Subclavian Catheterization Research Articles

Use of Suture-mediated closure device system after inadvertent medport placement in Subclavian artery leading to multifocal ischemic infarct: a case report

Abstract Background Totally implantable venous access devices or chemoports are progressively being used in oncologic patients for long-term chemotherapy administration. We present the case of an iatrogenic arterial catheter placement in the aortic arch complicated with multi-focal ischemic stroke. Case summary Case of a 73-year-old woman with a history of hypertension, diabetes mellitus, pineal gland tumor s/p VP shunt, and breast and bladder cancer who presented with a 2-week history of impaired balance, dysarthria, and right-sided facial drop. The chemoport was placed less than a month prior to the onset of symptoms at another institution. A brain MRI revealed a left hemispheric supra and infratentorial subacute ischemic infarcts. The head and neck CTA notably showed a misplaced venous port at the left subclavian artery with a distal tip projecting towards the ascending aortic arch, revealing the most likely etiology of multifocal ischemic stroke. The patient underwent successful subclavian artery catheter extraction and endovascular repair with a suture-mediated closure device system without complications. Discussion Subclavian artery iatrogenic cannulation may lead to catastrophic outcomes, including stroke. A high level of suspicion for venous port misplacement must be entertained when ipsilateral multifocal ischemic infarct occurs in time relation to catheter placement. Conducting an endovascular catheter retrieval and using a suture-mediated closure device is an alternative approach to manual compression in locations where achieving hemostasis is challenging. A suture-mediated closure device system might be useful for anatomy not amenable to manual compression, such as the subclavian artery.

14 Yıllık Bir Port Kateterin Sık Karşılaşılmayan Komplikasyonu

Percutaneous subclavian catheters or port-catheters are commonly used for oncology patients who require long-term or continuous intravenous therapy. There are several reported complications related to port-catheters like arterial puncture, pneumothorax and hematoma. We aimed to report an unusual port-catheter case. Our patient was a 45-year-old male who had a port-catheter inserted after the diagnosis of rectum cancer in 2009 and has never showed up for a catheter removal after his chemotheraphy regimen had been completed. The silicone port of the catheter was found to be disintegrated during the catheter removal procedure. Removal was performed but distal 5 cm of the catheter was missing. At the end of the procedure, control X-ray was obtained , but the last part of the catheter could not be visualized. There are reported cases of pinch-off syndrome in the literature however we couldn’t find any such case as we report. Following port-catheter implantation and throughout the course of treatment, patients should be consistently monitored, and an appropriate time should be scheduled for removal. Physicians should be aware of complications and multidisciplinary approaches should be made to avoid serious events and further harm. Keywords: Port-catheter complication, port-catheter removal, port-catheter detachment, pinch-off syndrome

Comparison of the Ultrasound-Guided Supraclavicular and Infraclavicular Approaches for Subclavian Vein Cannulation in Children With Congenital Heart Disease

Objective(s)Central venous catheterization (CVC) is widely used in pediatric critical patients. We thought to compare the success rate and safety of ultrasound-guided subclavian vein cannulation performed via infraclavicular and supraclavicular approaches. DesignWe compared the success rate of the first puncture and other information for cannulation in the children with congenital heart disease (CHD) requiring central venous catheterization who were randomly assigned to the supraclavicular approach group (Group A) or infraclavicular approach group (Group B). SettingMedical university hospital pediatric cardiac intensive care units (CICUs). ParticipantsPediatric patients diagnosed with CHD in the preoperative period who were admitted to the CICU and required subclavian vein catheterization. InterventionsUltrasound-guided subclavian vein cannulation. Measurements & Main ResultsSixty-seven children were included in the study, with 32 in Group A and 35 in Group B. Notably, there was a significant difference in the success rate of the first puncture between Groups A and B (90.6% vs. 71.4, %, p = 0.047). Furthermore, the access time in Group A was 11.8 (3.2–95) seconds, which was significantly shorter than that in Group B (16.0 [6.5–227] seconds, p = 0.001). In addition, the catheter malposition rate in Group A was significantly lower than that in Group B (0% vs. 11.4%, p = 0.049). Conversely, there were no significant differences in the total access time, overall success rate, and complications (e.g., pneumothorax, hemorrhage, puncture artery, and nerve injury) between the two groups. ConclusionsFor children with congenital heart disease requiring central venous catheterization during the perioperative period, the subclavian vein is a feasible site for catheterization. The supraclavicular approach, especially the left side, has a higher first-puncture success rate, shorter access time, lower complications, and the trend of lower incidence of catheter malposition. However, a larger sample size of randomized controlled study is expected to verify the advantages of ultrasound-guided subclavian catheterization in children.

Recurrent Medulloblastoma: Complete Response and > than 21 Years and Five Months Overall Survival in a One-Year and SevenMonth-Old Male Treated with Antineoplastons

Medulloblastomas arise in the posterior fossa, primarily in the region of the fourth ventricle. Recurrent medulloblastomas are high-risk and have a bad prognosis. Objectives: the case of a male child with recurrent, disseminated medulloblastoma is presented to detail the efficacy of ANP therapy (Antineoplaston A10 {Atengenal} and Antineoplaston AS2-1 {Astugenal}) in the treatment of high-risk medulloblastoma. This child was treated at the Burzynski Clinic (BC), as a Special Exception, according to Protocol BT-12, “Phase II Study of Antineoplastons A10 and AS2-1 in Children with Primitive Neuroectodermal Tumors”, with intravenous (IV) ANP therapy via a subclavian catheter and infusion pump. Tumor response was measured by sequential magnetic resonance imaging (MRI) of the brain with gadolinium enhancement. Findings: This child initially underwent tumor resection, placement of ventricular shunts, and chemotherapy, all performed elsewhere. Baseline MRI at the BC revealed recurrent, disseminated, and enhancing disease measuring 9.10 cm2 in total. IV ANP therapy began in March 2001 and ended in December 2002 after a complete response (CR) was achieved based on MRI criteria. Subsequently, the child received oral Antineoplastons as maintenance therapy, which were discontinued after eight months. At last follow-up, > 21 years and eight months since diagnosis and > 21 years and five months since the start of IV ANP therapy, the patient was well and showing no evidence of tumor recurrence. Conclusions: The utilization of ANP therapy to cure a patient with recurrent medulloblastoma is presented. We conclude that ANP therapy is an attractive therapeutic option for children with medulloblastoma

An Initial Investigation of Diaphragm Neurostimulation in Patients with Acute Respiratory Distress Syndrome.

Lung protective ventilation aims at limiting lung stress and strain. By reducing the amount of pressure transmitted by the ventilator into the lungs, diaphragm neurostimulation offers a promising approach to minimize ventilator-induced lung injury. This study investigates the physiologic effects of diaphragm neurostimulation in acute respiratory distress syndrome (ARDS) patients. The hypothesis was that diaphragm neurostimulation would improve oxygenation, would limit the distending pressures of the lungs, and would improve cardiac output. Patients with moderate ARDS were included after 48 h of invasive mechanical ventilation and had a left subclavian catheter placed to deliver bilateral transvenous phrenic nerve stimulation. Two 60-min volume-controlled mechanical ventilation (control) sessions were interspersed by two 60-min diaphragm neurostimulation sessions delivered continually, in synchrony with the ventilator. Gas exchange, lung mechanics, chest electrical impedance tomography, and cardiac index were continuously monitored and compared across four sessions. The primary endpoint was the Pao2/fraction of inspired oxygen (Fio2) ratio at the end of each session, and the secondary endpoints were lung mechanics and hemodynamics. Thirteen patients were enrolled but the catheter could not be inserted in one, leaving 12 patients for analysis. All sessions were conducted without interruption and well tolerated. The Pao2/Fio2 ratio did not change during the four sessions. Median (interquartile range) plateau pressure was 23 (20 to 31) cm H2O and 21 (17 to 25) cm H2O, driving pressure was 14 (12 to 18) cm H2O and 11 (10 to 13) cm H2O, and end-inspiratory transpulmonary pressure was 9 (5 to 11) cm H2O and 7 (4 to 11) cm H2O during mechanical ventilation alone and during mechanical ventilation + neurostimulation session, respectively. The dorsal/ventral ventilation surface ratio was 0.70 (0.54 to 0.91) when on mechanical ventilation and 1.20 (0.76 to 1.33) during the mechanical ventilation + neurostimulation session. The cardiac index was 2.7 (2.3 to 3.5) l · min-1 · m-2 on mechanical ventilation and 3.0 (2.4 to 3.9) l · min-1 · m-2 on mechanical ventilation + neurostimulation. This proof-of-concept study showed the feasibility of short-term diaphragm neurostimulation in conjunction with mechanical ventilation in ARDS patients. Diaphragm neurostimulation was associated with positive effects on lung mechanics and on hemodynamics.

Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study

IntroductionCentral venous catheters are indispensable in modern healthcare. Unfortunately, they are accompanied by minor as well as major complications, leading to increased morbidity, mortality and costs. Immediate insertion-related complications (mechanical...

Abstract 11430: A Bad Break: Cardiogenic Shock Complicated by an Intracardiac Foreign Body

Introduction: We report a case of cardiogenic shock complicated by an intracardiac foreign body. This is a rare occurrence during a dangerous cardiovascular disease process which necessitated urgent multidisciplinary management. Case: A 54-year-old female with a history of hypertensive cardiomyopathy and breast cancer was not improving during a hospitalization for acutely decompensated CHF and atrial flutter with RVR. Right heart catheterization demonstrated cardiogenic shock, with a foreign body noted in the right atrium favored to be a fragment of the left subclavian port catheter also seen on fluoroscopy. This object was present on admission imaging but likely mistaken as external artifact. Coronary angiography revealed severe multi-vessel CAD. A multidisciplinary team discussed the timing and modality of foreign body removal, electing to prioritize hemodynamic optimization before intervention. Once stable, the patient underwent successful endovascular removal of the catheter fragment with immediate improvement of her heart rhythm. She remained in sinus rhythm until discharge home in stable condition. Discussion: This episode of cardiogenic shock may have been precipitated by an arrhythmogenic intracardiac foreign body. However, medication non-adherence and severe CAD on angiography suggested a multifactorial etiology, justifying a delay in the removal of the foreign body until shock had resolved. Additionally, the catheter fragment present on admission imaging should have been identified earlier as a contributing factor. Timely recognition and removal of the fragment may have prevented the hemodynamic decompensation of the patient. Conclusion: This case demonstrates the efficacy of delaying the removal of an intracardiac foreign body in favor of hemodynamic optimization in patients with cardiogenic shock, while obviating the need for maintaining a broad differential when determining the underlying etiology of decompensated heart failure.

October 2023 Critical Care Case of the Month: Multi-Drug Resistant K. pneumoniae

No abstract available. Article truncated after 150 words. History of Present Illness: A 75-year-old man presented from a skilled nursing facility with altered mental status and hypotension. He had a seven-year-long history of steroid-dependent myasthenia gravis, but had previously declined Covid vaccination, and subsequently experienced a severe case of COVID-19 pneumonia five months prior to admission. This resulted in chronic respiratory failure and renal failure for which he subsequently underwent tracheostomy, tunneled subclavian vein dialysis catheter placement and percutaneous endoscopic gastrostomy (PEG). He had resided in a skilled nursing facility since then, requiring four subsequent hospital readmissions for complications. These sequentially included septic shock due to a catheter associated blood stream infection, an intra-abdominal abscess due to PEG migration into the peritoneum resulting in fungal blood stream infection, recurrent intra-abdominal infection with multiple organisms, and bacterial pneumonia. Treatment of these infectious complications included replacement of the tunneled dialysis catheter and exploratory laparotomy with debridement of multiple abscesses. The …

Newly Diagnosed Anaplastic Astrocytoma: > 23 Year Survival in a 31-Year and 11-Month-Old Female Treated with Antineoplastons

Rationale: Anaplastic astrocytoma (AA), a malignant brain tumor that arises from astrocytic cells, has a poor prognosis. It accounts for 6–7% of gliomas and 1-2% of brain tumors. Objectives: A 31-year and 11-month-old female with an AA is presented to discuss the efficacy of Antineoplastons A10 (Atengenal) and AS2-1 (Astugenal) in the treatment of AA. She presented to the Burzynski Clinic (BC) for treatment and was enrolled in Protocol BT-08, “Phase II Study of Antineoplastons A10 and AS2-1 in Adult Patients with Anaplastic Astrocytoma”, receiving both intravenous (IV) and oral Antineoplastons A10 and AS2-1 (ANP therapy). IV ANP therapy was delivered continuously via subclavian catheter and infusion pump. Tumor response was determined by comparison of baseline brain magnetic resonance imaging (MRI) to sequential brain MRIs during therapy. Findings: The patient presented to the BC with no prior treatment and a one-month history of right arm clumsiness and right leg weakness. Brain MRI and stereotactic biopsy performed elsewhere had demonstrated an AA. Baseline MRI at the BC showed a 2.0 cm2 nonenhancing lesion and two enhancing lesions (0.02 cm2 and 0.15 cm2 ) in the left parietal lobe. IV ANP therapy was given over 56 days, and a complete response (CR) was demonstrated after one month of therapy. Oral ANP therapy was subsequently provided for 17 months. At last follow-up, in June 2023, the patient was healthy and showed no evidence of recurrent disease. She had an overall survival (OS) of > 23 years and one month since diagnosis and an OS of > 23 years since the start of IV ANP therapy. Conclusions: The utilization of ANP therapy in an adult female patient with AA is presented. The patient achieved a CR and prolonged OS, suggesting that ANP therapy may be an effective therapeutic option for adults with AA.

Evaluation of infections associated with central venous catheters in ICU

Objective: Central venous catheter-related infections lead to an increase in widespread antibiotic use, prolonged hospital stays, increased costs, as well as morbidity and mortality. In this study, we aimed to evaluate the infections associated with central venous catheters used in our intensive care unit (ICU) and identify the possible contributing factors. Methods: The hospital records of patients aged 18 and above who were admitted to ICU and had central venous catheters (femoral, jugular, and subclavian catheters) were retrospectively evaluated. Patients’ demographic data and also reason for admission, APACHE II score, duration of ICU stay, and 28-day mortality were recorded. Additionally, data on the time of catheter insertion, catheter site, catheter type, administration of blood and total parenteral nutrition (TPN) through the catheter, presence of catheter-related infection, identified pathogens, time of infection development after catheter insertion, and concurrent blood culture results were recorded. Results: A total of 169 patients were included in the study, of whom 99 (58.6%) were male and 70 (41.4%) were female. The catheters were located in the femoral region in 56 (33.1%) cases, jugular region in 99 (58.6%) cases, and subclavian region in 14 (8.3%) cases. There was no significant difference in the development of catheter infection based on the site of application (p=0.929). The rates of infection were significantly higher in catheters used for TPN and blood transfusion (p=0.002 and p=0.005, respectively). The average duration of intensive care stay was significantly higher in patients who developed catheter infections. Conclusion: Catheter-related bacteremia is an important risk factor for morbidity and mortality, especially in critically ill patients. In our study, no significant differences were found in the rates of catheter-related infection based on the application sites. We observed that the use of TPN, blood transfusion, and longer catheter duration posed risks for infection.

Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition

The most common malposition seen during subclavian vein cannulation is to the ipsilateral internal jugular vein. We report a case of unusual malposition of a subclavian central venous catheter, where it was found to be forming a “figure of U” in the ipsilateral subclavian vein. Although the catheterization was done under ultrasound guidance, we could not visualize the course of the guidewire due to a poor ultrasound window. This report highlights the fact that although ultrasound can facilitate identification of the vessels and prevent inadvertent arterial puncture, it seldom helps in the positioning of the guidewire tip and prevention of catheter malposition.

The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children.

Catheter-associated bloodstream infection, also known as CLABSI, is the most serious consequence of central venous access devices. These infections increase the risk of mortality and morbidity. The use of central line bundles in clinical settings is increasing worldwide with the purpose of lowering the risk of catheter-associated bloodstream infections. In this study, we investigated the effect of implementing a central line bundle for the prevention of CLABSIs, the distribution of pathogens, and the duration of time it took for CLABSIs to develop in patients who had subclavian-inserted central venous catheters. This research project was a cross-sectional study investigation carried out in a pediatric tertiary teaching hospital. Participants consisted of children who had been admitted to the pediatric critical care unit with subclavian catheters during a period of 13years. We compared the prebundle period with the bundle period for CLABSI specifically focusing on the time to infection, the number of polymicrobial infections, the proportion of Candida parapsilosis, and the percentage of Coagulase-negative staphylococci (CoNS). The "prebundle period" included the period from May 2007 to May 2013, and the "bundle period" included the period from June 2013 to June 2020. Throughout the course of the study, a total of 286 cases of CLABSI were documented. Among these patients, 141 (49.3%) had CLABSIs associated with subclavian catheters. During the prebundle period, 55 CLABSIs were diagnosed in 5235 central line days, with an overall rate of 10.5 CLABSIs per 1000 central line days; after the implementation of central line bundle, 86 CLABSIs were diagnosed in 12,450 CL days, with an overall rate of 3.6 CLABSIs per 1000 CL days. This showed a statistically significantly lower rate in the bundle period (p = 0.0126). In the prebundle period, the mean time to develop CLABSI was 15days, whereas during the bundle period, the mean time to develop CLABSI was 27.9days, a significantly longer time to onset (p = 0.001). While the percentage of other microorganisms was not statistically different between the prebundle and bundle periods (p > 0.05), the percentage of C. parapsilosis was significantly higher in the prebundle period (p = 0.001). Conclusion: The results of this study imply that the use of central line bundles not only reduces the incidence of CLABSI but also delays the time to which CLABSI patients acquire an infection. In addition, as a direct consequence of the CLB, the number of CLABSIs caused by gram-positive cocci did not increase, while the proportion of CLABSIs caused by C. parapsilosis decreased. What is Known: • The most significant negative consequence of central venous access devices is catheter-associated bloodstream infections. • "Care bundles" for CLABSI prevention have been reported to reduce the CLABSI rate. What is New: • Consider what would happen if the "Care bundle" failed to prevent CLABSI. • The findings of this study imply that using central line bundles not only reduces the risk of CLABSI but also extends the time it takes for patients to develop CLABSI. While the number of CLABSIs caused by gram-positive cocci did not increase as a direct result of CLB, the rate of CLABSIs caused by C. parapsilosis, which has recently become a major problem, has decreased.

Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter: study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial

BackgroundThe right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes.MethodsAdult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients’ experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard.DiscussionThe use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations.Trial registrationClinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.

A hemodialysis case with fungemia due to Candida parapsilosis after COVID-19 infection

Bacterial and fungal infections may emerge with or following COVID-19 infection. Corticosteroids, antibiotics, and other therapies utilized in severe cases of COVID-19 pneumonia may pose a risk for fungal infections. In this paper, we present the case of a 59-year-old female patient with underlying chronic renal failure and diabetes who received long-term corticosteroid therapy for COVID-19 pneumonia and subsequently developed fungemia and catheter infection due to Candida parapsilosis. We removed her subclavian catheter and administered amphotericin -B therapy for 37 days. Overall, we recommend keeping in mind that opportunistic fungal infections may emerge in patients receiving long-term immunosuppressive drug therapy due to COVID-19 with risk factors such as hemodialysis, central venous catheter use, and broad-spectrum antibiotic use.

Spontaneous Catheter Fracture with Embolization: A rare complication of Totally Implantable Subclavian Venous Catheter

Totally Implantable venous access insertion has become routinely involved in the treatment of patients in oncology, However, certain complications are associated with the use of these devices: catheter migration with embolization, pinch-off sign. We report a case of successful extraction of an embolized distal portion of the Catheter from left pulmonary artery.

Subclavian Catheterization Procedure Performed by In-plane Technique Guided by Ultrasonography

Objective: Central venous catheterization (CVC) is one of the most commonly performed interventional procedures in intensive care unit (ICU) patients. According to guidelines, it is recommended as the first choice because it is better tolerated by patients, and the infection rate is lower compared to other areas of CVC placement.. However, complications such as pneumothorax, arterial puncture, nerve injury and bleeding may be relatively higher. For these reasons, it has become increasingly common to perform subclavian CVC applications with ultrasonography (USG) to minimize the risks in recent years. Our study aimed to evaluate 53 patients who underwent subclavian CVC with the in-plane technique accompanied by USG. Method: In this study, the system records of 53 patients with CVC indication, who were hospitalized in the ICU between January 1, 2020, and April 1, 2021, were reviewed retrospectively and subclavian CVC procedures performed using the USG-guided in-plane technique were analyzed. Results: A total of 53 patients (25 women (47.2%), 28 men (52.8%)) with CVC indication followed in the ICU underwent subclavian CVC with the in-plane technique under USG guidance. The mean age of the patients was 69.98±11.29 years. The mean BMI of the patients was found to be 26,10 kg/m2. Of the 53 patients evaluated, 28 had chronic obstructive pulmonary disease (COPD), 5 had lung malignant neoplasm, 16 had pneumonia, 2 had acute renal failure, and 2 required ICU follow-up after cardiopulmonary resuscitation.. Catheter malposition and other complications were not observed in any of the patients. Conclusion: Subclavian catheterization applied with an in-plane technique guided by USG is a method that experienced practitioners can safely apply.

A COMPARATIVE STUDY OF CHEMOPORT VERSUS PERIPHERAL VENOUS ACCESS IN BREAST CANCER PATIENTS IN GOA MEDICAL COLLEGE.

Background: Totally implantable venous access devices (TIVADs) considered standard of care for administration of intravenous chemotherapeutic drugs for patients needing long term chemotherapeutic drugs. Methodology: This prospective comparative study carried over a period 2 years in all patients diagnosed with breast cancer. Patients will be divided into 2 groups-1 group will receive chemotherapy using the chemoport and the other group through peripheral intravenous access. The group will be divided based on simple randomization on alternate basis. While the average dura Results: tion for the procedure of port insertion was 59mins, almost 90% patients were discharged within 24 hrs with no complications Of the 50 patients that underwent the procedure of chemoport implantation, 21 patients underwent by Internal Juglar Vein while the remainder by Subclavian vein out of which in 2 patients the procedure was abandoned owing to complications of migration of guide wire and hemothorax, both of which occurred while attempting subclavian catheterization. While the guide wire was retrieved under uoroscopic guidance, Intercoastal drainage tube was passed for patient with hemothorax. This complication can be avoided by using radiological guidance or under uoroscope. Of the remaining patients, 13 patients the port was removed as they had completed chemotherapy were termed disease free. While in 2 patients port was removed pre-maturely due local port site infection and generalized sepsis due to neutropenia. During the process of chemotherapy through port, 1 patient developed blockage of port as evidenced by no return ow by aspiration. This was managed by giving heparin ush and visualized under C-arm for patency. When it comes to morbidity of the port, majority of the people were in the opinion that the process of port insertion was painless, they had no sensation of foreign body, no itching/pain and did not interfere with day to day life.And on inquiring regarding the satisfaction by the patient, maximum people were of the opinion that port helped speed up chemotherapy sessions, satised with cosmesis, and preferred port over peripheral iv line. About 60% would agree to recommend port over peripheral iv line. In comparison to patients who received chemotherapy through peripheral iv line, out of 50, 11 patients had serious complication of extravasation and thrombophlebitis which required hospital admission and surgical debridement. In terms of patient morbidity, >40% experienced difculty in initiation of chemotherapy in more than 50% of cycles, 26 patients were forced to receive multiple pricks, 34 patients required a second iv line to complete the session in half the cycles and 10 patients required iv at the leg/neck as others were inaccessible. High satisfaction rate Conclusion: observed in patients using chemoports for chemotherapy-it speeded up the sessions, less painful and only few people felt its presence affecting cosmesis/ day-to-day activities. It avoids the blunt of undergoing painful process of multiple pricks, use of 2nd line, thrombophlebitis and prolonged sessions seen in peripheral IV lines. Although the procedure of port implantation has got serious complications, the rate is minimal and with the help of radiological tools and surgical expertise, these can be made negligible. The only set-back by using a port is the maintenance part, which requires periodic ushing with heparinized saline to prevent blockage when not in use for prolong period (>4weeks). And so, it is advisable to remove the port promptly after completion of treatment if patient is labelled cured. Complications like infection can be avoided by strict aseptic precautions taken while handling the port for chemotherapy sessions by trained personal. Above all patient education and compliance is utmost important to ensure proper functioning of the port.

Lung deflation while placing a subclavian vein catheter: Our experience in minimizing the risk of pneumothorax.

Lung deflation may reduce the risk of pneumothorax based on the assumption that the distance between the subclavian vein and the lung pleura would increase as well as the diameter of the vein. We aim to provide evidence to support the suggested desideratum of deflation in adults. A prospective database was created that included patients who underwent subclavian vein catheterization for monitoring and therapeutic reasons from January 2014 to January 2020. Measurements using ultrasonography of the diameter of the subclavian vein were taken while the patient's breathing was controlled by a ventilator and then repeated after disconnecting the mechanical ventilation and opening the pressure relief valve. A total of 123 patients were enrolled, with an average age of 41.9 years. The subclavian vein diameter was measured during controlled breathing with a mean average of 8.1 ± 0.6mm in males and 7.1 ± 0.5mm in females. The average increase after lung deflation with the pressure relief valve closed was 8.0± 5.1mm in males and 13.9 ± 5.4mm in females. An increase was noticed after opening a pressure valve, and the means were 5.5 ± 2.8mm in males and 5.1 ± 3.3mm in females. The catheter malposition rate was 0.8. The benefit of interrupting mechanical ventilation and lung deflation lies within possibly avoiding pneumothorax as a complication of subclavian vein catheterization. These findings support the need for evidence regarding the curtailment of pneumothorax incidence in spontaneously breathing patients and the suggested increase in first-time punctures and success rates.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management...

Evaluation of Subclavian Central Venous Port Catheters Placed by Anesthesiologists: Single-Center Experience

Evaluation of Subclavian Central Venous Port Catheters Placed by Anesthesiologists: Single-Center Experience