Cause Of Catheter Failure Research Articles

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

Subcutaneous edema as a potential cause of catheter failure in older inpatients receiving peripheral parenteral nutrition.

Malnutrition is a common problem among hospitalized older patients. Peripheral parenteral nutrition (PN) can improve patient outcomes but can also lead to complications that affect future treatment. Older inpatients, in particular, are expected to be prone to these catheter-related complications. However, the impact of peripheral PN on older inpatients has been rarely investigated. In the current study, the impact of PN on short peripheral catheters (SPCs) was evaluated by comparing signs and symptoms at the time of catheter removal between 22 patients with PN and 27 without. In addition to external clinical assessment, sonographic investigations of the SPC site were performed. The prevalence of external signs and symptoms of complications was similar between the patients (all P > 0.05). However, subcutaneous edema was found by ultrasound in > 80% of patients with PN, compared with 55.6% of those without PN (P = 0.051). Unlike cases without PN, all patients with PN who presented with external signs and symptoms developed subcutaneous edema (P = 0.022). Multivariate analysis demonstrated that administration of PN was independently associated with subcutaneous edema (adjusted odds ratio = 6.88, 95% confidence interval = 1.083-75.486, P = 0.040). For several decades, phlebitis has been the primary focus of complications related to peripheral PN in clinical settings. However, our results imply that peripheral PN causes subcutaneous edema, which can lead to catheter failure in older inpatients. This study contributes to understanding the etiology of catheter failure during peripheral PN in this population.

Additional antibiotic lock in peritoneal dialysis-associated refractory peritonitis: A case series study and literature survey.

Refractory peritonitis is one of the leading causes of catheter failure in peritoneal dialysis (PD) patients. However, there are no established curative therapies available, and only catheter removal should be performed. Here we present a case series study to illustrate the efficacy of antibiotic lock for PD-associated refractory peritonitis. Patients with refractory peritonitis treated with intraperitoneal antibiotics plus antibiotic lock from September 2020 to March 2022 were retrospectively analyzed. Medical cure was identified as a success of treatment. We identified 11 patients, of which 7 (63.64%) had a history of PD-associated peritonitis, with the episode of continuous ambulatory peritoneal dialysis (CAPD) ranging from 1 to 158 months at a median of 36 (9.5, 50.5) months. The dialysis effluent culture showed Gram-positive, Gram-negative bacteria, and was culture-negative in 5, 2, and 4 cases, respectively. The cure rates were 85.71% for culture-positive cases and 25% for culture-negative cases, and the total cure rate was 63.64%. No relevant adverse events occurred, including sepsis. Treatment with the additional antibiotic lock was successful in most cases, especially in those that were culture-positive. Additional antibiotic lock deserves great attention and further investigation in treating PD-associated refractory peritonitis.

Clavicular hook: Cuffed haemodialysis catheter insertion using a paramedian tunnel in patients with recurrent tip migration.

Tunnelled, cuffed central venous catheters are commonly used for the provision of haemodialysis. Internal jugular vein catheters are generally tunnelled subcutaneously to the anterolateral chest wall. However, the lateral subcutaneous tract may increase the risk of catheter migration, particularly in the setting of obesity or large breast tissue. Catheter tip migration is an important cause of catheter failure. We describe two cases in which a paramedian tunnel was fashioned in patients experiencing recurrent catheter migration.

Farklı Vasküler Giriş Yollarında Tünelli Hemodiyaliz Kateterlerinin Değerlendirilmesi

Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters. &#x0D; Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheter patency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated. &#x0D; Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV) n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were: catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time was higher in the right IJV group (732 and 1337 days, respectively) compared with the others (p

Exteriorizing the Outer Cuff to Treat Intractable Exit Site Infection and Tunnel Infection in Peritoneal Dialysis Cases: A Single Institute Experience

Peritoneal dialysis (PD) is an important treatment method for patients with end stage renal disease. Since its introduction in 1975, clinical studies have shown that PD can improve patient survival, retain residual renal function, and lower the risk of infection. It can also reduce financial stress in the growing population with end stage renal disease. However, PD has limitations, mainly technique failures. Of these, catheterrelated infection is a major cause of catheter failure in PD. We reviewed the medical records of 986 PD patients from 2008 to 2018 at our hospital. The patients with intractable tunnel and exit site infection received exteriorization of the outer cuff and cuff shaving. The favourable outcomes observed recommend this treatment for PD patients whose catheter infection is not well controlled.

Using Tablet-Type Ultrasonography to Assess Peripheral Veins for Intravenous Catheterization: A Pilot Study

Abstract Purpose: In clinical settings, ultrasonography (US) has recently been used to aid in the insertion of peripheral intravenous catheters (PIVCs). This cross-sectional study aimed to verify the reliability and validity of a tablet-type device in assessing vein size and depth for catheter site selection and detecting thrombus with resultant subcutaneous edema as a cause of catheter failure using US. Methods: Adult patients receiving infusions via a PIVC at a university hospital between January and February 2017 were included. All participants underwent US at the PIVC site. An expert sonographer and a nurse blinded to all information, except for ultrasonograms, evaluated the data. Intraclass correlation with 95% confidence interval (CI) was used to evaluate interrater and intrarater reliability of US assessment. To assess criterion-related validity, a high-end US notebook device was used for reference data collection. Pearson's correlation coefficient was used to evaluate criterion-related validity. Results: We observed 21 patients with 26 catheters. Intraclass correlations (95% CI) for the measured vein diameters and depths were as follows: intrarater reliability, 0.92 (0.57–0.98) and 0.78 (0.10–0.95); interrater reliability, 0.95 (0.78–0.99) and 0.94 (0.77–0.99); and Pearson's correlation coefficient for criterion-related validity, 0.74 (P = 0.02) and 0.77 (P = 0.02), respectively. However, the analysis of causes of catheter failure did not show reliable validity. Conclusion: This pilot study suggests that the tablet-type device is useful for assessing peripheral veins in clinical settings.

Exploring the causes of peripheral intravenous catheter failure based on shape of catheters removed from various insertion sites.

The risk of peripheral intravenous catheter failure varies according to the insertion site. This study examined catheter shape just after removal to evaluate the causes of catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the catheter insertion site before catheter removal and clinical images of the removed catheters. We analyzed 184 catheters from 142 participants. There were no significant differences in the catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the catheter was present in 9.2% of cases; the median bend angle at the catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of catheters inserted in the upper arm was significantly greater than of catheters in the forearm (p = 0.013). Catheter curvature was related to catheter failure (14.8% of failed catheters had curvature; p = 0.035) and occlusion (35.3% of occluded catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed catheters than for surviving catheters. To prevent catheter failure, especially occlusion resulting from catheter curvature, a catheter should be inserted at an appropriate insertion site far from the antecubital fossa.

CHRONIC PERITONEAL DIALYSIS in CHILDREN: Single center experience over 18 years

Objective: The aim of the study was to evaluate whether there is a change with time regarding the complications of PD and prognosis of children treated with chronic PD between time intervals of 1996-2004 and 2005-2014. Material and Method: The study group consisted of 109 patients (54 female, 55 male). The patients were divided into two groups based on the time of their admission. The patients followed up between 1996-2004 were enrolled in Group I and those followed up between 2005-2014 were enrolled in Group II. Forty-four patients in Group II were compared to 65 children in Group I regarding PD complications and prognosis. Results: The mean ages of onset of PD was 9.5±4.2 years and 7.14±5.73 years in Group I and II, respectively. The most common cause of chronic kidney disease (CKD) was uropathies in both groups. The percentage of the patients on automated PD (APD) was higher in Group II than Group I (73% and 60%, respectively). Catheter failure rate was 18% in Group II, while the rate was 36.9% in Group I. The most frequent cause of catheter failure was recurrent peritonitis in both groups. The rate of peritonitis was lower in Group II than in Group I (1: 22.4 episode/PD months vs 1: 14.3 episode/PD months). The most common causative microorganism of peritonitis was Staphylococcus aureus in both groups. The most important difference between the two groups was the percentage of the patients who received renal transplantation. Transplantation rate was 43.2% in Group II whereas 7.7% in Group I. Conclusion: The most important complication of PD is still peritonitis. The rate of peritonitis and catheter failure has diminished as the experience in the field of PD increased.

The role of laparoscopic surgery in the management of a malfunctioning peritoneal catheter.

Peritoneal catheter malfunction is a common complication of peritoneal dialysis (PD). It has a high failure rate with conservative management. Catheter replacement was historically the standard surgical treatment of choice. Nowadays, laparoscopy has been introduced as an alternative surgical modality to rescue the malfunctioning peritoneal catheter and also offers the possibility of replacement if indicated. The aim of this study was to compare the outcomes of these two surgical modalities. The medical records of consecutive patients who underwent surgical treatment for malfunctioning PD catheters (between January 2010 and April 2013) were analysed. The primary outcome included successful return to adequate PD. The secondary endpoint was length of catheter patency and the cause of catheter failure. A total of 32 cases were identified, of which 8 had open catheter replacement and 24 had a laparoscopic intervention. The overall median follow-up duration was 12.5 months. The success rate for laparoscopic surgery in terms of functioning catheter at 12 months was 62.5% but only 37.5% for open surgery. The mean length of catheter patency after laparoscopic intervention was 31.6 months compared with only 13.6 months for the open surgery group. The most common cause of catheter failure diagnosed during laparoscopic intervention was catheter migration (33.0%), followed by omental wrap and catheter blockage by fibrin/blood plug (25.0% each). Open surgery did not have any diagnostic potential. Laparoscopy is the treatment of choice for malfunctioning PD. Its proven benefit includes simultaneous identification of the aetiological cause of malfunction together with direct correction of this problem, thereby maximising outcome. It also allows for rapid recommencement of PD and avoidance of haemodialysis, saving cost and resources.

Comparison of silicone and polyurethane catheters for the catheterization of small vessels in mice.

Vascular catheterization is increasingly carried out in laboratory mice, but the long-term patency of catheters implanted in mice is limited owing to their small size. The authors compared mice that were catheterized in their right common carotid artery either with a silicone catheter with a polyurethane tip or with a 100% polyurethane catheter to determine which catheter type was better suited for long-term studies in mice. The catheters were inspected daily and were flushed if blood was visible in the catheters; if no blood was visible, they were flushed every 3 d. Silicone catheters were patent for a shorter period of time than polyurethane catheters, which were patent for a median of 6 d and up to 25 d. The authors identify the principal causes of catheter failure and discuss how they can be prevented.

Management of nonfunctional central venous catheters

Management of non-functional central venous catheters traditionally involves instillation of fibrinolytic agents, and if unsuccessful, removal and replacement of the catheter. Many of these catheters, however, are still usable for their original purposes. With time, collateral vessels open, allowing passage of fluids into the circulation. We attempted to preserve such catheters if they were not fractured and were not used for infusing sclerosing agents. In 75 patients, there were 91 occlusive events. Venograms, cathetergrams, or ultrasounds were used to detect the cause of catheter failure, searching for sheath thrombus, subclavian vein or superior vena cava thrombosis. Of the 75 patients, 9 had recurrent failures after original resolution. In 5, the catheter was removed due to sepsis. Therefore the total events available for analysis was 86. The various medical treatments included warfarin, heparin, low molecular weight heparin (LMWH) and fibrinolytics, and passage of time. Overall, 49 events were resolved. For 38 of these 49 events associated signs and symptoms resolved within one week. Thirty-four (34) catheters were removed due to persistent problems, including sepsis in 5. In 22 patients, the catheters remained functional until the patient's death, and in 14 the catheters remained functional until completion of the patient's therapy. Therefore, over half (54%) of the catheters associated with veno-occlusive events can be maintained with these medical approaches. Selective medical management should be applied to non-functioning central venous catheters to avoid added risk, inconvenience, and cost of their replacement.

Surface‐Treated Catheters—A Review

Almost 30% of prevalent hemodialysis patients use catheters for vascular access although outcomes are superior with the use of either an arteriovenous fistula or a synthetic graft. Catheter complications are a major cause of morbidity and mortality for hemodialysis patients and increase the burden on the health care system. Surface-treated catheters have been developed to combat the three most common causes of catheter failure: infection, fibrin sheath formation, and thrombus formation. Two types of catheter surface treatments are available: antimicrobial coatings and antithrombotic coatings. Surface treatment of central venous catheters with antimicrobial materials reduces both bacterial colonization and the incidence of catheter-related bacteremia in critical care patients by 30-50%. Antithrombotic coatings reduce platelet adhesion, inhibit the inflammatory response, and reduce thrombus formation on coronary stents, ventricular assist devices, central venous catheters, and vascular grafts. However, few reports on the use of surface-treated catheters in the chronic hemodialysis patient population exist. At the present time, it is difficult to justify the increased cost of surface-treated catheters for chronic hemodialysis in the absence of clinical data demonstrating that they reduce catheter-related complications in this patient population.

Role of Fogarty catheter manipulation in management of migrated, nonfunctional peritoneal dialysis catheters

Peritoneal dialysis (PD) catheter migration to the upper abdomen is not an uncommon cause of catheter failure. We prospectively examined the role of the Fogarty catheter manipulation technique to reposition the PD catheter in the pelvis and regain patency. All patients with PD catheter malfunction caused by migration, confirmed by abdominal radiograph, underwent the same protocol. The patient was placed flat on the back, and the Fogarty was advanced into the PD catheter to a premarked point at which the end of the Fogarty was near the end of the PD catheter. The Fogarty balloon was inflated with 0.5 mL of sterile saline, and manipulation was performed by tugging movements until proper placement of the PD catheter into the pelvis was suspected. Infusion and drainage of dialysate was performed to determine patency. The return of the PD catheter into the pelvis was then confirmed by repeated radiograph. Success rates of Fogarty catheter manipulation, early and late recurrence (remigration ≤90 days or >90 days), and complications were prospectively examined in 232 patients over a 6-year period. Catheter migration occurred in 34 of 232 patients (15% incidence). All patients had curled-end, double-cuffed, non–swan-neck PD catheters. Successful repositioning occurred in 24 of 34 patients (71%). None of the 24 repositioned catheters had early recurrence, and 1 of 24 catheters (4%) had late recurrence. None of the patients had procedure-related peritonitis, bowel perforation, or exit-site trauma. These results show that PD catheter migration is relatively common (15%). The Fogarty manipulation technique is a simple, cost-effective way to prolong PD catheter life and preserve its long-term patency. This eliminates the need for surgical intervention in approximately 70% of patients with PD catheter migration.

Efficacy of percutaneous fibrin sheath stripping in restoring patency of tunneled hemodialysis catheters.

Our objective was to determine the effectiveness of percutaneous fibrin sheath stripping as a method of restoring function to failing tunneled hemodialysis catheters. A total of 131 percutaneous fibrin sheath stripping procedures were performed on 100 failing tunneled hemodialysis catheters in 91 patients. Only the initial stripping procedure of the first catheter inserted in each patient was included for analysis. Patients were excluded if an additional cause of catheter failure was noted at the time of percutaneous fibrin stripping. Failure of the hemodialysis catheter was defined as inability to sustain an average blood flow rate of 250 ml/min or more in a hemodialysis session. Patients were followed up until the time of catheter failure, catheter removal, or a second stripping. Poststripping primary patency and complication rates were determined. The technical success of the procedure was 95.6%. Median follow-up was 16 weeks (range, 0-128 weeks). The overall median duration of primary patency after the first stripping was 89 days (3 months). No statistically significant difference in primary patency rates was seen between patients who underwent fibrin sheath demonstration by contrast injection and those who did not (p = .71). Female patients were statistically more likely to have catheter failure after catheter stripping than were male patients (p = .02). The route of catheter insertion did not significantly influence poststripping patency rates. No complications were associated with the procedure. Percutaneous fibrin sheath stripping is a safe, effective method of restoring patency to failing hemodialysis catheters when the failure is due to fibrin sheath formation and other causes are excluded.

Incidence of epidural catheter replacement in parturients: a retrospective chart review

We noted in our practice of obstetric anesthesia at a large teaching hospital that the epidural catheter failure rate was higher than previously reported. We undertook this study to determine the incidence of epidural catheter failure in parturients and to determine the primary causes of failure. After institutional approval, we evaluated the charts of parturients who received epidural analgesia for labor or anesthesia for cesarean section for 6 randomly selected months spanning one year. We examined 4240 anesthesia records for patient-related data, operator-related data (years of training) and technical information. The participants were unaware there was a study in progress, and data were collected in a systematic fashion so as to minimize data collection related biases. χ 2, Mantel-Haenszel χ 2, analysis of variance and univariate logistic regression were used to analyze data. P<0.05 was considered statistically significant. Overall epidural catheter failure rate was 13.1% with a dural puncture rate of 1.03%. The major causes of catheter failure were no analgesia and unilateral block. The experience of the anesthesiologist, the mode of delivery, patient age, patient weight, type of epidural catheter, occurrence of paresthesia and the use of CSE were all associated with significantly different epidural catheter replacement rates. Despite the initially high failure rate, the overall patient satisfaction rate was greater than 98%.

RIGHT ATRIAL CATHETERS: RELIABLE, IMMEDIATE AND DURABLE VASCULAR ACCESS FOR HAEMODIALYSIS AND PLASMA EXCHANGE

This paper prospectively evaluates 33 dual lumen, right atrial catheters inserted into either an external or internal jugular vein by open operation in 29 patients, of whom 15 required haemodialysis and 14 required temporary plasma exchange. The median (range) catheter survival in the haemodialysis and plasma exchange groups was 108 days (7-334 days) and 61 days (10-116 days), respectively. Life table analysis demonstrated that overall catheter survival was 58% at 200 days. The main causes of catheter failure were infection (four cases), poor flow (three cases) and accidental removal (one case). Another nine catheters were removed electively because of maturation of alternative methods of vascular access (five cases), completion of plasma exchange treatment (three cases), or successful renal transplantation (one case). Long-term silastic catheters, inserted into the right atrium via a jugular vein, have distinct advantages over temporary subclavian vein catheters and external arteriovenous (AV) shunts; this form of access is the method of choice for haemodialysis and plasma exchange patients who require immediate and short- to medium-term vascular access.

Cannulation of the bovine ampullary and isthmic oviduct.

Procedures were developed in the bovine for cannulating the ampulla and isthmus regions of the same oviduct. A total of 21 dual cannulation procedures were performed with an average patency of 103 +/- 16 days for the ampulla and 73 +/- 14 days for the isthmus. The major cause of catheter failure was avulsion. Daily fluid flow around estrus for the ampulla averaged 1.04 mL, but only 0.50 mL for the isthmus. Volumes were about half the estrus values during the luteal phase. Catheter materials used in the study were evaluated to determine their ion diffusion properties. These studies indicated that diffusion of 24Na was negligible.

Peritoneal Catheter Survival in Children

In children undergoing CAPD or CCPD, the authors compared two techniques for peritoneal catheter insertion by analyzing the probabilities for overall catheter survival, catheter outflow failure and peritonitis. Between January 1980 and December 1982, catheters were installed with a slightly arcuate subcutaneous tunnel with a predominantly transverse orientation. After December 1982 catheters were implanted with a straight subcutaneous tunnel directed caudally toward the pelvis. We found that a catheter directed toward the pelvis was associated with improved overall survival. Adoption of this technique greatly reduced outflow obstruction, the leading cause of catheter failure before 1983. However, the orientation of the extraperitoneal catheter segment did not appear to influence the overall risk for peritonitis.

Totally implantable system for peritoneal access.

A totally implantable system for providing access to the peritoneal cavity was evaluated. Fifty-six Port-A-Cath (Pharmacia Nu Tech, Piscataway, NJ) peritoneal access systems were implanted in 54 cancer patients receiving intraperitoneal chemotherapy. The catheters are accessed by transcutaneous placement of a Huber point needle through a silicone septum at the top of the portal. A total of 32 patient years of experience are reported. The Port-A-Caths have been in place for a median of 22 weeks (range, one to 85). A total of 401 entries have been made for paracentesis, chemotherapy administration, antibiotic administration, peritoneal lavage for cytology, and catheter flushing. There have been six episodes of peritonitis (five Staphylococcus epidermidis, one S aureus) in three patients. There have been no mechanical failures of the Port-A-Caths. Loss of bidirectional flow through the catheter due to fibrin deposition about the catheter has been the major cause of catheter failure. Patient acceptance of the Port-A-Cath has been excellent.