Central Venous Access In Patients Research Articles

Sodium zirconium cyclosilicate treatment and rates of emergency interventions for hyperkalaemia: a propensity-score weighted case-control study

Abstract Background Sodium zirconium cyclosilicate (SZC) reduces serum potassium in patients with chronic hyperkalaemia in clinical trials, but its role in the emergency treatment of hyperkalaemia is unproven. We hypothesised that SZC use for emergent hyperkalaemia would be associated with a reduction in rates of emergency interventions for hyperkalaemia. Methods This was a single centre, propensity-score weighted case-control study of patients admitted with hyperkalaemia to a specialist renal centre. We randomly selected 250 patients admitted between April 2021 and September 2022 (post-SZC era) with a potassium ≥ 5.5 mmol/L treated with at least one ≥ 10g dose of SZC (treatment group). We randomly selected a comparator group of 250 patients admitted between January 2018 and December 2019 (pre-SZC era) with a potassium ≥ 5.5 mmol/L (control group). Baseline demographic and clinical characteristics were recorded and used as covariates for propensity scoring (PS) and inverse probability treatment weighting (IPTW). Our primary outcome measure, rates of emergency haemodialysis, were tested using unadjusted models and multivariable logistic regression models on unweighted data in addition to unadjusted models on weighted data. We also reviewed rates of emergency temporary central venous access as a secondary outcome. Results 59% were male, the mean age was 67 (SD 14) years and 149 (30%) were receiving maintenance dialysis. IPTW achieved satisfactory balance of covariates between the treatment and control groups. In the treatment group, patients were 77% less likely to need emergency haemodialysis (OR 0.23; CI 0.17 to 0.31); this result was consistent following analysis of weighted and unweighted data. Similarly, patients treated with SZC were 73% less likely to require emergency temporary central venous access (OR 0.27; CI 0.20–0.36). Conclusion SZC was associated with signification reduction in rates of emergency haemodialysis and emergency temporary central venous access in patients admitted to a specialised renal centre with emergent hyperkalaemia.

Effect of Peripherally Infused Norepinephrine on Reducing Central Venous Catheter Utilization.

The purpose of this retrospective study was to evaluate the impact of peripherally administered norepinephrine on avoiding central venous catheter insertion while maintaining safety of the infusion. An institutional guideline allows peripheral infusion of norepinephrine via dedicated, 16- to 20-gauge, mid-to-upper arm intravenous (IV) catheters for up to 24 hours. The primary outcome was the need for central venous access in patients initially started on peripherally infused norepinephrine. A total of 124 patients were evaluated (98 initially on peripherally infused norepinephrine vs 26 with central catheter only administration). Thirty-six (37%) of the 98 patients who were started on peripheral norepinephrine avoided the need for central catheter placement, which was associated with $8,900 in direct supply cost avoidance. Eighty (82%) of the 98 patients who started peripherally infused norepinephrine required the vasopressor for ≤12 hours. No extravasation or local complications were observed in any of the 124 patients, regardless of site of infusion. Administration of norepinephrine via a dedicated peripheral IV site appears safe and may lead to a reduction in the need for subsequent central venous access. To achieve timely resuscitation goals, as well as to minimize complications associated with central access, initial peripheral administration should be considered for all patients.

Prophylactic platelet transfusion and risk of bleeding associated with ultrasound-guided central venous access in patients with severe thrombocytopenia.

Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 109 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts. This was a retrospective cohort study of patients with very low PLT counts (<20 × 109 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p< 0.05 was considered statistically significant. Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p= 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis. In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.

1253: EFFECT OF PERIPHERALLY INFUSED NOREPINEPHRINE ON REDUCING CENTRAL VENOUS CATHETER UTILIZATION

Introduction: Vasoactive agents like norepinephrine have been historically administered via central venous catheters (CVCs) due to the perceived risk of local tissue injury with peripheral infusion. While infusion-related complications may be reduced with CVC administration, the higher rates of bacteremia, pneumothorax, and air embolism must be weighed, along with delays in administration and achievement of hemodynamic stability. This study is designed to add to the available safety data of peripheral norepinephrine administration while also investigating the direct cost savings associated with CVC avoidance. Methods: This is a retrospective analysis of adult patients who received norepinephrine between January 1 and September 1, 2021. A hospital guideline allows peripheral infusion of norepinephrine via dedicated, 16 – 20 gauge, mid-to-upper arm IV catheters for up to 24 hours. The primary outcome was the need for central venous access in patients initially started on peripherally infused norepinephrine. Safety outcomes included local tissue injury attributed to norepinephrine infusion. Results: Ninety-eight of 124 total patients initially received peripheral norepinephrine infusions, most of which required vasopressors for distributive or mixed shock. Thirty-six patients (37%) avoided the need for central line placement. The median duration of vasopressors was 6 hours [IQR 3.3 – 11.3] at a median maximum rate of 0.08 mcg/kg/min [IQR 0.05 – 0.15]. In the remaining 62 patients who progressed from peripheral to central line placement, the median duration was 15.5 hours [IQR 6 – 38.5] at a median maximum rate of 0.15 mcg/kg/min [IQR 0.06 – 0.25]. Eighty of the 98 patients (82%) who started peripherally infused norepinephrine required therapy for ≤12 hours. No extravasation or local complications were observed regardless of site of infusion. Avoiding progression to a CVC in 37 of every 100 peripheral lines resulted in an estimated direct supply cost savings of $8,900. Conclusions: Initial administration of norepinephrine via a dedicated peripheral IV site was safe and led to a reduction in the need for subsequent CVC access. To minimize cost while achieving timely resuscitation goals and maintaining patient safety, initial peripheral administration should be considered for all patients.

The inside-out technique is safe and effective for thoracic central venous obstruction

BackgroundThoracic central venous obstruction (TCVO) presents a challenging scenario for patients requiring central venous access. The inside-out technique for crossing occluded veins has been described; however, to date, case series have reported on a limited number of patients. The purpose of the present study was to evaluate the indications for, efficacy of, and outcomes with the inside-out technique at a single tertiary academic center, with close attention to the severity of TCVO using the Society of Interventional Radiology (SIR) TCVO classification. MethodsPatients who had undergone central venous access using the inside-out technique were identified from August 2007 to May 2021. The patient demographics, procedure indication, procedural details, SIR TCVO classification, outcomes, and procedure-related complications were recorded. Statistical analysis was performed using analysis of variance. ResultsA total of 221 patients (109 men [49.3%] and 112 women [50.6%]) had undergone 338 inside-out procedures. Of the 221 patients, 49 had undergone the procedure multiple times (25 two times, 11 three times, 13 more than three times). The average patient age was 54.7 ± 14.8 years. The indications (n = 362) for the procedure included dialysis access (n = 230; 63.5%), infusion of parenteral nutrition, antibiotics, chemotherapy, or other medication (n = 81; 22.3%), cardiac access (n = 39; 10.8%), and other (n = 12; 3.3%); more than one indication for 20 procedures. Type 1 SIR TCVO was found during 147 procedures (43.5%), followed by type 4 for 142 (42.0%), type 2 for 36 (10.7%), type 3 for 6 (1.8%), and unable to determine for 7 (2.0%). The access site was the right femoral vein for 322 procedures (95.3%), left femoral vein for 14 (4.1%), and transhepatically for 2 (0.6%). The exit site location was the right supraclavicular region for 274 (81.3%), right subclavicular for 52 (15.4%), left supraclavicular for 3 (0.9%), left subclavicular for 6 (1.8%), and not defined for 2 (0.6%). Types 3 and 4 were associated with longer fluoroscopy times and more contrast compared with types 1 and 2. The median follow-up and device duration was 56.0 days and 76.5 days, respectively. No differences were found in device duration between the SIR TCVO types. Removal of a catheter was documented for 166 patients. The indications for removal included infectious causes (non–catheter-related bacteremia, catheter-related infection or bacteremia) for 70 (42.1%), catheter malfunction for 34 (20.5%), new hemodialysis access for 19 (11.5%), no longer needed for 19 (11.5%), patient removal of the catheter by 13 (7.8%), and replacement of a temporary catheter with a tunneled device for 11 (6.6%). No procedural complications were associated with the inside-out technique or catheter removal. ConclusionsFor a variety of indications, we have shown that the inside-out technique is safe and effective for establishing central venous access in patients with TCVO and can be performed repeatedly. More complex obstructive patterns were associated with longer fluoroscopy times and greater contrast administration. Durability was primarily limited by infectious complications.

A peripherally inserted central catheter is a safe means of ensuring long-term central venous access in patients with acute leukaemia – a single centre experience

A peripherally inserted central catheter is a safe means of ensuring long-term central venous access in patients with acute leukaemia – a single centre experience

Peripherally Inserted Central Venous Catheters Provide Safe and Easy Central Venous Access in Patients with Head and Neck Cancer

Abstract Purpose The use of peripherally inserted central venous catheters (PICCs) has increased recently; several reports have revealed that they can be easily and safely used in patients with various diseases. However, there are few reports on the use of PICCs in patients with head and neck cancer. This study was aimed at evaluating the safety and feasibility of use of PICCs in patients with head and neck cancer. Materials and Methods We retrospectively analyzed the date of 118 PICC insertions in 85 patients with head and neck cancer from January 2014 to December 2017. The PICCs have been placed under ultrasound guidance in all cases. Results The PICC puncture success rate was 95.2%. Catheter-related bloodstream infection occurred in four cases. The most common complication necessitating PICC removal was suspected catheter-related bloodstream infection (24 cases). All cases with confirmed and suspected catheter-related bloodstream infection improved with administration of antimicrobial agents. Phlebitis occurred in five cases, in all of whom the PICC placement had been made via an antecubital vein; the condition improved without treatment in all five cases. Deep vein thrombosis occurred in two cases, both of which improved with oral anticoagulant therapy. Conclusion This study demonstrated that the complications associated with ultrasound-guided PICC insertion are manageable, and improve with conservative treatment in the majority of cases. Therefore, use of PICCs may be considered for easy and safe central venous access in patients with head and neck cancer, because the insertion success rate was acceptable.

Peripherally Inserted Central Venous Catheters Provide Safe and Easy Central Venous Access in Patients with Head and Neck Cancer

Peripherally Inserted Central Venous Catheters Provide Safe and Easy Central Venous Access in Patients with Head and Neck Cancer

MANAGEMENT OF CENTRAL VENOUS ACCESS IN UKRAINE. SURVEY RESULTS AND REVIEW OF CURRENT GUIDELINES

Central vein catheterization is one of the most frequently performed invasive interventions in intensive care patients. There are many recommendations to minimize the risks of a vein puncture and avoid various complications during the operation of a central venous catheter. These recommendations are adjusted when new evidence of the effectiveness or harm of certain approaches appears. Comparing current activities with current evidence-based guidelines is the way to improve the practice of central venous access management.Objective. Evaluate clinical practice of central venous access in intensive care unit for adults, children and newborns in order to identify specific disadvantage, and based on the results and taking into account international recommendations to propose steps to improve management of central venous catheters.Methods. Free anonymous online survey of anesthesiologists and pediatric anesthesiologists about their practice of management central venous access.Results. We conducted a survey in which 766 intensive care physicians took part. When working with both adults and children, the majority prefers catheterization of the subclavian vein (69,9% and 69,8%, respectively). In neonatal intensive care units, 57,3% of doctors perform umbilical vein catheterization and 50,6% - central vein catheterization from peripheral access. 44,6% of the respondents do not have a central venous access protocol, 54,7% are guided by local, national or international recommendations. 28,2% of doctors use ultrasound navigation to provide central venous access, 54,6% – do not have the opportunity to use ultrasound. After catheterization of the central vein, control of the position of the catheter tip is always performed by 29,9%, 14,4% of respondents never control, 38% – sometimes, when they are in doubt, 9,9% – when it is possible, and 7,8% of respondents have no opportunity to control. For skin preparation before catheterization of the central vein, the majority, 45,6% use iodine-containing solutions and alcohol, 38,1% - only alcohol, 15,8% - a solution with chlorhexidine and alcohol. In the absence of blood sampling from the catheter, or its thrombosis, 34,8% remove the catheter and provide catheterization from another access, 14,7% change the catheter using a guidwire, and 47,9% try to restore patency using a guidewire or rinsing the catheter with a solution of 0,9% NaCl or heparin. The majority of respondents, 88,9%, do not use in their practice special solutions for the prevention of catheter-associated sepsis. With long-term use of the catheter for the prevention of thrombotic occlusion, the majority, 56,4%, use in their practice the routine administration of heparin, 36,7% consider this tactic ineffective. The majority, 55%, believe that the local use of antimicrobial agents at the site of the catheter entry into the skin contributes to the development of fungal infection and resistance to antimicrobial drugs, 19,9% of respondents use such tactics for the prevention of catheter-associated infection, 21,3% – sometimes use. To cover the catheter entry site into the skin, 42,9% use transparent stickers with or without chlorhexidine, 40,9% use the material that is available, 10,4% use ordinary adhesive plaster. 13,6% of the respondents use checklists when working with a central venous catheter, while 63,6% do not use it, but consider this tactic expedient.Conclusions. The survey results found heterogeneity in management of central venous access in patients of different age groups. Most of the answers that correspond to the current standards of central venous access management have been received from neonatal intensive care units’ doctors. Uncorrected management ofcentral venous access in some approaches is due to poor logistic of intensive care units. The practice of central venous access management should be standardized according current evidence-based guidelines.

Use of the Surfacer® Inside-Out® Catheter Access System to Obtain Central Venous Access in Dialysis Patients With Thoracic Venous Obstructions: Single-Center Series.

Thoracic central venous obstruction (TCVO) is a common condition which can impact the ability to achieve central venous access (CVA) in patients on hemodialysis. The Surfacer® Inside-Out® Catheter Access System is designed to enable repeated right-side central venous access in patients with TCVO. We retrospectively analyzed medical records of 10 dialysis patients who presented with TCVO and underwent the Inside-Out procedure with the Surfacer System to obtain CVA between 2017 and 2020. Patient demographics, hemodialysis vascular access history, and procedural data were identified and analyzed. The mean patient age was 62.4 ± 19.6 years (25.9-89.1 years) with 7 of the 10 patients being male. Eight patients (80.0%) were diagnosed with chronic kidney disease with time on hemodialysis ranging from 3 to 13 years. The remaining 2 required CVA to treat acute-on-chronic kidney injury due to septic shock. Patients in our series had a mean of 2.8 ± 1.6 previous catheters placed prior to the Surfacer procedure. CVA was achieved in all 10 patients with 1 patient requiring a second attempt to achieve access due to the inability to initially traverse the iliac vein with the device, possibly due to a history of kidney transplantation. One multimorbid patient died shortly after the successful procedure, possibly due to cardiac decompensation. Mean total procedure time for the 7 patients having only dialysis catheter placement using the Surfacer device was 67.2 ± 19.1 minutes (49-103 minutes). The remaining 3 patients received a Hemodialysis Reliable Outflow (HeRO) graft in conjunction with the Inside-Out procedure. All vascular accesses functioned properly during the immediate time period following placement. No adverse events associated with the use of Surfacer device were encountered. Data presented from our patient series confirms the effectiveness of the Surfacer System to safely achieve CVA in dialysis patients with TCVOs with a history of multiple catheter placements.

Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry

PurposeTo report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). Materials and MethodsFive sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. ResultsCentral venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6–70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2–25.5) minutes. ConclusionsThe Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.

Modified Inside-Out Technique for Continued Use of Chronically Occluded Upper Central Veins

This report describes a 2-step, inside-out procedure for upper body central venous access in patients with chronic central venous occlusions. Blunt cephalad dissection through the mediastinum was achieved with a curved metal cannula and guide wire followed by percutaneous puncture of an open snare from a right supraclavicular approach and dilation of the tract for a tunneled central venous catheter insertion. Of 9 patients, all had a successful placement of a tunneled central venous catheter using this method. Although this 2-step, inside-out technique is effective for creating access in the presence of central venous occlusion, further clinical evaluation is warranted.

A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited for patients with difficult and long-term central venous access needs, particularly those with chronic conditions such as intestinal failure. It is specifically useful when tunneled lines are broken, precipitated or clotted and unamenable to wiring.

Ultrasound-guided peripheral deep vein cannulation to perform automated red cell exchange-A pilot study in a single centre.

Securing adequate vascular access is essential for a successful apheresis procedure. In most, peripheral access is preferred but it is not always technically possible. Ultrasound-Guided Peripheral Vascular Access (USG-PIVA) is a well-documented technique in the setting of Emergency departments. However, limited data exists reporting its use in the context of automated red cell exchanges (a-RCEx). To assess the effectiveness and feasibility of USG-PIVA to undertake successful a-RCEx. Data was collected prospectively from patients with sickle cell disease and difficult venous access, undergoing a-RCEx at a single centre. The USG-PIVA technique was attempted and data relating to each attempt was collected and analysed. Between April 2014 and July 2015 84 USG-PIVA procedures were performed on 38 patients. 71 USG-PIVA (85%) were successful, 13 (15%) were unsuccessful. Veins successfully cannulated: in the upper arm, basilic (22), brachial (33) and cephalic (2) veins; in the antecubital fossa, basilic (3) and median cubital (7) and in the lower arm, cephalic (2) and radial (2). Cannulas used: Introcan Safety® Braun 22 g (1), 20 g (9) and 18 g (61). Inlet flow rates achieved: 30-60 ml/min (mean 45 ml/min). Depth of veins cannulated: 2-12 mm (mean 5 mm). two complications were observed-one cannula displacement and one nerve injury. No arterial punctures occurred. Central Venous Catheters avoided (49). The US-PIVA method offers an effective alternative to Central Venous Access in patients requiring a-RCEx procedures who lack visual or palpable peripheral access, with minimal complications seen in this series. J. Clin. Apheresis 31:501-506, 2016. © 2015 Wiley Periodicals, Inc.

Tip Location of Central Venous Access in Patients with Atrial Fibrillation and Pacemakers: An Algorithm Minimizing X-RAY Exposure

Tip Location of Central Venous Access in Patients with Atrial Fibrillation and Pacemakers: An Algorithm Minimizing X-RAY Exposure

Direct Translumbar Inferior Vena Cava Ports for Long-Term Central Venous Access in Patients with Cancer

PurposeTo evaluate the indications, complications, and long-term results of translumbar port placements to the inferior vena cava for long-term central venous access in a single tertiary center. Materials and MethodsThis retrospective study included all patients with cancer who underwent translumbar port placement from January 2000 to July 2012; 31 patients (all women) with an average age of 53.1 years ± 11.1 (range, 30–77 y) were included in the study. Of these patients, 26 (81%) had breast cancer, 3 had lung cancer, 1 had ovarian cancer, and 1 had rectal cancer. Indications included central venous occlusion in 9 patients (29%) and bilateral mastectomy and lymph node dissection in 22 patients (71%). ResultsAll procedures were technically successful. The overall 30-day complication rate was 9.7% (n = 3). Average catheter use was 14.1 months ± 21 (range, 0.75–108 mo). Thirteen (41.9%) ports were removed because they were no longer needed; 4 (12.9%) ports required removal for port malfunction; 12 (38.7%) patients died with their ports still in place; 2 (6.5%) ports remain in use. Three (9.7%) ports required delayed secondary intervention to remain functional. One patient had a systemic infection attributed to the port, resulting in an overall infection rate of 0.08 per 1,000 catheter days. ConclusionsTranslumbar inferior vena cava port placement is a technically feasible and safe alternative method for long-term central venous access.

Essential, but at what risk? A prospective study on central venous access in patients with haematological malignancies

Central venous catheters (CVC) are integral to modern haematology practice; however, they are associated with a range of complications. This prospective study aimed to determine the rate of CVC-related complications and risk factors in haematology patients, who are vulnerable because of their underlying pathology and treatments. All inpatients that had a non-tunnelled CVC inserted in a 14-month period in the haematology ward at St Vincent's Hospital were enrolled. Complications (immediate and late), demographics, type of device, insertion technique and duration of dwell, were examined using multivariate analysis. One hundred and seventy-four CVC in 84 patients were recorded, representing 3016 catheter-days. At least one complication was found in 43 (24.7%) patients. Immediate complications occurred in 13 (7.5%) insertions, with a higher rate in those inserted after ≥2 attempts compared with one (P = 0.02). Catheter-related bloodstream infection occurred at a rate of 7.6 per 1000 catheter-days, with acute lymphoblastic leukaemia associated with a higher rate (P = 0.02), and subclavian vein CVC had a lower rate compared with other locations (P < 0.01). Thrombosis was found in seven (4.0%) patients, with subclavian CVC carrying an increased risk (P = 0.02). This prospective observational study found almost a quarter of haematology patients experience a CVC-related complication. An association was found with a number of attempts at insertion and immediate complications; other risk factors included anatomical location, underlying disease and duration of catheterisation. The relatively high complication rate, compared with reports of non-haematology patients, highlights the need to improve CVC management, a vital part of care for this population.

Abstract No. 384: Central venous access in patients with chronic venous occlusion

1) To identify the various patient groups who require long-term central venous access, 2) to understand the various measures that can be used to reduce the risk of venous occlusion in these patients, 3) to describe the various techniques used to obtain long-term venous access in patients with chronic venous occlusion, 4) to discuss the requirements, advantages and disadvantages of the various techniques in relation to the current literature.

Atrial Thrombosis: A near Fatal Complication of a Portacath

Portacaths (Bard Medical Division, Georgia, USA) are routinely used for central venous access in patients with poor peripheral veins who require regular long-term venous access. Complications associated with central venous access devices, including infection and thrombosis, are well described in the literature; however, to our knowledge there have been few case reports of right atrial thrombi and pulmonary emboli related to implanted ports. This paper discusses the case of a patient who developed an atrial thrombosis 4 months after port placement and subsequent pulmonary emboli.

Electrophysiologic interventions in patients with inferior vena cava filters: Safety and efficacy of the transfemoral approach

The purpose of this study was to evaluate the transfemoral venous approach for electrophysiologic interventions in patients with inferior vena cava filters. Reports have detailed complications associated with obtaining central venous access in patients with inferior vena cava filters. Accordingly, electrophysiologic interventions have been modified or deferred altogether in such patients. Patients requiring interventions with a transfemoral approach who were at least 3 months post filter insertion underwent fluoroscopically guided insertion and withdrawal of electrode catheters with appropriate follow-up. Five patients underwent successful pacing, electrophysiologic study, or radiofrequency ablation using one to three catheters, with no complications attributable to filter placement. Transfemoral electrophysiologic interventions can be safely undertaken across vena cava filters provided appropriate precautions are taken.