Triple-lumen Central Venous Catheter Research Articles

Angiographic evidence of an inadvertent cannulation of the marginal sinus following central line migration: illustrative case.

Central venous catheters (CVCs) play an indispensable role in clinical practice. Catheter malposition and tip migration can lead to severe complications. The authors present a case illustrating the endovascular management of inadvertent marginal sinus cannulation after an internal jugular vein (IJV) catheter tip migration. A triple-lumen CVC was inserted without complications into the right IJV of a patient undergoing a repeat sternotomy for aortic valve replacement. Two weeks postinsertion, it was discovered that the tip had migrated superiorly, terminating below the torcula in the posterior fossa. In the interventional suite, a three-dimensional venogram confirmed the inadvertent marginal sinus cannulation. The catheter was carefully retracted to the sigmoid sinus to preserve the option of catheter exchange if embolization became necessary. After a subsequent venogram, which displayed an absence of contrast extravasation, the entire catheter was safely removed. The patient tolerated the procedure well. Clinicians must be vigilant of catheter tip migration and malposition risks. Relying solely on postinsertion radiographs is insufficient. Once identified, prompt management of the malpositioned catheter is paramount in reducing morbidity and mortality and improving patient outcomes. Removing a malpositioned catheter constitutes a critical step, best performed by a specialized team under angiographic visualization.

Is minimising waste volume for drawing blood samples in critically ill patients feasible?

IntroductionDrawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (−.536; .012); prothrombin time (−.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.

Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible?

IntroductionDrawing blood samples through a central venous catheter is a customary practice in intensive care units. It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary central venous catheters placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which 65 patients of over 18 years of age in intensive care units, who had been fitted with a triple lumen central venous catheter, were recruited over a period of 8 months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and haemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5ml from a total extracted volume of 10.2ml, similar to the usual waste in our ambit (10ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient were used to measure the agreement between methods. The reference change value was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α=0.05 for chlorine (−0.536; 0.012); prothrombin time (−0.092; 0.019) and prothrombin activity (0.284; 1.375). The intraclass correlation coefficient was greater than 0.9 in all the variables and the limit determined for the reference change value was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5ml.

The comparative accuracy of pooled vs. individual blood culture sampling methods for diagnosis of catheter-related bloodstream infection

BackgroundCatheter-related bloodstream infection (CRBSI) is associated with increased morbidity, mortality, and cost of treatment in critically ill patients. A differential time to positivity (DTP) of 120 min or more between blood cultures obtained through the catheter vs. peripheral vein is an indicator of CRBSI with high sensitivity and specificity. However, it is no clear whether pooled sampling would be as efficient as individual sampling in order to reduce costs, contamination, or anemia.MethodsThis was a prospective diagnostic study conducted at the medical ICU and semi-ICU of Khon Kaen University’s Srinagarind Hospital in Thailand from May 2020 to November 2021. Fifty patients with triple-lumen central venous catheters (CVCs) who were clinically suspected of CRBSI were enrolled. 15 mL of blood was drawn through each catheter lumen, 10 mL of which was inoculated into three blood culture bottles, and the remaining 5 mL was pooled into a single bottle. Sensitivity, specificity, accuracy, and time to positivity of the pooled blood cultures were calculated using individual blood cultures as a reference.ResultsOf the 50 patients enrolled, 14 (28%) were diagnosed with CRBSI, 57.9% of whom were infected with gram-negative bacteria as the causative pathogen (57.9%). Extensively drug-resistant (XDR) Klebsiella pneumoniae was the most common organism. Sensitivity and specificity of the pooled blood sampling method were 69.23% (95% CI [0.44–0.94]) and 97.3% (95% CI [0.92–1.02]), respectively. The area under the ROC curve (AUC) was 0.83 (95% CI [0.68–0.99]). A paired T-Test to compare time to positivity of the pooled blood bottle and the first positive culture from the individual bottles indicated statistical significance (14.9 and 12.4 h, respectively). The mean difference was 2.5 [0.9–4.1] h, with a 95% CI and a p-value of 0.006.ConclusionPooled blood sampling results in a lower sensitivity and longer time to positivity for CRBSI diagnosis in patients with triple-lumen CVCs than individual lumen sampling.Trial registration Retrospectively registered at Thai Clinical Trials Registry. The study was reviewed and approved on 08/03/2022. TCTR identification number is TCTR20220308002

Prodigious Valve: Ultrasound Will Surely Help!!!

Prodigious Valve: Ultrasound Will Surely Help!!!

Late venous air embolism following insertion of Mayfield head pins.

Dear Editor, Venous air embolism (VAE) is not an uncommon event during neurosurgical procedures. It is an iatrogenic complication that occurs when air from the atmosphere enters into the systemic circulation specifically when the surgical site is above the level of heart producing a sub-atmospheric pressure in the open veins. A 27-year-old male diagnosed as a case of fronto-temporo-parietal meningioma was posted for craniotomy and excision under general anesthesia. His Glasgow Coma Scale [GCS] was 15, and no neurological deficit was present. All laboratory investigations were within normal limits. His magnetic resonance imaging was suggestive of large well-defined lesion in left Sylvian fissure, extending into left basal cistern with mass effect. Following anesthesia induction, a Mayfield pin was used to stabilize the head of the patient in a supine position. The pin was removed and reinserted by the surgeon to improve the surgical access. Half an hour later, the surgeon repositioned the patient with head end elevated by 30 degree. We observe a sudden fall in end-tidal carbon dioxide concentration [EtCO2] from 30 to 19 mmHg with a drop of oxygen saturation from 100% to 95%. Rest of the vital parameters including heart rate and blood pressure demonstrated no change from baseline. We started the management with administration of 100% oxygen and intravenous fluids. We could aspirate 4–5 ml of air through the central venous line catheter [Arrow triple lumen central venous catheter, 7 French sizes, and 16-centimeter length]. We confirmed the central venous line position with electrocardiogram as a guide. The superior vena cava – right atrium junction positioning of the central venous line was confirmed with a tall P wave, which was equal to R wave height. The time frame between the event and air aspiration was one and half minutes. Within 1–2 min of air aspiration, oxygen saturation returned back to normal and EtCO2 rose up to 25 mmHg from 19 mmHg. No further episodes of VAE occurred during surgery. Mayfield head pin is commonly used in neurosurgical patients to keep the head stable during surgery. The literature is scarce in case reports showing an association of VAE and Mayfield head pins in adult patients.[12] Ture H et al. observed that the rate and severity of VAE were significantly lower in patients with 30-degree head elevation than in patients with 45-degree head elevation undergoing craniotomy in semi-sitting position.[3] This was a case of late VAE during repositioning of patient possibly following air entrainment through diploic veins injured at first attempt of pin insertion. In our case, we could not find any other possible explanation for this sudden decrease in EtCO2 except for the traumatized initial skull pin site being culprit for air entrainment after a change in position. At this time point, the surgery was not started and anesthetic depth was well maintained. The proper scanning of the surgical site by a surgeon before pin insertion, avoidance of sudden change in patient positioning, and proper suturing of the initial traumatized pin insertion site could avert this iatrogenic complication. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

Background: Abdominal compartment syndrome (ACS) is a life-threatening condition that develops in the setting of increasing and uncontrolled intra-abdominal hypertension (IAH), leading to cardiovascular, respiratory, neurologic and/or renal dysfunction. Aims: To establish a porcine model for the evaluation of the effects of IAH on renal blood flow (RBF) and to determine if IVC pressure and/or Camino fiberoptic direct intraabdominal pressure measurements can accurately predict IAPs that have been derived using bladder pressure measurements. Methods: Abdominal laparotomy, placement of IAP and RBF measuring devices, and fascial closure were performed on six adult feeder pigs with a mean body weight of 25 +/- 5 kg. A Transonic Doppler flow probe, a suprapubic bladder catheter, a Camino fiberoptic probe, and a triple lumen central venous catheter were placed and then baseline measurements were taken of renal blood flow, bladder pressure, direct intra-peritoneal Camino pressure and IVC pressure, respectively. Normal saline was then infused into the abdomen to simulate increasing IAP. Following a 5–10-minute stabilization period, all measurements were again taken. Results: The correlation between IVC pressure and bladder pressure was 0.98, with a mean bias of -0.5 (SD 2.0; 95% CI: -0.9, -0.2). The correlation between direct IAP readings by Camino probe and bladder pressure was 0.91, with a mean bias of -3.9 (SD 4.3; 95% CI: -4.6, -3.2). There was a strong negative correlation (-0.95) between RBF and bladder pressure. At an IAP of 20 mmHg, RBF reduced by an average of 45.4% (95% CI: 40%, 50.8%). Upon abdominal decompression, RBF returned to 66.6% (95% CI: 54.3%, 78.9%) of its baseline value. Conclusions: A porcine model is effective in accurately measuring changes in real time RBF. RBF progressively declines as IAP increases, however upon decompression, it fails to achieve complete recovery. IVC pressure measurements correlate well with, and therefore may substitute, the gold standard bladder pressure measurements as representatives of IAP. Keywords: Abdominal Compartment syndrome, renal blood flow, intrabdominal hypertension, bladder pressure

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

The Angel catheter for the prevention of pulmonary embolism: combining an IVC filter and a triple-lumen central venous catheter

ABSTRACTIntroduction: Pulmonary embolism is common in critical care patients and carries significant morbidity and mortality. Concurrent risk of severe bleeding in this population may prohibit anticoagulation.Areas covered: The Angel Catheter device is a central venous catheter combined with an inferior vena cava filter inserted at the bedside for pulmonary embolism prevention. Our review examines the role of this device, safety, efficacy and the limitations it presents.Expert commentary: We conclude the Angel catheter should be considered in critical care patients with significant risk of pulmonary embolus as bridging therapy until anticoagulation can be safely resumed.

Prophylactic use of the Angel® Catheter in a patient with paraneoplastic syndrome scheduled for surgical tumor resection: A case report and literature review

Introductio. The Angel? catheter (BiO2 Medical Inc, San Antonio, Texas, USA) is a novel device that combines a triple lumen central venous catheter with an inferior vena cava filter for prevention of pulmonary embolism (IVC filtercatheter). Case report. We present the case of a 53- yearold male patient with renal carcinoma and a history of recent deep venous thrombosis (DVT) on oral anticoagulation who was scheduled to undergo open radical nephrectomy. Because of concerns about the risks from documented pre-existing DVT, we decided to insert the Angel? catheter preoperatively in order to have central venous access during surgery and also to reduce the risk of perioperative pulmonary embolism. On the first postoperative day, active gastric bleeding was detected and nadroparine was stopped. Before removal of the Angel? catheter, a pre-removal cavagram revealed large thrombus mass in the catheter filter. Because of the presence of the thrombus mass, the catheter was removed surgically, after a permanent vena cava filter was inserted. Conclusion. This case suggests that the use of the Angel? IVC filter/3-lumen central catheter combination could be a reasonable option for pulmonary embolism prophylaxis in the patients at a high risk for DVT, such as the patients with malignant disease, paraneoplastic syndrome and chemotherapy who need to undergo surgery.

Validation of new marker of fluid responsiveness based on Doppler assessment of blood flow velocity in superior vena cava in mechanically ventilated pigs

BackgroundWe studied a novel approach for the evaluation and management of volemia: minimally invasive monitoring of respiratory blood flow variations in the superior vena cava (SVC). We performed an experiment with 10 crossbred (Landrace × large white) female pigs (Sus scrofa domestica).MethodsHypovolemia was induced by bleeding from a femoral artery, in six stages. This was followed by blood return and then an infusion of 1000 ml saline, resulting in hypervolemia. Flow in the SVC was measured by Flowire (Volcano corp., USA), located in a distal channel of a triple-lumen central venous catheter. The key parameters measured were venous return variation index (VRV)—a new index for fluid responsiveness, calculated from the maximal and minimal velocity time intervals during controlled ventilation—and systolic peak velocity (defined as peak velocity of a systolic wave using the final end-expiratory beat). A Swan–Ganz catheter (Edwards Lifesciences, USA) was introduced into the pulmonary artery to measure pulmonary arterial pressure, pulmonary capillary wedge pressure, and continuous cardiac output measurements, using the Vigilance monitor (Edwards Lifesciences, USA).ResultsWe analyzed 44 VRV index measurements during defined hemodynamic status events. The curves of VRV indexes for volume responders and volume non-responders intersected at a VRV value of 27, with 10% false negativity and 2% false positivity. We compared the accuracy of VRV and pulse pressure variations (PPV) for separation of fluid responders and fluid non-responders using receiver operating characteristic (ROC) curves. VRV was better (AUCROC 0.96) than PPV (AUCROC 0.85) for identification of fluid responders. The VRV index exhibited the highest relative change during both hypovolemia and hypervolemia, compared to standard hemodynamic measurement.ConclusionsThe VRV index provides a real-time method for continuous assessment of fluid responsiveness. It combines the advantages of echocardiography-based methods with a direct and continuous assessment of right ventricular filling during mechanical ventilation.

Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.

Liver transplantation for acute liver failure due to hepatitis E in a pregnant patient.

Liver transplantation for acute liver failure due to hepatitis E in a pregnant patient.

Are three ports better than one? An evaluation of flow rates using all ports of a triple lumen central venous catheter in volume resuscitation

BackgroundPoiseuille's law states flow rates are directly proportional to the radius to the 4th power and indirectly proportional to the length of a tube. Because of this property, large bore catheters are commonly used in the resuscitation of the critically ill patient. However, there are no studies comparing simultaneous use of all three lumens of a triple lumen (TL) central venous catheter (CVC) with other catheter types. Our objective was to compare the flow rates of normal saline (NS) through various resuscitation catheters against a TL CVC using all 3 ports. MethodsWe performed a blinded prospective observational study of flow rates utilizing multiple resuscitation catheters. Each catheter type was attached to a 1l bag of NS using standard saline tubing and mean time to infuse 1l of normal saline was determined. Three trials each were completed with and without pressure bags. ResultsSimultaneous infusion of NS through all ports of a TL CVC demonstrated no statistically significant difference compared to the following catheters: 16ga peripheral venous catheter (PVC) and 6 Fr CVC with pressure bag. The 14 g PVC and 8.5Fr CVC had statistically significant faster flow rates than the TL CVC both with and without a pressure bag. The 6Fr CVC showed significantly faster flow rates than the TL CVC without a pressure bag. ConclusionsSimultaneous use of all 3 ports of a TL CVC generates flow rates comparable to many other commonly used resuscitation catheters.

When Your Central Line Decides to Go for a Stroll

SESSION TITLE: Procedures SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Central venous catheters (CVCs) are fastened at the skin, but their free, intra-vascular end has a tendency to become malposition. CASE PRESENTATION: A 76-year-old woman was intubated for worsening hypoxemia, and a pigtail catheter was placed into the left lower pleural space to drain an effusion. 700 cc of serous exudative fluid was drained. A 16 cm, 7 F left subclavian triple-lumen CVC was placed on the 1st attempt for vasopressor administration, with blood being easily aspirated from all ports. A follow-up CXR demonstrated a left apical pneumothorax for which another pigtail catheter was placed in the left anterior 2nd intercostal space, resulting in lung re-expansion. Over the next 2 days there was a dramatic increase in pigtail drainage and vasopressor requirements. Repeat pleural fluid analysis revealed a glucose level of 734 mg/dL. A norepinephrine drip with a dextrose carrier was being infused though the CVC. Later that day, the fluid turned milky after propofol was started through the CVC. Chest CT done concurrently for worsening hypoxemia revealed the CVC traversing the left lung apex before entering the left brachiocephalic vein. These findings were consistent with an extravascular catheter, with the proximal ports in the pleural space. Now we could aspirate blood only from the distal port. The CVC was replaced resulting in resolution of the pleural drainage and decrease in norepinephrine requirements. DISCUSSION: Late migration of CVCs often occurs inadvertently due to arm/neck movements, increase in intra-thoracic pressure due to PEEP, PPV or the patient coughing, and due to a ‘jet effect’ of drug infusions (1). These factors can cause CVC migration up to 2-4 cm. Another factor that may have caused this migration in our patient is trans-fixation of the lung apex during CVC insertion and its subsequent outward drag by the re-expanding lung. An intrapleural CVC can cause an effusion with a pleural fluid to serum glucose ratio > 1. The fluid is usually transudative with protein < 1 g/dL, but varies depending on the infusate, degree of pleural inflammation or hemorrhage, and fluid osmolality (2). CONCLUSIONS: Malpositioned CVCs should be replaced. Intra-pleural position causes an increase in pleural effusion with fluid analysis revealing similarities to infusing drugs. Reference #1: Ahuja V, Bhaga H. Late migration of subclavian venous catheter after initial correct placement. J Anesth. 2009;23(2):310-1 Reference #2: Sahn SA. Pleural effusions of extravascular origin. Clin Chest Med. 2006;27(2):285-308 DISCLOSURE: The following authors have nothing to disclose: Udit Chaddha, Jamie Kaghihara, Kavitha Bagavathy, Ashley Prosper, Ami Oren No Product/Research Disclosure Information

Ultrasound-guided vessel catheterization in adult Yorkshire cross-bred pigs

ObjectiveTo describe an ultrasound-guided approach for venous and arterial vascular access and catheterization in anesthetized adult Yorkshire cross-bred pigs. Study designProspective experimental study. AnimalsTen adult female Yorkshire cross-bred pigs, weighing 78.4 ± 5.6 kg (mean ± standard deviation). MethodsUsing ultrasound guidance and the Seldinger technique, a 7 Fr, 20 cm triple-lumen central venous catheter was placed in the external jugular vein and an 18 gauge, 16 cm catheter was placed in the femoral artery. The success rate of catheterization and the incidence of catheter patency over 24 hours of general anesthesia were recorded. ResultsCatheterization of the external jugular vein was successful in 10 out of 10 pigs and catheterization of the femoral artery was successful in eight out of 10 pigs. A surgical dissection technique on the femoral artery was performed in two pigs. Venous and arterial catheter patency was maintained in all pigs over the 24 hour study period. Conclusions and clinical relevanceUltrasound guidance resulted in success rates of 100% for catheterization of the external jugular vein and 80% for catheterization of the femoral artery in anesthetized adult Yorkshire cross-bred pigs. This technique is a noninvasive, easily performed alternative to surgical exposure of the vessels in large pigs undergoing surgical instrumentation for biomedical device testing.

311 Are Three Ports Better than One? An Evaluation of Flow Rates Using All Ports of a Triple Lumen Central Venous Catheter in Volume Resuscitation

311 Are Three Ports Better than One? An Evaluation of Flow Rates Using All Ports of a Triple Lumen Central Venous Catheter in Volume Resuscitation

Abstract PR033

Background & Objectives: Increased lactate levels after heart surgery are associated with postoperative morbidity and prolonged length of ICU stay. The aim of our study was to assess the accuracy and applicability of a novel system for continuous lactate monitoring with intravascular microdialysis not requiring calibration in high-risk cardiac surgery. Materials & Methods: Twenty-one patients undergoing elective complex (repair or replacement of two or more valves) or combined (valve and coronary artery) cardiac surgery were enrolled into a prospective observational pilot study. In all patients continuous lactate monitoring was performed using a triple-lumen central venous catheter with an integrated intravascular microdialysis function. Lactate concentration was measured using EirusTM intravascular microdialysis system (Lactatecont) and compared to the lactate concentration in the arterial blood (Lactateart) at 15 stages during the surgery and postoperatively. Results: In total, 432 paired microdialysis–arterial blood gas lactate samples were obtained. After surgery, the concentration of lactate increased significantly peaking at 8 hrs (p < 0.05). The lactate clearance within 8 hrs after peak concentration was 50 (39–63) %. There was a significant correlation between Lactatecont and Lactateart (rho = 0.92, p < 0.0001). Bland-Altman analysis showed a bias (mean difference) ± limits of agreement (±1.96 SD) of 0.09 ± 1.1 mmol/L. In addition, we found a correlation between the lactate concentration in the central venous blood with the central venous-to-arterial carbon dioxide difference (rho = 0.35, p < 0.05) and mean arterial pressure (rho = –0.21, p < 0.001). We did not observe any relationship between lactate concentration, cardiac index, and ScvO2. In patients with postoperative complications, the median and the maximum lactate concentrations were 2.92 (1.75 – 3.50) and 6.75 (4.43 – 7.75) mmol/L, respectively, vs. 2.36 (1.50 – 3.00) and 4.20 (3.95 – 4.87) mmol/L in patients without complications (p = 0.002). Conclusion: Lactate concentration increases significantly after high-risk cardiac surgery. The intravascular microdialysis technique for lactate measurement provides acceptable accuracy and can be used for continuous blood lactate monitoring in open-heart surgery. Disclosure of Interest: None declared

A new device for the prevention of pulmonary embolism in critically ill patients: Results of the European Angel Catheter Registry.

Pulmonary embolism (PE) is a potentially life-threatening complication of critical illness. In trauma and neurosurgical patients with contraindications to anticoagulation, inferior vena cava (IVC) filters have been used to prevent PE, but their associated long-term complication rates and difficulties associated with filter removal have limited their use. The Angel catheter is a temporary device, which combined an IVC filter with a triple-lumen central venous catheter (IVC filter-catheter) and is intended for bedside placement and removal when no longer indicated. This study presents data from a European Registry of 60 critically ill patients in whom the IVC filter-catheter was used to prevent PE. The patients were all at high risk of PE development or recurrence and had contraindications to anticoagulation. The primary end points of this study were to evaluate the safety (in particular, the presence of infectious or thrombotic events) and effectiveness (the numbers of PEs and averted PEs) of the IVC filter-catheter. The main diagnosis before catheter insertion was major trauma in 33 patients (55%), intracerebral hemorrhage or stroke in 9 (15%), a venous thromboembolic event in 9 (15%), and active bleeding in 6 (10%). The IVC filter-catheter was placed as prophylaxis in 51 patients (85%) and as treatment in the 9 patients (15%) with venous thromboembolic event. The devices were inserted at the bedside without fluoroscopic guidance in 54 patients (90%) and within a median of 4 days after hospital admission. They were left in place for a mean of 6 days (4-8 days). One patient developed a PE, without hemodynamic compromise; two PEs were averted. No serious adverse events were reported. Early bedside placement of an IVC filter-catheter is possible, and our results suggest that this is a safe, effective alternative to short-term PE prophylaxis for high-risk patients with contraindications to anticoagulation. Therapeutic study, level V.

Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit.

Early central venous catheter (CVC) insertion in Ebola virus disease (EVD) is a novel approach and has not previously been described. This report delineates the safety, feasibility and clinical implications of early CVC insertion as the optimum means of vascular access in patients with EVD, in the setting of a deployed military Ebola virus disease treatment unit in Sierra Leone. In the gastrointestinal phase of EVD, a 7-French 20-cm triple-lumen CVC was inserted using aseptic technique. Data were collected prospectively on all cases to include baseline and subsequent blood test variables, insertion site and technique, and complications associated with CVC placement. Twenty-three patients underwent CVC insertion as follows: subclavian, 21 (88 %); internal jugular, 2 (8 %); axillary, 1 (4 %). The mean duration of CVC placement was 5 days. There were no significant procedure-related adverse events. Despite coagulopathy being present in 75 % of cases, CVC insertion was safe, and there was only 1 case of significant catheter site bleeding. A total of 152 needle venepunctures were avoided owing to the presence of a CVC, a mean of 7 (±3.8) per case over the average stay. The early use of CVCs in Ebola virus disease is safe, effective and facilitates patient care. It should be considered a feasible additional route of venous access, where physician expertise and resources allow.