Implantable Central Venous Catheters Research Articles

Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US.

This prospective study extending for more than 3 years had two objectives: (a) to use Doppler ultrasonography (US) to estimate the incidence of asymptomatic catheter-related upper extremity deep venous thrombosis (DVT) in a large population and (b) to study the effect of the catheter position as an individual risk factor for catheter-related DVT. Between October 1995 and June 1998, a total of 145 patients who had oropharyngeal tract cancer and who were fitted with the same totally implantable central venous catheters (CVCs) were included in the study. Follow-up included (a) estimation of the position of each catheter tip on a chest radiograph obtained immediately after surgery and (b) regular monthly Doppler US screening for catheter-related DVT. Seventeen patients developed catheter-related DVT; 13 of them were asymptomatic. The mean interval between CVC implantation and detection of thrombosis was 42.2 days. Correct positioning of the distal catheter tip was associated with a significantly lower rate of catheter-related DVT. Only five of 87 patients with a correctly positioned distal catheter tip (ie, either in the superior vena cava or at the junction between the right atrium and the superior vena cava) developed thrombosis, compared with 12 of 26 patients with a misplaced catheter (P <.001). The side on which the CVC was implanted did not influence the catheter-related DVT rate. The rate of asymptomatic catheter-related DVT is high and could be lowered with correct initial CVC positioning.

Catheter-related thrombosis in children with cancer

Objective: The prevalence of asymptomatic catheter-related thrombosis of the upper venous system in children with cancer has not been determined. We evaluated patients with cancer and implantable central venous catheters (ports) for this complication. Study Design: Children with cancer undergoing port removal were eligible for this study. Vessel patency was evaluated by contrast venography. We examined each child for physical stigmata of thrombosis and retrospectively assessed catheter-related mechanical difficulties and infections. Results: Thirty-one ports had been placed in 24 children (aged 20 months to 18 years; median age, 9 years) with diagnoses of leukemia/lymphoma (n = 10), solid tumor (n = 12), and histiocytosis (n = 2). Venography showed abnormalities in 12 of the 24 patients. Physical examination revealed dilated superficial veins on the chest in 3 patients. Venograms showed abnormalities in all 3 children with prominent superficial thoracic veins. Nine of the 21 other patients had clinically occult central venous occlusion. Conclusion: Fifty percent (95% CI, 30% to 70%) of children who had implantable ports removed during or after treatment of cancer exhibited deep venous thrombosis at the site of catheter placement. Future studies should determine the contribution of inherited and other acquired risk factors for thrombosis and assess measures to prevent and/or treat catheter-related thrombosis in this population. (J Pediatr 2001;138:255-9)

SEPTIC ARTHRITIS IN HEMOPHILIA WITH CENTRAL VENOUS CATHETER: A Case Report

A case is reported of septic arthritis in a child with human immunodeficiency virus-negative hemophilia A associated with a Staphylococcus aureus catheter-associated septicemia. The infection occurred in relation to the use of a totally implantable central venous catheter. The organism was eventually eradicated with antibiotics injected via the catheter. With increasing use of such catheters in the hemophilic population, clinicians should be alerted to the possibility of septic arthritis for prompt diagnosis and treatment.

Long-Term Central Venous Catheter Infection in HIV-infected and Cancer Patients: A Multicenter Cohort Study

To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients. Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period. Services of infectious diseases and oncology of 12 university hospitals in Paris, France. In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation. Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population. Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.

The K-port concept: Proposal for optimising a fully implantable port system

Objective. Typical reasons for the malfunction of implantable central venous catheters involve obstructions caused by blood clots, perforation through the skin, and contamination of the device. The objective of introducing this new port concept is to reduce the incidence of complications by making alterations to the design.Design. The main characteristics of this new port chamber are its drop-shaped interior, which opens into the catheter-connecting piece rather like a funnel, the lateral position of the puncture membrane, and the exchangeable catheter connection device. As a result, the following improvements with regard to conventional port catheters are feasible.Results. The puncture is made laterally next to the port chamber in a large, previously unstressed area of skin. The subcutaneous puncture channel can be used for a greater length of time so as to avoid ascending infections. In the event of an occlusion of the catheter, a wire can be pushed through the cannula to clean it. The puncture cannula lies against the skin and can be attached more readily. Various port chamber sizes can be combined with different catheter thicknesses to best meet the individual requirements of the patient.Current Status. The afore-mentioned port system is still at a conceptional stage of development. There are no data on practical experiences with the K-port, as licensing details have yet to be agreed upon with a manufacturer. We have applied for a patent for this device.

Implantable venous access devices in children with hemophilia: a report of low infection rates.

The objective of this study was to define the efficacy and complications of implantable venous access devices (IVADs) in children with hemophilia. Records were reviewed on all patients with congenital blood coagulation disorders monitored at two children's hospitals in whom one or more central venous catheters had been placed. Since 1989 external and implantable central venous catheters have been inserted to enhance venous access for regular factor concentrate infusion in 45 patients with hemophilia ranging in age from 8 months to 19.5 years (median 7.4 years); 37 patients had factor VIII deficiency and 8 factor IX deficiency. Hemorrhagic complications of catheter placement were infrequent and minor. In the 41 patients having one or more IVADs in place for a median of 31 months, only six episodes of bacteremia occurred in 5 patients during 44,070 days of follow-up. The overall rate of bacteremia complicating IVADs in these patients was 0.14 episodes per 1000 catheter days. Other catheter-related complications were uncommon. Catheters are still in place in 33 patients for a median of 32 months. The low risk of infection and other complications associated with the use of IVADs makes the use of these devices attractive in the treatment of patients with hemophilia who require frequent venous access for factor concentrate infusions.

Candida parapsilosis Fungemia Associated with Implantable and Semi-Implantable Central Venous Catheters and the Hands of Healthcare Workers

A cluster of six cases of fungemia among hematology, bone marrow transplant, and oncology patients was investigated in a case-control study (18 controls). The use of implantable and semi-implantable central venous catheters was significantly associated with cases ( p = 0.016). The hands of three healthcare workers (HCWs) were positive for Candida parapsilosis. Electrophoretic karyotyping showed two profiles among patients and HCWs, and five among six unrelated strains. The profiles of two HCWs matched the ones of the patients they had handled. The patients’ strains were moderate or strong slime producers, whereas none of the HCWs’ were strong producers. In conclusion, our results indicated the occurrence of an outbreak C. parapsilosis fungemia related to long-term central venous catheters in which the hands of HCWs were implicated. The amount of slime production might be associated with the pathogenicity of the strains.

Implantable central venous catheter facilitates prophylactic treatment in children with haemophilia.

Twelve children with a severe form of haemophilia A received a totally implantable venous access system (Port-A-Cath) to facilitate regular prophylactic treatment with factor VIII. The indication for implantation was difficulty in obtaining regular access to a peripheral vein. Postoperative bleeding around the portal site occurred in two of 12 cases. After a median duration of follow-up of 26 months (range 5-79 months), none of the systems had needed replacement due to bleeding, septicaemia or thrombosis. One child, with an inhibitor against factor VIII, had an infection at the portal site and this system was removed. None of the other children had any serious side effects. Nine of the 12 children's parents learned how to use the Port-A-Cath system, thus enabling optimal prophylactic home treatment with factor VIII to be begun early in life.

Biofilms and long-term use of totally implantable central venous devices

The long-term use of totally implantable central venous catheters has led to new problems of infection. The formation of bacterial biofilms appears to be an important factor in the development of infection as well as occlusion of the devices. In each of 18 children the entire catheter system was examined prospectively after removal. A biofilm was seen on the inner surface of every catheter. In 10 cases bacteria could be cultured. The predominant species were coagulase-negative staphylococci.

Implantable subcutaneous venous catheters.

Twelve totally implantable subcutaneous central venous catheter systems were used in paediatric oncology patients. Complications were few--namely, blockage and four infective episodes, all of which were successfully treated. Infective rate was 0.189 episodes per 100 days' use, which is substantially lower than that reported with other central venous catheters.

Experience with a totally implantable venous device in children.

Venous access was attained in 15 children by use of a totally implantable central venous catheter and reservoir. Catheters were in place from 28 to 581 days, giving a cumulative experience of 4,094 days. Although they were well accepted by physicians, parents, and the children, they were not without major complications. These included extravasation of a chemotherapeutic agent in one, migration of the catheter tip to an unacceptable location in another, and catheter thrombosis and catheter-related sepsis in two each. The malpositioned catheter, one of the thrombosed catheters, and both infected catheters were removed. Ease of care, freedom from protruding tubing, and compatibility with normal activities are major positive features of the implantable devices that should be considered when deciding on the type of prolonged central venous access for use in children being treated with cancer.

Renal clearance studies in the pig. Surgical procedures, performance of investigations and physiological data.

The pig, especially the miniature pig, has in recent years been used increasingly frequently as a laboratory animal and experience shows that as such it is very useful in many circumstances. The aim of the present investigation was to study the renal function in unsedated and unrestrained pigs. Techniques for the implantation of central venous catheters, for cystostomy, for thyroidectomy and for open kidney biopsy are described. Implantation of central venous catheters and cystostomy are necessary procedures for making clearance studies in unsedated and unrestrained pigs possible. The following mean values for the renal function were obtained: ClIn 4.11 ml/min/kg, Cl51Cr-EDTA-p 3.82 ml/min/kg, Cl51Cr-EDTA-w.b. 3.89 ml/min/kg, ClPAH 21.4 ml/min/kg, Cl125I-hippuran 17.4 ml/min/kg, TmPAH 4.31 mg/min/kg and TRP over 80%.