Success Rate Of Catheter Placement Research Articles

Sedative effects of intramuscular alfaxalone–methadone–midazolam versus ketamine–methadone–midazolam in cats

ObjectiveTo assess depth and quality of sedation and the ability to place an intravenous catheter in cats after intramuscular (IM) injection with alfaxalone–methadone–midazolam (AMM) or ketamine–methadone–midazolam (KMM). Study designBlinded randomized clinical trial. AnimalsA group of 46 healthy Domestic Short Hair cats. MethodsCats were randomly assigned to be administered IM methadone 0.3 mg kg–1 and midazolam 0.3 mg kg–1 with either alfaxalone 2 mg kg–1 (AMM group, n = 23) or ketamine 3 mg kg–1 (KMM group, n = 23). Before IM injection, a temperament score was assigned. The reaction to injection was scored. After 15 minutes, the depth of sedation was scored using a simple descriptive scale (SDS) and multidimensional sedation score. Success or failure to place an intravenous catheter at first attempt was recorded; p < 0.05. ResultsCats in the AMM group had a significantly higher median temperament score (p = 0.026). Behavioural reaction to injection with AMM was significantly less compared with KMM (p = 0.016). Median sedation scores were significantly higher in the AMM group than in the KMM group: SDS 4 (0–4) versus 2 (0–4), p = 0.01, respectively; multidimensional sedation score AMM 13 (0–13) versus 3 (0–10), indicating superior sedative effect in the AMM group, p = 0.01. Success rate of catheter placement was significantly higher in the AMM group (18/23) than in the KMM group (10/23), p = 0.033. Conclusionsand clinical relevance Addition of 2 mg kg–1 alfaxalone to 0.3 mg kg–1 methadone and 0.3 mg kg–1 midazolam provided better sedation after IM injection than ketamine 3 mg kg–1 combined with the same doses of methadone and midazolam. This combination of drugs may be particularly desirable as an alternative to α-2 adrenoceptor agonist-based protocols for cats requiring IM sedation.

Clinical application of intracavitary electrocardiogram localization combined with ultrasound in central venous catheterization in critically ill patients: An observational study.

To explore the clinical application value of intracavitary electrocardiogram (ECG) localization combined with ultrasound in central venous catheterization in critically ill patients. A total of 103 patients who were treated in the intensive care unit of our hospital from October 2020 to June 2023 were selected as the study subjects, and according to the differences in their central venous catheter placement methods, they were divided into study group (n = 52, receiving ultrasound combined with intracavitary ECG localization for catheterization) and control group (n = 51, receiving routine catheterization). The differences in the catheter placement accuracy, catheter depth, catheter placement duration, incidence of catheter-related complications, length of stay, and hospitalization expenses between the 2 groups were compared. The analysis utilizing X-ray for catheter tip positioning indicated that the catheter tip placement rate was higher in the study group than in the control group, and the catheter tip malposition rate was lower than in the control group (P < .05). There was no statistical significance in the catheter depth between study group and control group (P > .05), and the catheter placement duration of study group was significantly lower than that of control group, with statistical significance (P < .05). One case of partial catheter blockage, one case of catheter-related bloodstream infection, and one case of phlebitis were observed in study group, with an overall incidence of complications of 5.77% (3/52), which was significantly lower than 21.57% (11/51) of control group (P < .05). The length of stay and hospitalization expenses in study group were significantly lower than those in control group, with statistical significance (P < .05). The combined use of ultrasound and intracavitary ECG localization in critically ill patients undergoing central venous catheterization can help increase the success rate of catheter placement, shorten the catheter placement duration, reduce the incidence of various catheter-related complications, and also reduce the length of stay and hospitalization expenses.

Image Quality and Related Outcomes of the ShuntScope-Guided Catheter Implantation in Adult Hydrocephalus: Experience of 63 Procedures.

Ventricular catheter (VC) placement in the selected subset of adult hydrocephalus can be highly challenging due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the success rate of catheter placement. This study evaluates the image qualities of ShuntScope and related surgical outcomes in adults. A retrospective analysis of all adult patients undergoing VC placement using the ShuntScope from November 2011 to July 2022 in the authors' department was performed. Demographic, clinical, and radiologic data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into excellent, medium, and poor, and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter misplacement. A total of 63 ShuntScope-assisted surgeries have been performed on 60 adults. The mean age of the patients was 48.43 years. The most common underlying pathology was a tumor- or cyst-related cerebrospinal fluid (CSF) impairment in 38.33%, followed by a pseudotumor cerebri in 21.66%. The achieved image quality was excellent in 39.68%, medium in 47.62%, and poor in 12.7%. Ideal catheter placement was achieved in 79.37%. There were no intraoperative complications associated with the use of the ShuntScope. The revision rate due to suboptimal proximal VC placement was 4.76% during a mean follow-up period of 27.75 months. A statistical correlation between the image quality and accuracy of the catheter position was observed (p < 0.001). The ShuntScope can be considered an important addition to standard surgical tools in treating a selected subset of adult hydrocephalus. Direct visualization might even help achieve correct placement of the catheter in the cases with blurred vision and limited visual overview.

Comparison of Open and Ultrasound-Guided Placement of Central Venous Catheter in Children Weighing Less Than Five Kilograms; A Randomized Clinical Trial

Ultrasound is currently utilized to locate the internal jugular vein (IJV), reduce the complications of catheter placement, and increase the likelihood of accessing IJV. Therefore, the aim of the present study was to evaluate the effectiveness of ultrasound in reducing complications during catheter placement in children weighing less than 5 kg. The current randomized clinical trial was performed on 111 children weighing less than 5 kg who required a central venous catheter (CVC). Children were divided into two groups: in the first group (Seldinger group; n=55), a CVC was inserted using the Seldinger wire method under ultrasound guidance, and in the second group (open surgical cutdown (OSC); n=56), the catheter was inserted via the open method. Two weeks after catheter placement, patients were evaluated for thrombosis, catheter occlusion, catheter tip migration, infection, catheter removal, and catheter dysfunction. The success rate of catheter placement in the ultrasound-guided method was 85.5%. The incidence of thrombosis (3.6% vs. 5.4%), infection (1.8% vs. 7.4%), and bleeding (zero vs. 3.6%) was lower in the Seldinger group, but the difference was not significant (p ˃ 0.05). Hematoma (7.3% vs. 3.6%) occurred less frequently in the patients of the OSC group (p=0.33). Hemothorax, pneumothorax, catheter migration, and occlusion did not occur in any of the patients. In the OSC group, two deaths (3.6%) occurred due to underlying diseases. When ultrasound is used to insert a CVC in children weighing less than 5 kg, the incidence of complications is not significantly different compared to when the open method is employed.

Application of ultrasound-guided peripheral arterial puncture in severe patients with Coronavirus disease 2019 under three-level protection

Objective To explore the application of ultrasound-guided arterial line placement in severe patients with COVID-19. Methods From February to April 2020, we retrospectively collected and analyzed the clinical data of critical patients with COVID-19 with an indwelling peripheral arterial catheter treated by the medical team of Peking Union Medical College Hospital. Patients with ultrasound-guided peripheral arterial catheterization were taken as the study group, while patients whose arterial catheter was placed by traditional palpation were taken as the control group. The puncture condition and complication rate were compared between the two groups. Results A total of 60 severe patients with COVID-19 who met the inclusion and exclusion criteria were enrolled in this study. There were 30 cases in the study group and 30 cases in the control group. In the study group, the success rate of the first catheterization of the peripheral artery (63.3% vs. 26.7%) and the total puncture success rate [(79.43± 25.79)% vs. (53.07±30.21)%] were higher than those in the control group (all P < 0.05), the puncture times(1.43±0.56 vs. 2.50±1.28) were less than those of the control group (P < 0.05). The rates of 24-hour disuse (6.7% vs. 30.0%), local hematoma (10.0% vs. 36.7%), occlusion, and tortuous (3.3% vs. 40.0%) in the study group were lower than those in the control group (all P < 0.05). Conclusion Under the three-level protection, ultrasound-guided arterial catheter placement for severe patients with COVID-19 can improve the success rate of catheter placement, reduce puncture times, and reduce the incidence of complications. © 2021, Peking Union Medical College Hospital. All rights reserved.

P1314TEN YEAR EXPERIENCE ON VASCULAR ASSESS PLACEMENT BY NEPHROLOGIST

Abstract Background and Aims Across the globe, vascular assess placement for haemodialysis is performed by Anaesthesiologist, Nephrologist, Radiologist, and surgeons depending on the experts availability of that locality. Patient care should not suffer because of lack of round the clock surgical and radiological expertise. We would like to share our ten year experience of vascular assess placement and their outcomes which were performed in the Department of Nephrology. Method A total 11429 vascular assess procedures have been carried out during 2009 to 2019. There were 781 AVF, cuffed 476 and non-cuffed 10172 (Internal Juglar 5375, Subclavian 2042 and femoral 2755) catheter insertions were performed. For construction of AVF, Pre-procedure ultrasound Doppler was performed to see both the anatomy of vein and artery. Radiocephalic and brachiocephalic AVF construction were done by side to side arteriovenous anastomosis using 6-0 Prolene double ended needle under strict asepsis. Insertion complications (bleeding and air-embolism), procedure time, patency, blood flow, and post-procedure complications (hematoma) were recorded. Follow up was done on 10th and 30th day of post surgical period. Of 476 Permcath, 58 were placed without valve guided peel away sheath catheters and rest with valve guided peel away sheath catheters in right internal jugular vein. Results Of 781 AVF, 557 (71.3%) were males and mean age 42.7±15.1 years. Of them, diabetes 330 (42.25%) and non-diabetes 451 (57.74%) were, Basic disease were DM 134 (16.15%), HTN 115 (14.72%), CGN 121 (15.49%), CTIN 124 (15.87%), Unknown 173 (22.15%) and others 114 (14.59%) were respectively. Common sites of AVF site were were left radiocephalic 319 (40.84%), left brachiocephalic 321 (41.1%) and both side brachiobasilic 141 (18%). Pre procedure ultrasound doppler findings were arterial diameter 2.79±0.96, venous diameter 2.75±0.86, arterial pulse wave velocity 57.93±19.49, diameter. The average duration of the procedure was 70 min without any intra operative complication. Five patients developed post-operative bleeding required re-exploration. The average duration between the construction of the fistula and the day of successful cannulation was 37 days. After six weeks venous diameter were 5.06±1.58 having blood blow of 766.17±536.36 ml/min. Successful cannulation could be done in 418 (53.52%) patients and another 363 (46.47%) patients did not have satisfactory thrill even after the stipulated time of maturation were declared failed AV fistulas. Other common complications observed were stenosis 351 (44.94%), edema 140 (17.92%), ischemia 124 (15.87%), thrombosis 124 (15.87%), infections 109 (13.95%) and aneursyms 112 (14.34%) respectively The technical success rate of catheter placement were 98% without any major insertion or post-procedure complications. Average procedural time was 20 minutes. Mal position of Permcath was seen in 38 (7.9%) patients, catheter thrombosis 45 (9.4 %) patients. Conclusion It is quite safe for nephrologists to perform surgical procedures required for vascular access for dialysis. The valve-guided tunnelled catheter insertion and side to side anastomosis AVF construction may be adopted as a routine practice by the Nephrologists.

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers.

Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers.Design: Prospective study.Setting: Private referral center.Animals: Eleven fresh canine cadavers.Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated.Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01).Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.

Fluoroscopic-Guided Paramedian Approach for Lumbar Catheter Placement in Cerebrospinal Fluid Shunting: Assessment of Safety and Accuracy.

BACKGROUNDSpinal catheter insertion in lumboperitoneal (LP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) is frequently associated with technical difficulties especially in patients with obesity and elderly patients with vertebral deformities.OBJECTIVETo elucidate the accuracy and safety of image-guided spinal catheter placement using a paramedian approach (PMA).METHODSWe retrospectively analyzed 39 consecutive iNPH patients treated by LP shunting with spinal catheter insertion via the PMA. The success rate of catheter placement and the number of changes in puncture location were evaluated. Accuracy of catheter insertion was assessed by measuring both vertical and horizontal deviations in the point of catheter dural penetration from the center of the interlaminar space.RESULTSThe success rate of catheter placement was 100% (39/39). The difficulty rate for catheter insertion, measured by the number of changes in puncture location, was 2.6% (1/39). No bloody punctures or surgical infections were observed. Accuracy of catheter insertion, measured as the degree of deviation, was 0.5 ± 1.9 mm horizontally and 0.0 ± 2.4 mm vertically. The rates of minor complications, including caudal catheter insertion, transient low-pressure headache, and root pain, were 5.1% (2/39), 10.4% (4/39), and 0% (0/43), respectively. Subdural hematoma requiring surgical intervention occurred in 1 case (2.6%). During the mean follow-up period of 36 mo, spinal catheter rupture at the level of the spinous processes was not observed.CONCLUSIONFluoroscopic-guided spinal catheter placement via the PMA was safe, accurate, and reliable, even for use in geriatric and obese patients.

Clinical application of homemade percutaneous abdominal paracentesis needle in ventriculo-peritoneal shunt

To explore the manipulation and safety of homemade percutaneous abdominal paracentesis needle for abdominal paracentesis in ventriculo-peritoneal shunt. A total of 36 hydrocephalus patients were enrolled in the study. The whole process of abdominal paracentesis and catheter placement was observed, and the time, success rate and safety were evaluated. As results, the success rate of catheter placement was 100%; the average time of paracentesis and catheter placement was 5 min; neither intra-abdominal bleeding nor organ injury was found. The results prompt the homemade percutaneous abdominal paracentesis needle for abdominal paracentesis in ventriculo-peritoneal shunt is safe, minimally invasive, easy to perform with a high success rate and a small surgical scar. doi: 10.3969/j.issn.1672-6731.2014.06.015

Safety and efficacy of the PleurX catheter for the treatment of malignant ascites.

Malignant ascites is a common complication seen in association with various types of neoplastic processes. Due to high recurrence rates, patients may require multiple paracenteses, which have associated complications such as increased risk of bleeding, infection, pain, and volume and electrolyte depletion. This study evaluated the management of malignant ascites by placement of the PleurX® tunneled catheter system at a single center. This was a retrospective study of 38 patients who underwent PleurX catheter placement for refractory malignant ascites between February 2006 and March 2012 at our institution. Pretreatment characteristics and outcome measures were reported using descriptive statistics. The population included 21 males and 17 females with a mean age of 60.6 years (range, 36-79 years) diagnosed with metastatic disease from a variety of primary malignancies, the most common of which was pancreatic cancer (10 patients). In 84% of patients (32/38) who were not lost to follow-up, mean survival time was 40.7 days (range 4-434 days). Technical success rate of catheter placement was 100%. The PleurX catheter can be used to manage malignant ascites in severely ill patients with metastatic cancer, with a high rate of procedural success and a low incidence of potentially serious adverse events, infections, or catheter-related complications.

Feasibility of ultrasound-guided posterior approach for interscalene catheter placement during arthroscopic shoulder surgery

BackgroundContinuous interscalene block has been known to improve postoperative analgesia after arthroscopic shoulder surgery. This was a prospective study investigating the ultrasound-guided posterior approach for placement of an interscalene catheter, clinical efficacy and complications after placement of the catheter.MethodsForty-two patients undergoing elective arthroscopic shoulder surgery were included in this study and an interscalene catheter was inserted under the guidance of ultrasound with posterior approach. With the inplane approach, the 17 G Tuohy needle was advanced until the tip was placed between the C5 and C6 nerve roots. After a bolus injection of 20 ml of 0.2% ropivacaine, a catheter was threaded and secured. A continuous infusion of ropivacaine 0.2% 4 ml/hr with patient-controlled 5 ml boluses every hour was used over 2 days. Difficulties in placement of the catheter, clinical efficacy of analgesia and complications were recorded. All patients were monitored for 48 hours and examined by the surgeon for complications within 2 weeks of hospital discharge.ResultsEasy placement of the catheter was achieved in 100% of the patients and the success rate of catheter placement during the 48 hr period was 92.9%. Postoperative analgesia was effective in 88.1% of the patients in the post anesthetic care unit. The major complications included nausea (7.1%), vomiting (4.8%), dyspnea (4.8%) and unintended vascular punctures (2.4%). Other complications such as neurologic deficits and local infection around the puncture site did not occur.ConclusionsThe ultrasound-guided interscalene block with a posterior approach is associated with a success high rate in placement of the interscalene catheter and a low rate of complications. However, the small sample size limits us to draw definite conclusions. Therefore, a well-designed randomized controlled trial is required to confirm our preliminary study.

Clinical Outcome of the Tal Palindrome Chronic Hemodialysis Catheter: Single Institution Experience

To report the authors' clinical experience with the Tal Palindrome chronic dialysis catheter with a symmetric tip. During a 39-month period, 126 Palindrome catheters were placed consecutively in 85 patients. Follow-up was available for 115 catheters. Insertion complications, patency, catheter-related bacteremia, exit site infections, and reasons for catheter removal were recorded. The patient's initial cause of end-stage renal disease, underlying diseases, and site of access were recorded as well. Patient ranged in age from 35 to 91 years (median, 69 years). Fifty percent of patients had diabetes. One hundred twenty-six Palindrome catheters were placed for a total of 12,046 catheter-days. The technical success rate of catheter placement was 100%. The average catheter indwell time was 105 days (range, 1-673 days). Catheters were inserted via the right (n = 107) or left (n = 19) jugular vein in all patients without insertional complication. Catheter-related infections occurred in 16 of the 115 catheters (13.9%) during the study period and culture-proved bacteremia occurred in four (3.5%). Seven exit site infections were recorded, and 10 catheters (8.7%) developed fibrin sheaths that necessitated catheter exchanges. Clinical experience with the Tal Palindrome hemodialysis catheter demonstrated safe and reliable use with low infection rates.

Cervical epidural analgesia via a thoracic approach using nerve‐stimulation guidance in adult patients undergoing total shoulder replacement surgery

Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1-10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2-8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 +/- 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4-7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization.

Outcome of Tunneled Infusion Catheters Inserted via the Right Internal Jugular Vein

Purpose: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. Materials and Methods: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. Results: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. Conclusion: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

Evaluation of Percutaneous Radiologic Placement of Peritoneal Dialysis Catheters: Technical Aspects, Results, and Complications

Purpose: To evaluate the technical aspects, results and complications of the percutaneous radiologic placement of peritoneal dialysis catheters. Materials and Methods: Between December1999 and April 2001, 26 peritoneal dialysis catheters were placed percutaneously in 26 consecutive patients by interventional radiologists. The patient group consisted of 16 men and ten women with a mean age of 55 (range, 30-77) years. The results and complications arising were reviewed, and the expected patency of the catheters was determined by means of Kaplan-Meier survival analysis. Results: The technical success rate for catheter placement was 100% (26/26 patients). Severe local bleeding occurred in one patient due to by inferior epigastric artery puncture, and was treated by compression and electronic cautery. The duration of catheter implantation ranged from 1 to 510 days and the patency rate was 416 45 days. Catheter malfunction occurred in four patients. In two, this was restored by manipulation in the intervention room, and in one, through the use of urokinase. In three patients, peritonitis occurred. Catheters were removed from four patients due to malfunction (n=2), peritonitis (n=1), and death (n=1). Conclusion: Percutaneous radiologic placement of a peritoneal dialysis catheter is a relatively simple procedure that reduces the complication rate and improves catheter patency.

Continuous plexus and peripheral nerve blocks for postoperative analgesia.

Continuous plexus and peripheral nerve blocks for postoperative analgesia.

Long-term Arterial Cannulation in ICU Patients Using the Radial Artery or Dorsalis Pedis Artery

To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting > or = 4 days. Prospective, observational study of two cohorts of ICU patients. ICU of a university hospital. In a first group of 131 consecutive patients, the DPA was selected for arterial cannulation. In the second group, 134 consecutive patients were considered for radial artery cannulation. In the DPA group, the overall success rate for catheter placement was 85%. Patients were cannulated for 16 +/- 5 days (mean +/- SD). In the radial artery group, the overall success rate was 97.7% (129 of 132 patients; p < 0.0001 vs DPA group). Patients were cannulated for 13.3 +/- 4.0 days. In both groups, no signs of ischemia were detected at the clinical examination. In the DPA group, no thrombosis was detected at the angiographic examination in 21 patients (38%), a thrombosis without vessel obstruction was observed in 21 patients (31%), and a thrombosis with vessel obstruction was observed in 21 patients (31%). In the radial artery group, no thrombosis was observed in 31 patients (24%; not significant vs DPA group), a partial thrombosis was found in 73 patients (57%), and a total thrombosis with vessel obstruction was found in 25 patients (19%). Two cases of catheter-related infection were observed in the DPA group. In the radial artery group, four cases of catheter-related infection were diagnosed vs DPA group (not significant). The rate of serious complications was similar for both sites of arterial cannulation. Accepting a 12.7% lower rate of successful placement, the DPA route provides a safe and easily available alternative when radial arteries are not accessible.

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.

Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures.

To evaluate the safety and efficacy of fluoroscopically directed percutaneous gastrostomy and gastrojejunostomy catheter placement with gastropexy. The authors retrospectively reviewed the charts from 643 patients referred for fluoroscopically directed percutaneous gastrostomy or gastrojejunostomy during a 9 1/2-year period. In 615 patients, placement was attempted with use of three T-fastener gastropexy devices followed by percutaneous gastric puncture. Placement of a 14-F gastrostomy or gastrojejunostomy catheter was then accomplished with the Seldinger technique. A catheter could not be placed in 28 patients (4.4%) owing to overlying viscera or prior gastric surgery. In the remaining patients, 701 procedures, including revisions, were performed, including 643 gastrojejunostomies (92%) and 58 gastrostomies (8.3%). The success rate for catheter placement was 100%. Revision was necessary in 83 instances in 64 patients (13.5%). Forty-six (55%) of these were attributed to tube dislodgment, but only two repeat gastric punctures were necessary secondary to tract disruption. There were three major complications (0.5%) and 29 minor complications (5.3%). No complications were attributed directly to gastropexy. Thirty-day follow-up data were available for 393 patients (64%), and 14-day follow-up data were available for 550 (89%). The 30-day mortality rate was 5.8% (23 of 393 patients); none of the deaths were related to the procedure. Fluoroscopically directed percutaneous placement of gastrostomy and gastrojejunostomy catheters with routine gastropexy is a safe procedure. Catheter revision was necessary in 13% of patients and was usually secondary to tube dislodgment, with tract disruption an unusual complication.

Importance of Doppler Analysis of Transmitted Atrial Waveforms prior to Placement of Central Venous Access Catheters

To assess the sensitivity of Doppler flow analysis of the axillary and internal jugular veins to screen for clinically occult thoracic central veno-occlusive disease and predict successful placement of central access catheters. Sixty-seven patients underwent both duplex sonographic evaluation of the axillary and internal jugular veins and contrast venography prior to placement of a central venous catheter. Duplex evaluation included visual evidence of veno-occlusive disease as well as the presence or absence of normal transmitted polyphasic atrial waves and respiratory variation of flow. Diagnostically adequate venograms were available for comparison with the duplex sonograms in 168 access routes (access site plus downstream conduit veins). The contrast venograms and sonograms were compared by using retrospective blinded interpretation. Outcome of attempted catheter placement was tabulated. Directed sonographic imaging of the axillary and internal jugular vein allowed detection of access route veno-occlusive disease with a sensitivity of only 33.3%. Alternatively, when Doppler flow analysis found atrial waveforms that were not polyphasic, central conduit occlusive disease was detected with a sensitivity of 79.6%. Monophasic atrial waveforms were associated with a 25% failure rate of catheterization due to central vein occlusive disease, whereas polyphasic atrial waveforms were correlated with a 100% success rate for catheter placement. In asymptomatic patients, sonographic imaging alone misses most instances of central veno-occlusive disease. However, Doppler flow analysis of transmitted atrial waveforms substantially improved the sensitivity. A normal polyphasic atrial waveform virtually excludes the possibility of a more central venous occlusion or stenosis greater than 80% and ensures an adequate route for central venous catheterization.