Method Of Catheter Placement Research Articles

Immediate Initiation of CAPD following Percutaneous Catheter Placement without Break-in Procedure

To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD). A prospective, observational clinical study. Peritoneal dialysis (PD) units of two university-based hospitals. This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD. Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period. The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.

Mini‐laparoscopic placement of peritoneal dialysis catheter: New technique

Background: Leakage remains a problem with all methods of catheter placement. We describe our experience with a new mini‐laparoscopic technique for catheter placement in patients with end‐stage renal failure.Patients and methods: Between May 2002 and March 2004, 24 patients underwent mini‐laparoscopic placement of peritoneal dialysis catheters. All patients had end‐stage renal failure with difficult vascular access for haemodialysis. There were 11 men and 13 women with a mean age of 51.4 years (range: 18–75 years). Operative time, interval to initiation of successful peritoneal dialysis, postoperative pain management, resumption of diet and postoperative complications were recorded.Results: The mean operative time was 32.3 min (range: 15–40 min). All patients were given a normal diet on the day of surgery. Postoperative pain was controlled with paracetamol tablets three times daily for 2–3 days. The mean hospital stay was 3.2 days (range: 3–4 days). No patients developed leakage either from the ports or around the catheter. Two (8.3%) patients had blockage of the catheter and underwent diagnostic laparoscopy and laparoscopic correction. Two (8.3%) patients had migration of the catheter which required laparoscopic repositioning. The follow‐up range was between 2 and 22 months.Conclusion: Mini‐laparoscopic technique for placement of peritoneal dialysis catheter is unique because it uses only two ports. The catheter is made to exit via a 2 mm port site and does not require specially designed instruments.

Placement of a Long Tapered Side-Hole Catheter in the Hepatic Artery: Technical Advantages, Catheter Stability, and Arterial Patency

The purpose of this study was to evaluate the technical advantages, safety, and efficacy of placing a catheter distally in the hepatic artery using a long tapered side-hole catheter with an implantable port for hepatic arterial infusion chemotherapy. Fifty patients with unresectable malignant liver tumors underwent radiologic implantation of catheter-port systems using the long tapered catheter placement method. A 2.7-French distal shaft of the catheter was inserted distally in the hepatic artery with its side hole located proximally, and a 5-French proximal shaft was placed in the aorta; the catheter tip was not fixed. Technical success, complications including catheter stability and hepatic artery patency, and tumor response were assessed and compared with the following two historical controls: 35 patients with a 5-French catheter inserted simply in the hepatic artery (conventional method), and 131 patients with a 5-French catheter, the tip of which was fixed in the gastroduodenal artery (the fixed-catheter-tip method). The technical success rate using the long tapered catheter placement method was 92% (46/50 patients), whereas the feasibility of the fixed-catheter-tip method was confined to 79% of historical controls (131/166 patients). Among patients in whom the gastroduodenal artery was present, a decreased frequency of gastroduodenal artery embolization was seen using the long tapered catheter placement method (39%; 17/44 patients) compared with the conventional method (p = 0.0112) and the fixed-catheter-tip method (p < 0.0001). Cumulative stability rates of the catheter (6 months, 94.9%; 1 year, 94.9%; 2 years, 86.2%) and cumulative patency rates of the hepatic artery (6 months, 89.9%; 1 year, 89.9%; 2 years, 83.5%) were significantly higher using the long tapered catheter placement method than using the conventional method (p = 0.0208 and p = 0.0066, respectively) but were similar to those using the fixed-catheter-tip method. The time of hepatic tumor progression was significantly longer using the long tapered catheter placement method than using the conventional method (p = 0.0299) but was comparable to the time using the fixed-catheter-tip method. The long tapered catheter placement method should find wider application in hepatic arterial infusion chemotherapy because it is useful in preventing catheter dislodgment and hepatic artery occlusion.

A preliminary study of natural-fill radiotelemetered ovine fetal cystometry.

To determine whether fetal cystometric studies by radiotelemetry are feasible in the fetal lamb, and potentially suitable for chronically monitoring fetal bladder pressures in an experimental fetal model of bladder outlet obstruction (BOO), as in utero BOO (e.g. caused by posterior urethral valves) results in significant postnatal bladder dysfunction but the pathophysiological progression of fetal bladder maldevelopment remains poorly understood. The procedure required fetal sheep surgery and anaesthesia. Radiotelemetry implants comprised catheters that transmitted pressure fluctuations to an implant body; data were then transmitted using radio frequency to a receiver that passed this information to a computer. Four fetuses were used with different methods of catheter placement to optimize the technique. Recordings were possible in three of the four sheep; during observation there were: (i) quiet periods with no abdominal or bladder pressure rises; (ii) synchronous activity in the bladder and abdomen; and (iii) discriminate activity, associated with intravesical activity only. Four patterns of discriminate bladder activity were observed, defined as void, immature void, staccato activity and 'unstable' type activity. Radiotelemetry cystometry for long-term monitoring is feasible in the experimental fetus without causing death or morbidity, or inhibiting growth. The method can discriminate reproducible patterns of detrusor activity. Recorded 'voiding' types were consistent between experiments and as reported in other fetal animal studies.

Percutaneous Radiologic Placement of Peritoneal Dialysis Catheters: Long-term Results

To evaluate the efficacy of percutaneous radiologic placement of peritoneal dialysis (PD) catheters. Nineteen patients with end-stage renal disease were referred for percutaneous radiologic placement of a commercially available PD catheter. The patient group consisted of 11 men and eight women with a mean age of 58 years (range, 38-85 y). All procedures were performed on an outpatient basis with use of conscious sedation. Patients were followed up to determine technical success, complication rate, catheter survival (continuous patency without infection or mechanical dysfunction), and long-term outcome. The technical success rate for catheter placement was 95% (18 of 19). Complications included one (5%) failed attempt at catheter placement and one (5%) case of postplacement peritonitis. Mean and median catheter survival durations were 320 and 289 days, respectively (range, 33-823 d). A Kaplan-Meier survival analysis yielded 6-, 12-, and 24-month probabilities of catheter survival of 0.89 +/- 0.15, 0.81 +/- 0.20, and 0.81 +/- 0.20, respectively. Long-term outcomes included: continued PD, n = 9 (47%); death, n = 6 (32%; all related to comorbid disease); successful renal transplant, n = 2 (10.5%); and continued or resumed hemodialysis, n = 2 (10.5%). Percutaneous radiologic placement of PD catheters has a high technical success rate, low complication rate, and can be performed on an outpatient basis. Catheter survival is comparable to that achieved with surgical and percutaneous endoscopic methods of catheter placement.

95 Breast brachytherapy - a method of catheter placement offering improvements in cost, time, safety and accuracy

95 Breast brachytherapy - a method of catheter placement offering improvements in cost, time, safety and accuracy

Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: Assessment of factors affecting patency of the hepatic artery

OBJECTIVE: To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously. PATIENTS AND METHODS: Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed. RESULTS: Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method ( P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE ( P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE. CONCLUSION: We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.

Percutaneous drainage of fluid collections in the extremities.

To analyze the results of percutaneous drainage of fluid collections in the extremities. From 1990-1997, 28 patients aged 14-90 years underwent percutaneous drainage of 33 fluid collections in the extremities; two patients underwent multiple drainages. Fluid collections were in the hip-groin area (n = 16), thighs (n = 6), buttocks (n = 6), knees (n = 3), calf (n = 1), and axilla (n = 1). Three intraarticular collections were included. The patients who had undergone prior procedures were eight who had undergone surgical drainage, 10 who had undergone needle aspiration, and one who had undergone surgical débridement. The two most common guidance methods of catheter placement were ultrasound localization and fluoroscopy. The average drainage duration was 18.2 days (range, 1-93 days). The estimated cavity sizes were 4-733 cm3. Purulent fluid was drained in 13 patients. Staphylococcus aureus was the most commonly identified organism (n = 9). Nine patients had postoperative lymphoceles; five of these patients underwent sclerotherapy. Two (7%) patients had two complications, one of which was major. Failure occurred in four (16%) of 25 patients; two needed repeat drainage for recurrence, and two needed subsequent surgery. Success could not be determined in three patients who were lost to follow-up. Percutaneous drainage of fluid collections in the extremities is an effective alternative to open-incision drainage in inpatients and outpatients.

Peritoneoscopic Placement of Swan Neck Peritoneal Dialysis Catheters

Peritoneoscopic placement of peritoneal dialysis catheters, although accomplished in only about 10% of dialysis centers, is a nonsurgical technique that fulfills requirements for safety and dependability. Over a 40-month period, 136 catheters were placed with the peritoneoscope, 135 of which were double-cuffed, Swan neck curled catheters, with a uniform radiopaque stripe. Patients were followed longitudinally for outcome. Catheters were placed in 44 diabetic patients, 1 human immunodeficiency virus (HIV)-positive patient, and 18 morbidly obese patients. No complications occurred as a direct result of placement. Catheters were used, on average, nine days after placement (many on days 1 to 4) usually with 1.5 to 2 L exchanges. With 1183 patient-months’ experience, complications were few: 28 patients experienced catheter-related infections, and there were five leaks that resolved with supine, low-volume dialysis for several days. Leakage did not correlate with time of usage after placement. Of ten outflow/mechanical problems that required catheter removal, nine involved catheter migration, probably due to lack of attention during placement to orientation of the radiopaque stripe. One was due to a preperitoneal placement early in this institution's experience with the peritoneoscope. Five of the migrated catheters were removed and then successfully replaced with the peritoneoscope at the same sitting. Four patients requested surgical removal and replacement. Sixteen catheters were removed because of catheter-related infections: five refractory Staphylococcus aureus, six Pseudomonas aeruginosa, two fungal, two Serratia species, and one Mycobacterium chelonei. Actuarial life table analysis showed that at the end of the 40-month follow-up, 62% of the catheters were expected to survive. Because more than 50% survived, median catheter survival could not be calculated. The adverse responses were removal because of infection or catheter migration. Peritoneal dialysis catheter implantation with the peritoneoscope represents a safe and dependable method for catheter placement. Literature review and comparison indicate that catheter-related complications are fewer and catheter longevity is better with peritoneoscopic placement than with surgical placement. Our experience with prompt postplacement utilization suggests the need for further evaluation of catheter break-in procedure with the peritoneoscope.

A simplified technique of Hickman catheter insertion at bedside in gynecologic oncology patients

In 23 patients with gynecologic malignancies, 24 Hickman catheters were placed for long-term venous access. Using the described percutaneous supraclavicular approach, the right brachiocephalic vein was successfully cannulated in 23 patients. One patient required removal of her catheter because of fungal sepsis and another catheter was later placed from the left supraclavicular approach. In two patients, catheter placement was unsuccessful, resulting in a success rate of 24:26 (92%). Twenty-one catheters were placed at the bedside and three others using the same technique were placed in the operating room concomitant with a major operative procedure. Infectious complications occurred in 3 patients (12%) and complications associated with catheter maintenance occurred in 4 (16%) patients. Total procedure time was 15-30 min. Based on our findings, we believe that the right supraclavicular placement of the Hickman catheter is an easily taught procedure which can be performed safely at the patient’s bedside, resulting in significant cost containment. Many “simplified” techniques of semipermanent silicone central venous or right atria1 catheter placement have been described since Heimbach and Ivey [I] outlined their standard method of insertion in 1976. An important contribution was the introduction of the percutaneous approach to catheter placement described by Stellato [2] and Linos [3]. Both authors, utilizing the Seldinger technique, describe the use of a vein dilator and peel-away Teflon sheath in their method. Recently, Rettenmaier [4,5] described the safe percutaneous placement of the right atrial catheter at the bedside without the need for fluoroscopy. With increasing stress placed on cost containment, a simple, safe and effective method of catheter placement is important. The generally accepted method of percutaneous catheter placement is by the

Prevention of intracranial hypertension during the insertion of a pulmonary artery catheter.

Abstract The placement of a pulmonary artery catheter may be indicated to assess cardiac filling pressures and cardiac output during the treatment of intracranial hypertension. Because many patients with intracranial hypertension are hypovolemic, flotation of the catheter may be difficult and can cause an increase in intracranial pressure. We describe a method of catheter placement using barbiturates and calcium that prevented a rise in intracranial pressure.

Vessel puncture with epidural catheters. Experience in obstetric patients.

The reported incidence of blood vessel puncture after placement of a needle and catheter into the lumbar epidural space in obstetric practice appears to vary between 1 and 10%. This study was undertaken to assess the incidence of blood vessel puncture related to catheter insertion. Two methods of catheter placement were used to see if there were any difference in the incidence of vessel puncture. The incidence of blood vessel puncture after direct catheter placement was found to be 9% compared to 3% after prior injection of 10 ml of 0.5% plain bupivacaine into the epidural space. (p = 0.05).

Central Venous Catheterization Via the External Jugular Vein

CENTRAL venous pressure (CVP) measurement provides valuable clinical data during the perioperative period. A variety of routes and techniques for obtaining CVP data have been described. Cannulation of the antecubital vein is easy, but passage of a long catheter to a central location from the antecubital site is frequently difficult and unsuccessful. Cannulation of the subclavian or internal jugular vein provides reliable and accurate CVP, but is technically demanding and has resulted in severe complications. Peripheral venous pressure measurement from the external jugular vein can accurately reflect CVP, but is position-dependent and often unreliable. Passage of a catheter into a central venous position via the external jugular vein is very difficult with present methods. This study was designed to evaluate an easy, dependable, and safe method of catheter placement in the superior vena cava via the external jugular vein, employing a flexible angiographic wire catheter guide (J-wire). Methods A pilot