significantly higher in the group with catheters equipped with Mac‐Loc than in the group without Mac‐Loc (P = .003).ConclusionsThe use of catheters equipped with Mac‐Loc for PCN reduces the risk of unintentional catheter slippage.

The Long-Term Patency of the Internal Jugular Vein and the Common Facial Vein as Entrance Sites for Venous Access in Ventriculoatrial Shunts: A Comparative Analysis from a Single-Center Study

The ventriculoatrial (VA) shunt is a surgical intervention used to manage hydrocephalus, although it is less often utilized compared to the ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy. Placement of the distal catheter typically involves the utilization of either the common facial vein (CFV) or the internal jugular vein (IJV), 2 frequently employed options for venous access. This study aims to determine whether there is a statistically significant difference between the long-term patency (2years) of the distal end of the VA shunt of these 2 options. A retrospective cohort analysis was conducted of patients who received VA shunt surgeries with the employment of the CFV or IJV as access veins at Rajavithi Hospital in Thailand between January 2015 and December 2020. The analysis focused on long-term patency and potential complications. The study comprised a total of 42 participants. Twenty-six (61.9%) individuals underwent ventriculoatrial (VA) shunt surgery via the CFV, while the other 16 (38.1%) underwent the same procedure using the IJV. Neither of the 2 groups required shunt revision due to distal catheter malfunction. Most cases exhibited no significant complications apart from a single instance of shunt system infection. In VA shunt surgery, both the CFV and IJV can be used as venous access sites for the right atrium because there is no discernible difference between their complications or long-term patency. Anatomical considerations, patient-specific characteristics, and the surgeon's preference should all be considered when choosing the venous access location for the placement of a VA shunt.