Complications Of Central Venous Catheters Research Articles

Fatal Hemoptysis With Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization

Fatal Hemoptysis With Pleural Effusions Secondary to Superior Vena Cava Obstruction as a Complication of Central Venous Catheterization

Life on the line - Incidence and management of central venous catheter complications in intestinal failure

Background & AimsLoss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs. MethodsFor this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDT) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/ port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDT were compared. ResultsOverall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 “CVC-days”). Broviac type “B” was found to be significantly superior to type “A” regarding occlusion, CRI, and material defects (log-rank test: p=0.05; p=0.026; p=0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 388.5 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications. ConclusionsDifferent complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce.

Results of a long-term, prospective study on complications of central venous catheter in pediatric patients with hematologic-oncologic diseases.

Central venous catheter (CVC)-related complications remain a significant cause of morbidity in pediatric hematology-oncology. We prospectively surveyed the incidence of CVC-related complications in children with hematologic-oncologic diseases. Five-hundred-eighty-one CVCs were inserted in 421 patients from January 2010 to June 2022 (153,731 CVC days observation; follow-up data up to December 31, 2022). Overall, 671 complications were recorded (4.365/1000 CVC days): 49.7% malfunctions (1.88/1000 CVC days, 4.8% of CVC early removals), 23.9% bacteremia (0.90/1000, 15.1%), 19.6% mechanical complications (0.74/1000, 70.2%), 20.1% localized infections (0.76/1000, 17.1%), 0.5% thrombosis (0.02/1000, 33.3%). At multivariate analysis, risk factors for malfunction were Broviac-Hickman type of CVC (hazard ratio [HR] 2.5) or Port-a-cath (HR 3.4) or Proline (HR 4.3), p<.0001; for bacteremia double-lumen CVC (HR 3.2, p<.0001); for mechanical complications age at CVC insertion under median (HR 4.5, p<.0001) and Broviac-Hickman (HR 1.6) or Proline (HR 2.7), p=.01; finally for localized infections Broviac-Hickman (HR 2.9) or Proline (HR 4.4), p=.0001. The 2-year cumulative incidence of premature removal was 23.5%, and risk factors were age at CVC insertion under median (HR 2.4, p<.0001), Broviac-Hickman (HR 2.3) or Proline (HR 4.2), p<.0001. Premature removal occurs in approximately 20%-25% of long-term CVCs. A surveillance program has a fundamental role in identifying the risk factors for CVC complications and the areas of intervention to improve CVC management.

Outcomes for central venous catheter repair in patients receiving long-term home parenteral support: A descriptive cohort study.

Central venous catheter (CVC) complications are frequently reported in patients receiving home parenteral support (HPS). Compromised CVC integrity or breakage is one such issue. Repairing such breakages can potentially avoid costly and risky catheter replacements. We completed a retrospective descriptive cohort study using a prospectively maintained data set, in a national UK intestinal failure reference center. Repair success, CVC longevity, and catheter-related bloodstream infection (CRBSI) rates after repair were the primary outcome measures. A total of 763 patients received HPS. There were 137 CVC repairs: 115 (84%) tunneled CVCs and 22 peripherally inserted central catheters (PICCs) attempted in 72 patients. Of the 137 attempts at CVC repair, 120 (88%) were deemed to be successful, allowing a median duration of subsequent CVC use of 336 days following repair (range 3-1696 days), which equates to 99,602 catheter days of HPS infusion. Three patients had a CRBSI within 90 days of repair, and patients required admission to the hospital for refeeding on 14 occasions following repair, such that hospitalization was avoided in 103/120 (86%) occasions following successful CVC repair. There was no increase in the recorded rate of CRBSIs in patients undergoing CVC repair compared with the CRBSI rates of all HPS-dependent patients under our care during the study period (0.03 vs 0.344/1000 catheter days, respectively). This is the largest single-center experience to demonstrate that CVCs, including PICCs, used for the administration of HPS can be safely repaired, prolonging CVC longevity without leading to an increased risk of CRBSI.

A 4-year tunneled hemodialysis catheter malpositioned into the azygos vein and how to remedy the hemodialysis circuit.

Mispositioning in the azygos vein is a rare but hazardous complication of central venous catheterization. A patient was admitted for a dysfunctional hemodialysis tunneled cuffed catheter (TCC) placed in the azygos vein for 4 years. Computed tomography angiography revealed multiple sites of occlusion, including the superior vena cava (SVC), right and left innominate veins (IVs), and right femoral vein. Percutaneous transluminal angioplasty and a TCC replacement based on a segment-by-segment recanalizing strategy were performed. First, an 8-Fr sheath was inserted through the left femoral vein approach to retrogradely traverse the occlusive SVC followed by a guidewire extending to the occlusive left IV. A left transjugular 15-cm snare was inserted to capture the transfemoral guidewire and achieve recanalization from the left IV to the SVC. Second, a transjugular guidewire was advanced through the dysfunctional TCC yet shunted into the left IV due to the inability to cross the SVC. A left transfemoral 15-cm snare was inserted to capture the guidewire and achieve complete recanalization from the right internal jugular vein to the SVC. Balloons were passed over the guidewires to dilate the obstructive lesions sequentially, and a new TCC was inserted successfully with the tip positioned in the right atrium.

Predictors of central line-associated bloodstream infections in cancer patients undergoing chemotherapy through implanted venous access ports: a retrospective, observational study.

Central venous catheters (CVCs) are sometimes superior to peripheral vascular access for chemotherapy. Central line-associated bloodstream infections (CLABSIs) are an important complication of CVCs in chemotherapy. A retrospective, observational study was conducted to investigate patients with implanted venous access ports (PORTs) from July 2010 to June 2021 in a teaching hospital. General conditions of the PORTs, backgrounds, and characteristics of patients were compared between CLABSI cases and uninfected cases to identify predictors of CLABSI. A total of 566 patients with PORTs who underwent chemotherapy were enrolled in this study, with CLABSI identified in 41 patients, for a total of 436,597 catheter-days. The median duration of PORT use was 26 vs. 494 days (P<0.001) in the CLABSI and uninfected groups, respectively. There were no significant differences in tumor classification, staging, white blood cell (WBC) count, neutrophil proportion, lymphocyte proportion, albumin, C-reactive protein (CRP), and performance status between the CLABSI and uninfected groups. Multivariable analysis showed that antibiotic usage within the previous week, total protein (TP), and immediate PORT use were independently associated with CLABSI, and their odds ratios (ORs) were 4.89 [95% confidence interval (CI): 1.67, 14.35], 1.95 (95% CI: 1.14, 3.53), and 3.13 (95% CI: 1.18, 8.30), respectively. The area under the curve (AUC) of the receiver-operating characteristic curve for TP was 0.63, and the cutoff value was 5.9 g/dL. PORT implantation should be avoided in patients who had antibiotic treatment episodes within 1 week, especially for those with low serum TP levels.

A Survey of Clinician Perspectives on the Management of Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients with Cancer

Background: Central venous catheters (CVCs) are commonly used in cancer patients to facilitate blood draws, administration of chemotherapy or other supportive care treatment. Catheter-related upper extremity deep vein thrombosis (DVT) is a major complication of CVCs, with studies reporting a rate of symptomatic venous thromboembolism (VTE) of 7% over 3 months in patients with active cancer and a new CVC. Despite the frequent occurrence, the optimal management in patients with cancer and catheter-related upper extremity DVT is unclear, given the lack of high-quality data. Objective: We conducted a survey aiming to characterize practice patterns and perceptions of clinicians who treat patients with cancer and catheter-related upper extremity DVT. Methods: An online survey was distributed to international clinicians who manage patients with cancer and catheter-related upper extremity DVT. The survey explored the type and duration of anticoagulation, focusing on the management after the initial 3 months of anticoagulation, as well as treatment strategies upon catheter removal and interests in future clinical studies. Descriptive statistics was used to summarize survey responses. Results: The survey was generated on LimeSurvey ® in English and publicized by Twitter ® and email communications via multiple international organizations of hematologists, oncologists, and/or thrombosis specialists, including the International Society on Thrombosis and Haemostasis (ISTH), Thrombosis Canada, the Canadian Venous Thromboembolism Research Network (CanVECTOR), and more. As of July 30, 2023, 115 clinicians from 26 countries had completed the survey. The majority of the respondents specialized in thrombosis (N=72, 62.6%) and/or hematology (N=60, 52.2%), followed by internal medicine (N=38, 33.0%) and oncology (N=14, 12.2%) (multiple selection was permitted for this question). For the initial management of a patient without unresected gastrointestinal (GI) or genitourinary (GU) cancer, thrombocytopenia, or relevant drug-drug interactions, 75% of clinicians would prescribe a direct oral anticoagulant (DOAC) and 25% would give low-molecular-weight heparin (LMWH). On the other hand, in patients with unresected GI/GU cancer, the majority (N=105, 91.3%) of respondents chose to initiate LMWH. After the initial 3 months of anticoagulation, if the CVC remains in place in a patient with active cancer, the majority (N=112/114, 98.2%) of clinicians would continue anticoagulation, but with variable doses (57% and 43% chose therapeutic and prophylactic dosing, respectively). If the CVC remains in place but the cancer is in remission, fewer (70%) respondents would continue anticoagulation, and more would continue prophylactic as compared to therapeutic dosing (73% vs. 27%) in this setting. Practice variation further increases upon catheter removal, especially in the presence of active cancer (Figures 1 and 2). The majority of respondents (N=111, 96.5%) agree that there is a need for prospective studies to evaluate the management of patients with cancer and catheter-related upper extremity DVT, and over 91% (N=105) would consider enrolling their patients in a study to evaluate prophylactic dosing of anticoagulation for secondary prevention of VTE in patients with cancer and catheter-related upper extremity DVT. To help plan such a study, we evaluated respondents' perception on the maximal “tolerable” recurrent VTE rate between 3 and 6 months (as the main interest is in the management strategy after the initial 3 months), and 2% and 3% were the most common responses (41.2% and 31.6% of the respondents, respectively). Conclusions: Our survey demonstrates that current practice in managing patients with cancer and catheter-related upper extremity DVT is heterogenous, especially after the initial 3 months of anticoagulation and upon catheter removal. Well-conducted prospective studies in this population are needed, which is supported by most clinicians.

Complications associated with central venous catheterization in pediatric ICU of a tertiary care hospital of Pakistan.

Objective: To determine the frequency of complications of central venous line insertion among children admitted in Pediatric Intensive Care Unit (PICU). Study Design: Cross-sectional study. Setting: PICU of Shifa International Hospital, Islamabad, Pakistan. Period: March 2022 to February 2023. Material &amp; Methods: Children of either gender aged between 2 months to 16 years admitted in PICU during study period and underwent central venous catheterization(CVC) during admission were analysed. The patients were observed for immediate and late complications of CVC. Results: In a total of 160 children, 89 (55.6%) were boys. The mean age at the time of admission was 6.00±4.87 years. Immediate complications occurred among 9 (5.6%) children including catheter malposition, pneumothorax, hematoma, and arterial puncture observed in 4 (2.5%), 2 (1.3%), 2 (1.3%) and 1 (0.6%) children respectively. The CLABSI rate was 16.8 per 1,000 catheter days. The most common micro-organisms causing CLABSI were Methicillin Resistant Staph Epidermidis (MRSE), and Klebsiella, reported in 3 (21.4%) cases each. Younger age (p&lt;0.001), relatively low body weight (p&lt;0.001), and increased duration of central venous line placed (p&lt;0.001) were found to be significantly associated with CLABSI. Conclusion: In this study, CLABSI rate was found to be 16.8 per 1,000 catheter days which is comparable to the regional data. Common immediate complications of CVC were catheter malposition, pneumothorax, hematoma, and arterial puncture. Younger age and increased duration of CVC were associated with CLABSI.

Ultrasound-guided placement of Midline catheters performed by Neurosurgery resident as a substitute for conventional central venous catheter placement in Neurosurgical Intensive Care Unit patients

Background: Midline catheters (MCs) and peripherally inserted central venous catheters (PICCs) are placed by a specialist or trained nurse to avoid the complications of conventional central venous catheters (CCVCs). The safety of MC placements by residents has not been evaluated. We investigated the safety of ultrasound-guided MC placement by neurosurgery residents as a substitute for CCVC placement in patients in the neurosurgical intensive care unit (ICU) requiring intravenous (IV) therapy ≤14 days.Methods: Between July 2022 and June 2023, 57 MCs for 44 patients, 36 CCVCs for 35 patients, and 32 PICCs for 32 patients were placed during their ICU stay. One resident performed all MC placements under ultrasound guidance. The baseline and procedure-related parameters of the three catheter groups (MC, CCVC, and PICC) were analyzed, with focus on the comparison of complications between MC and CCVC.Results: The first-attempt success rate was significantly higher (p=0.003) in the MC group (96.5%) than in the CCVC group (80%). Insertional injuries occurred more frequently in the CCVC group than in the MC group (13.3% vs 0%, p=0.012). The rate of completion of therapy was significantly higher (p=0.002) in the MC group (86.0%) than in the CCVC group (53.3%). The incidence of bloodstream infections did not differ significantly between the MC and CCVC groups (p=0.605). Conclusion: MCs placed under ultrasound guidance by neurosurgery residents for neurosurgical ICU patients is safe and may be a substitute for CCVC indicated for IV therapy ≤14 days.

Use of Basilic vein in arteriovenous fistulas construction for hemodialysis access. Is it a good option alternative to prosthetic arteriovenous grafts?

For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month followup: 77.7% vs 53.1% (p < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (p = 0.063), respectively. In addition, BGs required more interventions to preserve patency. AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs.

Central venous Catheters Indications and Complications: Review Article

Central venous Catheters Indications and Complications: Review Article

10: Incidence and management of mechanical and infectiologic complications of different central venous catheters in use for home parenteral nutrition

10: Incidence and management of mechanical and infectiologic complications of different central venous catheters in use for home parenteral nutrition

Case report: Central venous catheter thrombosis complicated by chronic thromboembolic disease/pulmonary hypertension in two children requiring parenteral nutrition

Chronic thromboembolic pulmonary hypertension is a rare but life-threatening complication of long-term central venous catheters (CVC) in children. However, evidence in terms of potential treatment strategies and outcome data remains scarce. We describe two cases of CVC-related thrombosis (Hickman-catheter) complicated by recurrent pulmonary emboli. One patient experienced a complete thromboembolic obstruction of the right pulmonary artery with normal pulmonary pressures and the second patient suffered from a central thromboembolic obstruction of both pulmonary arteries associated with severe pulmonary hypertension. Both patients successfully underwent surgical thromboendarterectomy with deep hypothermic circulatory arrest.

Short bowel syndrome: Complications and management.

Short bowel syndrome (SBS) occurs when a patient loses bowel length or function significantly enough to cause malabsorption, oftentimes requiring lifelong parenteral support. In adults, this occurs most commonly in the setting of massive intestinal resection, whereas congenital anomalies and necrotizing enterocolitis predominate in children. Many patients with SBS develop long-term clinical complications over time related to their altered intestinal anatomy and physiology or to various treatment interventions such as parenteral nutrition and the central venous catheter through which it is administered. Identifying, preventing, and treating these complications can be challenging. This review will focus on the diagnosis, treatment, and prevention of several complications that can occur in this patient population, including diarrhea, fluid and electrolyte imbalance, vitamin and trace element derangements, metabolic bone disease, biliary disorders, small intestinal bacterial overgrowth, d-lactic acidosis, and complications of central venous catheters.

Massive hemothorax secondary to internal jugular vein central venous catheter placement in a patient undergoing spinal surgery complicated by chest trauma: a case report

BackgroundPlacement of a central venous catheter (CVC) is a common procedure for spinal surgery and is relatively safe under ultrasound guidance.Case presentationWe report the case of a 56-year-old female who underwent ultrasound-guided placement of an internal jugular vein CVC for fluid replacement during spinal surgery for thoracic vertebral burst compression fracture and multiple rib fractures as a result of a high-altitude fall injury. Hemothorax developed intraoperatively. During a thoracotomy, the tip of the CVC was found within the chest cavity. The presence of chest trauma may impact on clinician’s appreciation of the potential complications of internal jugular vein CVC placement.ConclusionThe present case demonstrates the need for clinical awareness of the potential complications of CVC placement in patients with chest trauma and the need for adequate training in this technique.

Intravascular Complications of Central Venous Catheterization by Insertion Site in Acute Leukemia during Remission Induction Chemotherapy Phase: Lower Risk with Peripherally Inserted Catheters in a Single-Center Retrospective Study.

The basilic/brachial (BBV), internal jugular (IJV), and subclavian veins (SCV) are commonly used as central venous catheter (CVC) sites. A BBV approach [peripherally inserted central catheter (PICC)] is increasingly used for short- to intermediate-term CVCs for acute leukemias undergoing cytotoxic intensive regimens. In this retrospective study, the catheterization of the BBV, IJV, and SCV in patients with previously untreated acute leukemia was assessed. The primary outcome was the composite incidence of catheter-related symptomatic deep-vein thrombosis (sDVT) and bloodstream infection (BSI) from catheterization up to 30 days later. In a 10-year period, 336 CVC were inserted in the BBV (n = 115), IJV (n = 111), and SCV (n = 110) in 336 patients suffering from AML (n = 201) and ALL (n = 135) and undergoing induction chemotherapy. The primary outcome events were 8, 20, and 27 in the BBV, SCV and IJV cohorts (2.6, 6.9, and 9.6 per 1000 catheter-days, respectively; p = 0.002). The primary outcome risk was significantly higher in the IJV-cohort than in the BBV-cohort (HR, 3.6; 95% CI, 1.6 to 7.9; p = 0.001) and in the SCV-cohort than in the BBV-cohort (HR, 2.6; 95% CI, 1.2 to 5.9; p = 0.02). PICC was a valid CVC for the induction chemotherapy of acute leukemia for the lowest risk of sDVT and BSI.

Overview about Complications of Central Venous Catheters of Hemodialysis and Their Prevention in Adults: Review Article

Overview about Complications of Central Venous Catheters of Hemodialysis and Their Prevention in Adults: Review Article

Tunneled central venous catheters for hemodialysis-unfairly condemned? Catheter-related complications in a university hospital setting.

Central venous catheters (CVCs) provide an immediate hemodialysis access but are considered to be of elevated risk for complications. It remains unclear, if CVCs per se have relevant impact on clinical outcome. We provide an assessment of CVC-associated complications and their impact on mortality. In a single center retrospective study, CVC patients between JAN2015-JUN2021 were included. Data on duration of CVC use, complications and comorbidities was collected. Estimated 6-month mortality was compared to actual death rate. About 478 CVCs were analyzed. Initiation of dialysis was the main reason for CVC implantation. Death was predominant for termination of CVC use. Infections were rare (0.6/1000 catheter days), complications were associated with certain comorbidities. Actual 6-month mortality was lower than predicted (14.3% vs 19.6%). (1) CVCs are predominantly implanted for initiation of hemodialysis; (2) serious complications are rare; (3) complications are associated with certain comorbidities; and (4) CVC patients survive longer than predicted.

Predictive factors of infection in patients with chronic kidney disease using hemodialysis catheters.

Infection is the most frequent complication of central venous catheters used for hemodialysis. The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Unusual complication of central venous catheter detected on contrast-enhanced EUS (with video).

Unusual complication of central venous catheter detected on contrast-enhanced EUS (with video).