Implantable Central Venous Catheters Research Articles

Pericardial Tamponade Two Years after Central Venous Catheter Implantation in a Patient with Breast Cancer: A Case Report

We report a rare and diagnostically challenging case of pericardial tamponade in a breast cancer patient, treated two years earlier. Echocardiogram and an enhanced computed tomography (CT) scan revealed a large mass in the right pericardium with indistinct borders. A positron emission tomography-computed tomography (PET-CT) scan showed no uptake of fluorine-18 fluorodeoxyglucose (18F-GDP) by the mass. Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement confirmed no signal enhancement within the mass and a clear border, decisively ruling out malignancy. This case highlights the importance of late gadolinium enhancement in this diagnostically challenging case and explores the pericardial tamponade development mechanism.

Nurses' evidence-based knowledge and self-efficacy in venous access device insertion and management: Development and validation of a questionnaire.

To develop and psychometrically test an instrument to assess nurses' evidence-based knowledge and self-efficacy regarding insertion and management of venous access devices (short peripheral catheter (SPC), long peripheral catheter/midline (LPC) and PICC) and the management of totally implantable central venous catheter (Port) in adult patients. Multicenter cross-sectional observational study with questionnaire development and psychometric testing (validity and reliability). An evidence-based instrument was developed including a 34-item knowledge section and an 81-item self-efficacy section including four device-specific parts. Nineteen experts evaluated content validity. A pilot study was conducted with 86 nurses. Difficulty and discrimination indices were calculated for knowledge items. Confirmatory factor analyses tested the dimensionality of the self-efficacy section according to the development model. Construct validity was tested through known group validity. Reliability was evaluated through Cronbach's alpha coefficient for unidimensional scales and omega coefficients for multidimensional scales. Content validity indices and results from the pilot study were excellent with all the item-content validity indices >0.78 and scale-content validity index ranging from 0.96 to 0.99. The survey was completed by 425 nurses. Difficulty and discrimination indices for knowledge items were acceptable with most items (58.8%) showing desirable difficulty and most items (58.8%) with excellent (35.3%) or good (23.5%) discrimination power, and appropriate to the content. The dimensionality of the model posited for self-efficacy was confirmed with adequate fit indices (e.g., comparative fit index range 0.984-0.996, root mean square error of approximation range 0.054-0.073). Construct validity was determined and reliability was excellent with alpha values ranging from 0.843 to 0.946 and omega coefficients ranging from 0.833 to 0.933. Therefore, a valid and reliable tool based on updated guidelines is made available to evaluate nurses' competencies for venous access insertion and management.

P425 0.9% saline is as effective as heparinised saline at preventing occlusion of totally implantable central venous catheters (TIVADs): a systematic review

P425 0.9% saline is as effective as heparinised saline at preventing occlusion of totally implantable central venous catheters (TIVADs): a systematic review

A Stepwise Interventional Strategy for the Removal of Adherent Totally Implanted Central Venous Access Port Catheters

To evaluate the safety and effectiveness of a stepwise interventional strategy for the removal of adherent totally implanted central venous access port catheters, consisting of a guidewire support, antegrade coaxial separation, and retrograde coaxial separation with increasing technical complexity. This study has a retrospective design. Thirty-two patients who had failed routine removal of the port catheter and were then transferred to interventional radiology between November 2017 and December 2023 were reviewed. The technical success and complication rates were recorded. All adherent catheters were successfully removed without catheter fragmentation, using guidewire support (n=21), antegrade coaxial separation (n=5), and retrograde coaxial separation (n=6). The technical success rate was 100%, and no complications occurred. The proposed stepwise interventional strategy successfully removed adherent port catheters, with good safety and high effectiveness. It appeared to reduce the incidence of catheter fracture during the removal of adherent totally implantable central venous access port catheters.

Complications after peripherally inserted central catheter versus central venous catheter implantation in intensive care unit: propensity score analysis using a nationwide database

ABSTRACT Background It remains unclear whether peripherally inserted central catheters (PICCs) are superior to central venous catheters (CVCs); therefore, we compared post-implantation complications between CVC and PICC groups. Research design and methods Patients who received CVCs or PICCs between April 2010 and March 2018 were identified from the Diagnosis Procedure Combination database, a national inpatient database in Japan. The outcomes of interest included catheter infection, pulmonary embolism, deep vein thrombosis, and phlebitis. Propensity score overlap weighting was used to balance patient backgrounds. Outcomes were compared using logistic regression analyses. Results We identified 164,185 eligible patients, including 161,605 (98.4%) and 2,580 (1.6%) in the CVC and PICC groups, respectively. The PICC group was more likely to have overall complications (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.32–2.19), pulmonary embolism (OR, 2.32; 95% CI, 1.38–3.89), deep vein thrombosis (OR, 1.86; 95% CI, 1.16–2.99), and phlebitis (OR, 1.72; 95% CI, 1.27–2.32) than the CVC group. There was no significant intergroup difference in catheter infection (OR, 1.09; 95% CI, 0.39–3.04). Conclusions Patients with PICCs had a significantly greater incidence of complications than did those with CVCs. Further research is necessary to explore the factors contributing to these complications.

The different forms of the left brachiocephalic vein visualised during cardiovascular implantable electronic device implantation procedures.

Among the factors ensuring successful completion of such minimally invasive procedures as cardiac implantable electronic device (CIED) implantation and central venous catheter (CVC) placement are the morphometry and topography of the vessels used for cardiac lead or catheter advancement. Venous access through the left clavipectoral triangle makes use of the left brachiocephalic vein (BCV). The purpose of this study was to present the radiology images of various individual forms of this vessel observed during CIED implantation procedures. Our analysis included 100 venography recordings illustrating the left BCV, obtained during de novo CIED implantation procedures. We assessed the mediastinal course of the left BCV, with its natural angles, including angle α (in the middle section of the vessel) and the two angles created by the left BCV and the left subclavian vein (angle β) and the left BCV and the superior vena cava (angle γ). The mean values of angle α tended to be higher (approximately 141°) than those of the two remaining angles (γ and β), which were comparable at 123° and 127°, respectively. An increase in mean angle α values were accompanied by increased mean angle γ and β values (p = 0.05), with only 5% of β and γ angles, in total, having values close to those of a right angle (90 ± 10º). Individual variability of left BCV topography and morphology comes from developmental formation of the physiological angle in the middle section of this mediastinal vessel's course. The presence of near-right angles along the course of left BCV may potentially result in injuries to the vessel during intravascular procedures.

Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement.

Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.

Double superior vena cava and left brachiocephalic vein agenesis: a rare systemic vein anomaly and potential source of cardiac implantable electronic device and central venous catheter placement complications.

Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies - detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter placement - may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double superior vena cava and left brachiocephalic vein agenesis, who ultimately required reoperation.

Fever and Neutropenia Management and Infectious Prevention Strategies in Children with Severe or Very Severe Aplastic Anemia: A North American Pediatric Aplastic Anemia Consortium (NAPAAC) Study

Introduction: Evidence-based clinical practice guidelines (CPGs) exist for supportive care interventions including fever and neutropenia (FN), infection prevention for children with cancer, however FN management in benign hematological conditions specifically for conditions with bone marrow failure (BMF) is not standardized. Pediatric Severe Aplastic Anemia (sAA) is an acquired BMF which develops severe and prolonged neutropenia. Data regarding FN management and infection prevention strategies in this population are lacking to inform best practices. Objective: Evaluate current practices across 53 centers participating in the North American Pediatric Aplastic Anemia Consortium (NAPAAC) regarding FN management and infection prevention strategies in pediatric patients with sAA or very severe aplastic anemia (vsAA). Method: A RedCap survey was created and electronically distributed to the 53 NAPAAC institutions. The instrument consisted of the following domains: 1. Participant demographics; 2. Institutional practices for usage of vascular catheters; FN management; Infectious Disease (ID) screening and prevention strategies, including isolation precautions, hand-hygiene and vaccination practices, and education around mitigating infection risk in pediatric patients with sAA/ vsAA. Pediatric patients were defined as individuals 0 to 18 years of age who had not received a HCT and met standard diagnostic criteria for sAA/ vsAA. Each institution was asked to submit one collective survey from June 1, 2022 through July 16, 2022. Descriptive analyses were performed. Results: In total 43 (81%) NAPAAC sites completed the survey. The participant demographics were as follows: 68% (N=29) hematologists, 30% (N=13) HCT specialists, 2% (N=1) practiced as both. Most centers diagnosed 0 to 5 new sAA/vsAA cases/ year (N=28, 65%), 3 (7%) centers diagnosed ≥11/yr. With regards to central venous catheter (CVC) utilization, 32 (74%) of centers report ≥50% of their sAA patients have a CVC placed with a majority being placed at time of anti-thymocyte globulin initiation. The preferred CVC is a peripheral intravenous central catheter (PICC, N=24, 56%) followed by an implantable CVCs (N=17, 40%). Thirteen (30%) centers had a FN CPG specific to sAA/vsAA. An additional 28 (65%) centers report using a FN CPG adapted from the management of children with malignancy. In hemodynamically stable sAA with FN, the majority of respondents prescribe empiric monotherapy with cefepime (N=36, 84%). In hemodynamically unstable FN, either vancomycin plus an anti-pseudomonal Beta-lactam (APBL) (N=30, 71%) or triple combination with vancomycin, APBL, and aminoglycoside (N=6, 14%) are prescribed. Empiric antifungals are not routinely prescribed in stable FN sAA (N=28, 70%) though 19 (48%) centers would start empiric antifungals in hemodynamically unstable sAA patients, including echinocandins (N=8, 42%), mold-active azoles (N=6, 32%), or amphotericin (N=3, 16%). Furthermore, 42% of participants reported that adequate criteria for discontinuation of FN antibiotics and discharge in clinically stable patients with sterile cultures was afebrile status for > 24 hours for both sAA and vsAA patients, regardless of ANC. Prior to the COVID-19 pandemic, centers were divided on recommendations for patients to wear a surgical mask (N=24, 43%) to outpatient clinic visits or not (N=19, 44%). 95% of institutions routinely discussed safe living and ID prevention (Table 1), though only 16 (37%) provided written education. 86% of respondents report reviewing vaccinations in all sAA /vsAA at diagnosis. Only 12 (34%) provided non-influenza, inactivated vaccines to incompletely immunized patients. Lastly, 37 (97%) of respondents provided inactivated influenza vaccine to sAA/vsAA in their clinics and 39 (93%) recommend and 27 (73%) provided COVID-19 mRNA vaccination in their clinics. 7 centers (16%) performed SARSCoV2 antibody testing to inform need for initial or booster COVID-19 vaccination. Conclusion: Most NAPAAC centers applied malignancy driven CPGs to manage FN in sAA/vsAA patients. Other infection control/prevention strategies were quite variable, including use of masks, education around topics related to infectious risk mitigation, and vaccination practices. Variation in supportive care practices in this population highlights an urgent need for quality improvement initiatives to develop evidence-based CPGs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Complications of Totally Implantable Central Venous Catheters (Ports) Inserted via the Internal Jugular Vein Under Ultrasound and Fluoroscopy Guidance in Adult Oncology Patients: A Single-Center Experience.

IntroductionIn this retrospective study, the safety and complication rates of port implantations via the internal jugular vein under ultrasound and fluoroscopy guidance in adult oncology patients were analyzed.Material and methodsEight hundred seven ports implanted in 799 adult oncology patients at a tertiary Oncology-Anticancer Hospital during a 36-month period from January 1, 2017 to December 31, 2019 were retrospectively reviewed. Data acquisition was obtained until December 31, 2020. All procedures were performed by two specialized interventional radiologists under ultrasound and fluoroscopy guidance. The vein access was via the internal jugular vein. Catheter days (the total number of days of maintenance of the port by all of the patients until removal, death, or December 31, 2020), technical success rates, and complication rates were evaluated based on the interventional radiological reports and patient medical records. Multivariate analysis regarding patients such as age, sex, body mass index (BMI), marital status, educational level, cancer type, side of insertion, diameter of internal jugular vein, diabetes, anticoagulants/antiplatelets, purpose of implantation, and catheter material as to the risk of complications was conducted.ResultsA total of 369,329 catheter maintenance days were observed (457.7±345.0). The technical success rate was 99.9%, and a total of 85 (10.5%) complications occurred, of which 24 (28.2%) occurred early (<30 days) and the remaining 61 (71.8%) were late (>30 days) complications. Specifically, 28 (3.5%) were catheter-related thrombosis (CRT), 27 (3.4%) related to infection, 17 (2.1%) were mechanical complications (16 fibrin sheath formation and one catheter occlusion), six (0.7%) related to catheter migration, four (0.5%) related to incision healing problems, and the remaining three (0.4%) related to ischemic skin necrosis. Forty-seven (5.8%) ports were removed due to complications. On multivariate analysis, cancer type was found as a risk factor for the development of a complication. Additionally, there was an indication that hematologic malignancy is related to infection.ConclusionPlacement of ports via the internal jugular vein under ultrasound and fluoroscopy guidance is a safe procedure, with low rates of early and late complications.

Recurrent Atrial Tachycardias Associated With Implantable Central Venous Access Catheters in Patients With Cancer.

Recurrent Atrial Tachycardias Associated With Implantable Central Venous Access Catheters in Patients With Cancer.

Topical Lidocaine plus Diclofenac as a Local Anesthetic Agent in Central Venous Catheterization; a Randomized Controlled Clinical Trial.

Introduction:Various methods of analgesia can be used to reduce or prevent procedural pain in emergency department (ED). This study aimed to evaluate the effectiveness of topical lidocaine-diclofenac combination compared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter (CVC) insertion.Methods:In this randomized clinical trial, 100 adult patients requiring CVC insertion in the ED were enrolled. These patients were randomly divided into two groups. The site of CVC insertion was covered with 2 g of topical Xyla-P cream in the first group, and 2 g of topical lidocaine-diclofenac cream in the second group. The primary outcome was the pain during CVC implantation. The secondary outcomes were physician satisfaction and the incidence of side effects.Results: On the visual analog scale (VAS), the pain score during CVC insertion was significantly lower in the second group (p = 0.027). However, there was no difference in pain scores during lidocaine injection between the two groups (p = 0.386). Also, there was no significant difference in the rate of side effects between the two groups (p = 1.0). The physician’s satisfaction with the first group was significantly lower than the second group (p = 0.042).Conclusion:Although the CVC insertion pain was significantly lower in patients who received the topical combination of Lidocaine plus Diclofenac, there was no clinically important difference between the two groups and both topical anesthetics were effective and safe in reducing pain intensity. Also, lidocaine-diclofenac combination cream was more cost-effective than Xyla-P cream.

Lokalne zaburzenie drożności lewej żyły ramienno-głowowej podczas cyklu oddechowego przez potencjalny czynnik inicjacji zmian pozakrzepowych po zabiegach implantacji wszczepialnego urządzenia do elektroterapii serca czy wprowadzeniu cewnika do żyły centralnej

Introduction. The left brachiocephalic vein (LBCV) courses between the sternum and the aortic arch (or its main branches). Anomalous spatial positioning of the LBCV and these adjacent anatomical structures may result in LBCV compression. Such circumstances result in a narrowing or complete occlusion of this vein, which may affect the course of intravascular procedures, such as cardiac implantable electronic device (CIED) or central venous catheter (CVC) placement. This increases the risk of venous injury and/or the subsequent occlusion due to thrombus formation. Material and methods. Out of 2,112 de novo CIED implantation procedures performed in the period 2014–2019, 391 cases required intraoperative venography to identify the cause of difficulties in endovascular lead advancement. Venography data from these cases were analysed and only those cases were included for further analysis where the cause of difficulties was shown to be LBCV compression, further exacerbated on expiration. Results. Severe localized LBCV compression affecting the course of CIED implantation procedures was detected in 12 patients (8 women and 4 men, aged 80 ± 7 years). Such localized venous compression was observed mainly at the level where the brachiocephalic trunk and the left common carotid artery branch of the aortic arch. Conclusions. The analysed data showed the phenomenon of localized, respiration-related LBCV compression, which became exacerbated on expiration, in 3% of the analysed de novo CIED implantation procedures. This phenomenon may be associated with increased long-term thrombotic venous occlusion in the vascular segments containing cardiac leads or CVCs.

Cateterização venosa central de longa permanência em adolescentes com doenças onco-hematológicas

Objetivo: analisar o uso dos cateteres venosos centrais, de longa permanência, em adolescentes com doenças onco-hematológicas, atendidos no período compreendido entre 2008 e 2018, em uma enfermaria especializada de atenção integral a saúde do adolescente. Método: Estudo descritivo transversal, retrospectivo, de análise documental, com abordagem quantitativa, desenvolvido em um Hospital Universitário do Estado do Rio de Janeiro, Brasil. Resultados: Amostra composta por 49 impressos sobre as condições clínicas de adolescentes com doenças onco-hematológicas submetidos à implantação dos cateteres venosos centrais. 65% (n=32) eram do sexo masculino com a idade mínima e máxima de 12 e 19 anos, sendo 22,45% (n=11) com a idade de 15 anos. Quanto às doenças onco-hematológicas, observou-se predomínio das leucemias destacando-se a Leucemia linfoide aguda, representada por 43% (n=21) dos casos, seguida dos linfomas em 35% (n=17). Dentre os tipos de dispositivos, houve predomínio do Cateter Central de Inserção Periférica em 71,43% (n=35), e dentre os motivos de retirada dos cateteres prevaleceu a ausência de registros em 51,02% (n=25), seguida da obstrução e da infecção, ambas com 12,24% (n=6). Em relação ao tempo de permanência, notou-se que dos 49 cateteres implantados, 55,10% (n=27) apresentou ausência dos registros e 36,74% (n=18) permaneceram em um tempo menor que um ano. Conclusão: Os dados evidenciados reforçam a necessidade dos registros de enfermagem e da aplicação de boas práticas de manutenção e manuseio destes cateteres. Ressalte-se a importância da capacitação da equipe de enfermagem, a fim de promover a segurança do paciente por meio de uma assistência qualificada de enfermagem.

Risk factors and change in the nutritional status in patients who develop catheter‐related bloodstream infection following implantation of a totally implantable central venous catheter port

Risk factors and change in the nutritional status in patients who develop catheter‐related bloodstream infection following implantation of a totally implantable central venous catheter port

Evaluation of Demographic and Clinical Characteristics of the Patients Undergoing Surgery With Ultrasound in Internal Jugular Vein Cannulation Requiring Central Venous Catheter

Background and Aim This study aimed to investigate the demographic and clinical information of patients undergoing surgery with ultrasound in internal jugular vein cannulation. Methods &amp; Materials After the approval of the plan in the ethics committee of Guilan University of Medical Sciences, this study was performed in the general surgery department of Razi Hospital in 2018 on 100 patients in need of central venous catheter implantation. The neck type (distance between the two designated areas) was entered in a special form made by the researcher and after the completion of the design, it was examined and statistically analyzed. Ethical Considerations This research ethically approved by the Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1396.20) Results The mean age of the studied patients was 58.72±16.09 years. The anatomical and sonographic margins between the two Land Mark areas were higher in men VS women, but there was no statistically significant difference (P&gt;0.05). However, there was no statistically significant difference between the other variables. (P&gt;0.05). Conclusion The findings of this study show that catheterization of the internal jugular vein under the guidance of ultrasound was less access time and fewer complications.

Reconstruction of aneurismal arteriovenous fistula after arrosive bleeding

Aneurysmal transformation of arteriovenous fistula (AVF) is a common complication and associated with increased risk of arrosive bleeding. Ligation of fistulous vein is conventional surgery for bleeding. This is followed by AVF malfunction and need for implantation of central venous catheter. We report reconstructive surgery and maintaining the function of AVF in a patient with aneurysmal transformation of AVF after arrosive bleeding. Reconstructive vascular surgery can significantly extend the period of patent AVF for hemodialysis. This is extremely important in patients with reduced resources of native vessels suitable for AVF formation. The same is true if conversion of the type of renal replacement therapy is associated with significant difficulties.

A Case of Transcutaneous Removal of Fractured Subcutaneous Implantable Central Venous Catheter in the Pulmonary Artery From the Hepatic Vein

A Case of Transcutaneous Removal of Fractured Subcutaneous Implantable Central Venous Catheter in the Pulmonary Artery From the Hepatic Vein

Real-time ultrasound-guided supraclavicular technique as a possible alternative approach for Hickman catheter implantation

BackgroundTunneled Hickman/Broviac central venous catheter implantation is performed when patients require a central vein route for long-term therapy. The subclavian or internal jugular vein approach is often chosen for their implantation sites. However, access to the central vein can be difficult owing to thrombosis or stenosis when the same vein has already been accessed several times. In such situations, other possible alternative approaches to the central vein should be considered to avoid serious complications owing to further unsuccessful attempts. Description of operative techniqueWe encountered a 1-year-old patient admitted to our hospital for a Hickman catheter implantation after multiple unsuccessful attempts at central venous catheter insertion via bilateral subclavian approaches in another hospital. An ultrasound showed that no more subclavian veins were available on either side. A real-time ultrasound-guided right supraclavicular approach was performed as a solution to this situation. ConclusionsIn this article, we introduce a real-time ultrasound-guided supraclavicular approach as a possible alternative method for Hickman catheter implantation. We present step-by-step instructions including figures and a video and further discuss the advantages and disadvantages of this procedure, comparing the right and left approaches with references to existing literature. Level of evidenceLevel I.

A Rare Cause of Misplaced Port Catheter: Episternal Ossicles With Abundant Fibrous Capsule

A 71-year-old woman with newly diagnosed inferior vena cava leiomyosarcoma received a port catheter for chemotherapy. Resistance was noticed during the procedure. The chest radiograph showed that the catheter was kinked in clavicular region (Figure 1). There was no history of previous implantation of central venous catheter, a pacemaker, trauma, or surgery. Chest computed tomography demonstrated that episternal ossicles surrounded by excessive soft tissue (Figure 2, arrow) narrowed the space where the left brachiocephalic vein passed through and caused severe stenosis of the left brachiocephalic vein (Figure 2, arrowhead).