Central Vein Catheter Research Articles

Longer operative time is associated with higher risk of severe complications after percutaneous nephrolithotomy: Analysis of 1511 cases from a Japanese nationwide database

To evaluate risk factors of severe adverse events after percutaneous nephrolithotomy with an emphasis on operation time, and to develop a nomogram for predicting them. This was an observational retrospective study including 1511 patients who underwent percutaneous nephrolithotomy in 332 hospitals identified from the Japanese Diagnosis Procedure Combination database between 2007 and 2010. Severe adverse events were defined as follows: (i) in-hospital mortality; (ii) postoperative medications including catecholamine, gamma-globulin products, protease inhibitors and medications for disseminated intravascular coagulation; and (iii) postoperative interventions including central vein catheterization, dialysis and mechanical cardiopulmonary support. Univariate and multivariate logistic regression analyses were carried out for the occurrence of severe adverse events, and a nomogram was generated from this model. Overall, 126 severe adverse events (8.34%) were identified. In the multivariate model, a linear trend between severe adverse events and operation time was observed (OR 4.72 for 120-179 min to 17.95 for ≥300 min compared with ≤119 min; each P < 0.05) after adjustment for sex, age, Charlson Comorbidity Index and type of admission. Female sex and emergency admission were also significant risk factors (OR 1.92 and 2.04, respectively), and hospital volume did not reach statistical significance. The nomogram based on these results was well fitted to predict a probability between 0.05 and 0.40 (concordance index 0.696). Longer operation time is a significant and independent risk factor for severe adverse events after percutaneous nephrolithotomy. Our nomogram can be an effective tool for predicting postoperative complications.

Erratum to: The central vein access port and catheter in outpatient chemotherapy for colorectal cancer: a retrospective study of 101 patients

Erratum to: The central vein access port and catheter in outpatient chemotherapy for colorectal cancer: a retrospective study of 101 patients

Non-tunneled central vein catheter for refractory ascites drainage: 30 patients with recurrent paracentesis

Background and Aim: About 10% of cirrhotic patients are unresponsive to sodium restriction and diuretics and develop refractory ascites. Such patients usually require recurrent large volume paracentesis and lots of hospital admissions. Hereby, we introduce a method applying a central vein (CV) catheter for large volume paracentesis in patients with refractory ascites.

Novel Ultrasound Technique for Central Venous Line Placement

As part of a pilot study, researchers in Japan evaluated a novel three-step ultrasound technique for central vein catheterization. The steps were (1)

Three-step method for ultrasound-guided central vein catheterization

The long-axis view and in-plane needle approach (LAX-IP) for ultrasound-guided central vein catheterization is considered ideal because of the quality of real-time imaging. We describe a novel technique, using a step-by-step procedure, to overcome the pitfalls associated with the LAX-IP. This study was undertaken to demonstrate the clinical utility of this approach. All operators underwent training before participation in this study. One hundred patients were enrolled in this study and underwent central venous catheterization using this method. Using a portable ultrasound and vein catheterization kit, patients were appropriately positioned and a straight portion of the vein identified (Step 1). A needle guide was used (Step 2) and the vein imaged in real time in two directions (Step 3), to identify the true long axis and prevent damage to surrounding tissues. The overall success rate for catheterization was 100% with a median of one puncture for each patient. All catheterizations were performed within three punctures. Problems with the first puncture included difficult insertion of the guide-wire due to coiling, difficult anterior wall puncture, less experience with the procedure, and other reasons. There were no complications associated with the procedure. This three-step method is not dependent on an operator's ability to proceed based on spatial awareness, but rather depends on logic. This method can prevent difficulties associated with a two-dimensional ultrasound view, and may be a safer technique compared with others. Further clinical trials are needed to establish the safety of this technique.

Fatal arterial complications following ultrasound-guided attempt of internal jugular vein catheterization

Puncture of the posterior venous wall during ultrasound-guided internal jugular vein cannulation seems to be common, making underlying artery at risk of injury. Two cases of injury through the posterior wall of the internal jugular vein and an injury to the underlying artery are reported. In case number 1, a small injury of the carotid arterial wall resulted in a retrograde dissection of the common carotid artery and ascending part of the aorta, causing a fatal cardiac tamponade—a sequence of events never previously described. In case number 2, an unexpected injury to the thyrocervical trunk in a severely thrombocytopenic patient caused an extensive hematoma that compromised the upper airway, eventually leading to a fatal outcome. These two reported fatal arterial complications during ultrasound-guided cannulation of the internal jugular vein add to other publications of complications after central vein catheterization. It is important to increase awareness of these avoidable serious complications.

Loss of guide wire: A lesson learnt review of literature

Catheterization of central veins is a routine technique which is widely used in emergency department and medical intensive care units. Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guide wire-related complications are rare but potentially serious. We describe a case of a lost guide wire during central venous catheter (CVC) insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.

A prospective observational study of the outcome of central venous catheterization in 100 patients.

Context:To Study the outcome following central vein catheterization in patients receiving chemotherapy.Aims:To Study the outcome of central venous catheterization in terms of difficulty during insertion, duration, incidence of infections and other complications and reasons for removal.Settings and Designs:Prospective observational study conducted in 100 patients attending to Gujarat Cancer and Research Institute.Materials and Methods:Both onco-medical and onco-surgical patients who required insertion of central venous catheters were enrolled after ethical approval from June 2008 to November 2010. The study comprised 100 patients.Statistical Analysis Used:Mean and percentage.Results:Mean duration of the indwelling catheter was 109 days for Hickman catheter, 39 days for cavafix and 59 days for certofix. Difficulty in insertion and arrhythmias were common complications. There were no incidences of major life threatening complications. Catheter related infection was 30%. The commonest reason for catheter removal was treatment completion 72%. The next frequent cause was catheter infection 14% and patient death 6%.Conclusions:Even though central venous catheterization is associated with acceptable complications, they serve a useful aid in management of patients on chemotherapy.

Multiple left subclavian venous catheterizations in premature infant

Multiple left subclavian venous catheterizations in premature infant

Continuous on-line glucose measurement by microdialysis in a central vein. A pilot study

IntroductionTight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes. Also the variability of glucose may have an impact on morbidity. An accurate and feasible on-line/continuous measurement is therefore desired. In this study a central vein catheter with a microdialysis membrane in combination with an on-line analyzer for continuous monitoring of circulating glucose and lactate by the central route was tested.MethodsA total of 10 patients scheduled for major upper abdominal surgery were included in this observational prospective study at a university hospital. The patients received an extra central venous catheter with a microdialysis membrane placed in the right jugular vein. Continuous microdialysis measurement proceeded for 20 hours and on-line values were recorded every minute. Reference arterial plasma glucose and blood lactate samples were collected every hour.ResultsMean microdialysis-glucose during measurements was 9.8 ± 2.4mmol/l.No statistical difference in the readings was seen using a single calibration compared to eighth hour calibration (P =0.09; t-test). There was a close agreement between the continuous reading and the reference plasma glucose values with an absolute difference of 0.6+0.8mmol, or 6.8+9.3% and measurements showed high correlation to plasma readings (r = 0.92). Thelimit of agreement was 23.0%(1.94 mmol/l) compared to arterial plasma values with a line of equality close to zero.However, in a Clarke-Error Grid 93.3% of the values are in the A-area,and the remaining part in the B-area.Mean microdialysis-lactate was 1.3 ± 1.1mmol/l. The measurements showed high correlation to the blood readings (r = 0.93).ConclusionContinuous on-line microdialysis glucose measurement in a central vein is a potential useful technique for continuous glucose monitoring in critically ill patients, but more improvements and testingare needed.

超音波ガイド下血管穿刺 (1)超音波ガイド下血管穿刺（内頚，鎖骨下，大腿）の実際

超音波ガイド下血管穿刺 (1)超音波ガイド下血管穿刺（内頚，鎖骨下，大腿）の実際

An Unusual Cause of Left Brachiocephalic Vein Occlusion: Extrinsic Compression by the Aortic Arch in a Hemodialysis Patient

The most common cause of central venous obstruction including left braciocephalic vein is intrinsic stenosis associated with a previous central venous catheter or other devices. Occasionally, patients with no history of central venous catheterization present with left brachiocephalic vein occlusion. This occurs as a result of extrinsic compression of the brachiocephalic vein by adjacent vascular structures, especially the aortic arch and its branches. Here, we report a case of left brachiocephalic vein compression caused by a tortuous, ectatic aortic arch in a patient with no history of central vein catheterization. To our knowledge, this is the first report of extrinsic compression of the brachiocephalic vein by the aortic arch in Korea. (Korean J Med 2013;84:597-601)

A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 372 patients in a Japanese national series

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Ureteroscopic lithotripsy sometimes causes severe complications, e.g. septic shock, and the relationship between long operative duration and complication rate has been empirically recognised. But due to the rarity, evidence is limited. We analysed 12372 cases and showed that the complication rate increased according to operative duration, especially for operations taking >90 min. Also, we found that high-volume centres had lower complication rates. To develop a nomogram to predict severe adverse events (AEs) after ureteroscopic lithotripsy (URSL) including the effects of operative duration and hospital volume. We identified patients undergoing URSL from the Japanese Diagnosis Procedure Combination database between 2007 and 2010, and defined severe adverse events as (i) in-hospital mortality; (ii) postoperative medication including catecholamine, γ globulin, protease inhibitors, medications for disseminated intravascular coagulation and transfusion; and (iii) postoperative interventions including percutaneous nephrostomy, central vein catheterisation, intensive care unit, dialysis, mechanical cardiopulmonary support. Univariate and multivariate logistic regression models addressed the occurrence of severe AEs. Of 12 372 patients, 296 patients (2.39%) had severe AEs. Multivariate analysis showed a positive linear trend of operative duration and severe AEs (odds ratio [OR] 1.58 in 90-119 min to OR 4.28 in ≥210 min compared with ≤ 59 min; each P < 0.05) and an inverse relationship between hospital volume and severe AEs (OR 0.64 in ≥39 URSLs/year compared with ≤ 15 URSLs/year; P = 0.004) with adjustment for other significant factors including sex, age, Charlson comorbidity index, type of anaesthesia and type of admission. A nomogram and a calibration plot based on these results were well-fitted to predict a probability between 0.01 and 0.10 (concordance index 0.677). Severe AEs after URSL were associated with longer operative duration and lower hospital volume, and were accurately predicted using the present nomogram.

Massively Calcified Intravascular Cast after Removal of a Tunneled Central Vein Catheter for Hemodialysis

Vascular calcifications usually affect the arteries, while central vein calcifications are rare. A 45-year-old hemodialysis patient underwent a chest CT scan before central vein catheterization required for arteriovenous access thrombosis, in July 2011. He was on hemodialysis since 1995 and from 2005 on warfarin treatment because of repeated thrombosis and dysfunction of arteriovenous fistula and central vein catheters (CVC). A previous tunneled CVC placed in the left external jugular vein was removed in December 2010. Eight months later a chest CT scan showed a 79-mm irregular, linear, tubular radiopaque density in the superior vena cava and left brachiocephalic vein. The possibility of a retained catheter fragment was considered, but the final diagnosis was: calcified "cast" adherent to the vessel wall. This is the first report of an intravenous calcified "cast" (originating from peri-catheter calcification) retained after removal of a tunneled dialysis CVC. This finding is significant because it mimics a retained catheter fragment possibly leading to misdiagnosis and exposing patients to additional risk for unnecessary retrieving interventions. Catheter removal or over the wire substitution in the presence of a calcified cast could also be considered a risky procedure. Retained calcified cast should be included among the long-term complications of hemodialysis CVCs. At the time of publication, the patient is alive without any complication related to the pathology reported.

Evaluation of the Effects of Sterilization by Irradiation on Teratogenic Toxicity of Central Vein Catheter

Purpose: The objective of this study was to evaluate the teraogenic toxicity of central vein catheters after irradiation sterilization and provide basis for further application of medical apparatus in future. Methods: central vein catheters were sterilized by irradiation as ISO11137 standard, afterwards, a series of tests including chromosome aberration test, micronucleus test and Ames test were performed to evaluate their teratogenic toxicity. Results: After irradiation sterilization, the samples showed no genetic toxicity (did not cause chromosomal aberrations) and no mutagenic effect, and did not increase the incidence of bone marrow cells micronucleus, demonstrating that the product material was quite stable after irradiation. Conclusions: No teratogenicity was induced in central vein catheters by the setting dose of irradiation sterilization. And therefore irradiation sterilization is a commendable method for such kind of materials, which deserves further promotion and application.

Femoral Tunneled Central Venous Catheters for Terminally Ill Patients with Cancer

Oral administration of medication is often difficult in terminally ill patients with cancer. These patients require intravenous routes for high-dose opioid administration and/or parenteral nutrition. When the superior vena cava (SVC) is unsuitable for central vein catheter insertion (i.e., in patients with mediastinal masses involving the SVC), alternative access routes are needed. Of these, the femoral vein is most utilized. In our experience, the femoral tunneled catheter (FTC) is easy and safe to use. We retrospectively studied FTC outcomes in terminally ill patients with cancer. Charts of consecutive patients admitted to the palliative care unit between April 2008 and December 2011 were reviewed. FTC is inserted into the vein by the single-puncture method using a 16-gauge catheter with a 14-gauge peel-away introducer. Eleven patients underwent FTC insertion. In total, there were 207 days of FTC placement; the mean period in place was 19±15 days. Eight patients received parenteral opioid therapy, high doses in four cases, via FTCs. Complications were incidental arterial puncture and poor infusion rate due to hip joint bending in one case each. Neither catheter-related infection nor clinical venous thrombosis occurred. FTCs were successfully inserted, with a low complication rate. FTC, a simple technique, might be an acceptable alternative in selected terminally ill patients with cancer, when SVC insertion is difficult or contraindicated.

Central vein stenosis in a dialysis patient: a case report

IntroductionCentral vein stenosis is not a rare problem in patients on dialysis. Placement of a central vein catheter for dialysis access substantially increases the risk of central vein stenosis. However, even in patients without a previous history of central vein catheter placement, a stenosis can be found in up to 40% of patients.Case presentationWe report the case of a 60-year-old male Caucasian German dialysis patient who complained of dry cough, swelling of his right arm and facial edema. Computed tomography venography showed a near-total stenosis of his brachiocephalic vein. We discuss the incidence and risk of central vein stenosis in patients on dialysis and report on a successful minimally invasive interventional treatment.ConclusionCentral vein stenosis is not a rare problem in patients on hemodialysis and can even occur without previous placement of central venous catheters. High shunt volumes seem to increase the risk associated with central vein catheters.

Dressing disruption is a major risk factor for catheter-related infections*

Major catheter-related infection includes catheter-related bloodstream infections and clinical sepsis without bloodstream infection resolving after catheter removal with a positive quantitative tip culture. Insertion site dressings are a major mean to reduce catheter infections by the extraluminal route. However, the importance of dressing disruptions in the occurrence of major catheter-related infection has never been studied in a large cohort of patients. A secondary analysis of a randomized multicenter trial was performed in order to determine the importance of dressing disruption on the risk for development of catheter-related bloodstream infection. Among 1,419 patients (3,275 arterial or central-vein catheters) included, we identified 296 colonized catheters, 29 major catheter-related infections, and 23 catheter-related bloodstream infections. Of the 11,036 dressings changes, 7,347 (67%) were performed before the planned date because of soiling or undressing. Dressing disruption occurred more frequently in patients with higher Sequential Organ Failure Assessment scores and in patients receiving renal replacement therapies; it was less frequent in males and patients admitted for coma. Subclavian access protected from dressing disruption. Dressing cost (especially staff cost) was inversely related to the rate of disruption. The number of dressing disruptions was related to increased risk for colonization of the skin around the catheter at removal (p < .0001). The risk of major catheter-related infection and catheter-related bloodstream infection increased by more than three-fold after the second dressing disruption and by more than ten-fold if the final dressing was disrupted, independently of other risk factors of infection. Disruption of catheter dressings was common and was an important risk factor for catheter-related infections. These data support the preferential use of the subclavian insertion site and enhanced efforts to reduce dressing disruption in postinsertion bundles of care.

Central venous catheter‐associated bloodstream infections

To investigate the epidemiologic and microbiological aspects of long-term central vein catheter (CVC)-associated bloodstream infections (CABSI) in children <18 years old treated at the hemato-oncology unit during 1998-2008. The two long-term access devices used were Hickman and Port-A-Cath catheters. Information retrieved included demographic data, baseline pathologies, methods of insertion, anatomical insertion sites, duration of use, microbiological, and antibiotic susceptibility data and outcome. There were 178 CABSI episodes; average number of episodes/1,000 catheter days was 4.7. More CABSI episodes were recorded among patients with Hickman catheter than in patients with Port-A-Cath catheter (5.05 vs. 3.57/1,000 catheter days, P = 0.059). The CVC was removed due to BSI in 52/178 (29.2%) episodes. Overall, 243 pathogens were isolated (144 Gram-negative, 92 Gram-positive, and 7 Candida spp). More Enterobacteriaceae spp. were isolated in CABSI in patients with Hickman catheters than in patients with Port-A-Cath catheters (35/103, 34%, vs. 10/65, 15%, P = 0.008); more coagulase-negative staphylococci were isolated in patients with Port-A-Cath catheters than in patients with Hickman catheters (25/65, 38.5%, vs. 23/103, 22.3%, P = 0.02). No differences in pathogen distribution were found between CABSI recorded for jugular versus subclavian veins, open versus close inserted-CVC or for CVC requiring removal versus those treated conservatively. No fatalities directly related to CABSI were recorded. CABSI rates were higher in patients with Hickman catheters compared with those with Port-A-Cath catheters; Gram-negative organisms were the dominant etiologic agents of CABSI; CABSI in patients with Hickman catheters had different etiologies compared with patients with Port-A-Cath catheters.

Multi-Detector Computed Tomography Venography in the Assessment of Dysfunction of Tunneled Hemodialysis Central Vein Catheters

To assess the value of multi-detector computed tomography venography (MDCTV) in the assessment of tunneled hemodialysis central vein catheters (CVCs) dysfunction. Twenty-five patients who had tunneled CVC dysfunction without abnormality found by x-ray and ultrasound were enrolled. Anti-platelet agents, anticoagulants, and thrombolytic therapy with urokinase failed to resume normal catheter function. MDCTV was performed to observe the position of catheters and to detect central venous stenosis, thrombosis, and fibrin sheath formation. Correct intervention was given according to MDCTV results. MDCTV revealed that the catheter was malpositioned in 10 cases; there were five cases of central venous stenosis, four cases of central venous thrombosis, one case of fibrin sheath formation, and the other five had no abnormalities found. Blood flow on hemodialysis had reached over 300 mL/min after correct intervention. MDCTV provided a new possible way to assess dysfunction of tunneled hemodialysis central venous catheters.