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Central line placement

Carl A Johnson, Amber L Melvin, Brandon F Lebow, Amanda Yap, Peter A Knight
Aortic valve replacement through minimally invasive access is increasing. These procedures have several advantages over conventional sternotomy including decreased intensive care unit and hospital length of stay and decreased ventilation time. The right anterior mini-thoracotomy (RAM) approach is potentially attractive in that it completely spares the sternum leading to improved cosmesis, reduced blood loss, and improved patient satisfaction. However, this approach is underutilized due to anticipated technical challenges including difficulty with visualization and annular suture placement...
2018: Journal of Visualized Surgery
Maxim Yu Rykov, Sergei V Zaborovskij, Alexander N Shvecov, Vladimir V Shukin
PURPOSE: To review our experience with peripherally inserted central catheters in pediatric cancer patients. METHODS: The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011-2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy...
March 1, 2018: Journal of Vascular Access
Afsha Aurshina, Anil Hingorani, Ahmad Alsheekh, Pavel Kibrik, Natalie Marks, Enrico Ascher
OBJECTIVE: It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. METHODS: A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years...
March 1, 2018: Journal of Vascular Access
Peter Paik, Sanjay K Arukala, Anupam A Sule
Central venous catheters are placed in approximately five million patients annually in the US. The preferred site of insertion is one with fewer risks and easier access. Although the right internal jugular vein is preferred, on occasion, the left internal jugular may have to be accessed. A patient was admitted for septic shock, cerebrovascular accident, and non-ST-segment elevation myocardial infarction. A central venous line was needed for antibiotic and vasopressor administration. Due to trauma from a fall to the right side and previously failed catheterization attempts at the left subclavian and femoral veins, the left internal jugular vein was accessed...
January 9, 2018: Curēus
Jay Burmeister, Adrian Nalichowski, Michael Snyder, Robert Halford, Geoff Baran, Brian Loughery, Ahmad Hammoud, Joe Rakowski, Todd Bossenberger
We describe the commissioning of the first dedicated commercial total body irradiation (TBI) unit in clinical operation. The Best Theratronics GammaBeam 500 is a Co-60 teletherapy unit with extended field size and imaging capabilities. Radiation safety, mechanical and imaging systems, and radiation output are characterized. Beam data collection, calibration, and external dosimetric validation are described. All radiation safety and mechanical tests satisfied relevant requirements and measured dose distributions meet recommendations of American Association of Physicists in Medicine (AAPM) Report #17...
March 11, 2018: Journal of Applied Clinical Medical Physics
Ammara Mushtaq, Bhagyashri Navalkele, Maninder Kaur, Amar Krishna, Aleena Saleem, Natasha Rana, Sonia Gera, Suganya Chandramohan, Malini Surapaneni, Teena Chopra
BACKGROUND: With the rising use of midline catheters (MCs), validation of their safety is essential. Our study aimed to evaluate the incidence of bloodstream infections (BSIs) and other complications related to the use of MCs and central venous catheters (CVCs). METHODS: A retrospective cohort study was performed at a tertiary care hospital in Detroit, Michigan, from March-September 2016. Adult patients with either MC or CVC were included. Outcomes assessed were catheter-related BSI (CRBSI), mechanical complications, hospital length of stay, readmission within 90 days of discharge (RA), and mortality...
March 7, 2018: American Journal of Infection Control
Mustafa M Haddad, Benjamin Simmons, Ian R McPhail, Manju Kalra, Melissa J Neisen, Matthew P Johnson, Andrew H Stockland, James C Andrews, Sanjay Misra, Haraldur Bjarnason
PURPOSE: To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS: We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis...
February 28, 2018: Cardiovascular and Interventional Radiology
Dia Byrne, Linda Penwarden
The purpose of this article is to share the efforts of one institution in reducing risk of central line-associated bloodstream infections (CLABSIs). The aim is to review alteplase use as a marker for peripherally inserted central catheter (PICC) occlusions, which may increase risk of CLABSIs. The discovery that alteplase use increased with the number of PICC lumens allowed for exploration of ordering and placement practices. Following education, placement of double-lumen PICCs decreased.
March 2018: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
Joshua P Parreco, Antonio E Hidalgo, Alejandro D Badilla, Omar Ilyas, Rishi Rattan
PURPOSE: The purpose of this study was to compare machine learning techniques for predicting central line-associated bloodstream infection (CLABSI). MATERIALS AND METHODS: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all ICU admissions. The variables included six different severities of illness scores calculated on the first day of ICU admission with their components and comorbidities. The outcomes of interest were in-hospital mortality, central line placement, and CLABSI...
February 21, 2018: Journal of Critical Care
Anthony N Hage, Ravi N Srinivasa, Steven D Abramowitz, Joseph J Gemmete, Shilpa N Reddy, Jeffrey Forris Beecham Chick
PURPOSE: To report global iliocaval stent reconstruction practices by interventionalists. MATERIALS AND METHODS: A 45-question survey focusing on iliocaval stent reconstruction evaluation was distributed through the Open Forum and Venous Disease Service Line of the Society of Interventional Radiology Connect website from June 20, 2017 until September 7, 2017 and the Cardiovascular and Interventional Radiological Society of Europe electronic newsletter on August 11, 2017...
February 24, 2018: Annals of Vascular Surgery
Christos Farazi-Chongouki, Ioannis Dalianoudis, Anestis Ninos, Pantelis Diamantopoulos, Dimitrios Filippou, Stefanos Pierrakakis, Panagiotis Skandalakis
INTRODUCTION: Various anomalies in the development of the great thoracic veins of the embryo can be incidentally discovered in the normal adult. Duplication of superior vena cava (SVC) is a rare abnormality, but the most common thoracic venous congenital anomaly. Case reports-methods: We present two cases in the intensive care unit of our hospital, of asymptomatic patients who underwent an uneventful central line placement in the left subclavian vein. The track of the catheter, as shown in the X-ray, was misplaced to the left of the aorta and further investigation with computed tomography angiography confirmed a persistent left SVC...
February 19, 2018: Acta Chirurgica Belgica
Steven J Campbell, Rabih Bechara, Shaheen Islam
Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume...
March 2018: Clinics in Chest Medicine
Riten Kumar, Joseph Stanek, Susan Creary, Amy Dunn, Sarah H O'Brien
A hypercoagulable state resulting in increased venous thromboembolism (VTE) has been described in adults with sickle cell disease (SCD), but similar data for children are lacking. The objective of this retrospective cohort study was to describe the rate of VTE and risk factors associated with VTE in children with SCD across tertiary-care children's hospitals in the United States between the years 2009 and 2015. We used the Pediatric Health Information System database to investigate all pediatric patients with SCD admitted to 1 of 48 participating institutions between 1 January 2009 and 30 September 2015...
February 13, 2018: Blood Advances
Alex Chau, Jose Alberto Hernandez, Sheena Pimpalwar, Daniel Ashton, Kamlesh Kukreja
BACKGROUND: Femoral tunneled central line placement in the pediatric population offers an alternative means for intravenous (IV) access, but there is concern for higher complication and infection rates when placed at bedside. OBJECTIVE: To describe the complications and infection outcomes of primary femoral tunneled central venous catheter placement in the interventional radiology suite compared to the portable bedside location at a single tertiary pediatric institution...
February 8, 2018: Pediatric Radiology
Miriam Martínez, Mar García Romero, Luis García Guereta, Marta Cabrera, Rita M Regojo, Luis Albajara, Maria L Couce, Miguel Saenz de Pipaon
RATIONALE: Infantile-onset Pompe disease, also known as glycogen storage disease type II, is a progressive and fatal disorder without treatment. Enzyme replacement therapy with recombinant human acid alpha-glucosidase (GAA) enhances survival; however, the best outcomes have been achieved with early treatment. PATIENT CONCERNS: We report a case of a newborn with infantile-onset Pompe disease diagnosed in the first days of life who did not undergo universal neonatal screening...
December 2017: Medicine (Baltimore)
Kushal Patel, Jessica J Kram, Dennis J Baumgardner
INTRODUCTION: Pseudomonas aeruginosa infections resistant to carbapenem antimicrobials have increased. Traditional risk factors for non-carbapenem resistance include intensive care unit stay, mechanical ventilation, previous hospitalization, and major comorbidities. As microbes evolve, our understanding of their risk factors for resistance also should evolve. METHODS: We conducted a retrospective study of adult inpatients and outpatients with a positive Pseudomonas aeruginosa culture during 2014...
December 2017: WMJ: Official Publication of the State Medical Society of Wisconsin
Laurence Weinberg, Diana Abu-Ssaydeh, Manfred Spanger, Patrick Lu, Michael H-G Li
INTRODUCTION: Brachial arterial catheters provide a more accurate reflection of central aortic arterial pressure compared to their radial counterparts. Although brachial arterial line complications are uncommon, we report a case of a rare iatrogenic brachial artery dissection with complete anterograde occlusion from elective arterial line placement. PRESENTATION OF CASE: A 41-year-old female presented for a right upper and middle lobe resection of a large neuroendocrine lung cancer...
December 27, 2017: International Journal of Surgery Case Reports
Flora Habas, Julien Baleine, Christophe Milési, Clémentine Combes, Marie-Noëlle Didelot, Sara Romano-Bertrand, Delphine Grau, Sylvie Parer, Catherine Baud, Gilles Cambonie
Placement of a central venous catheter (CVC) in the brachiocephalic vein (BCV) via the ultrasound (US)-guided supraclavicular approach was recently described in children. We aimed to determine the CVC maintenance-related complications at this site compared to the others (i.e., the femoral, the subclavian, and the jugular). We performed a retrospective data collection of prospectively registered data on CVC in young children hospitalized in a pediatric intensive care unit (PICU) during a 4-year period (May 2011 to May 2015)...
March 2018: European Journal of Pediatrics
Muhammad Aanish Raees, Paul V Dubar, David P Bichell
We describe a strategy aimed at maximizing the safety and minimizing the thrombogenicity of central venous lines for neonates with congenital heart defects. Our method involves the use of a tunneled technique to place a 4.2 Fr single-lumen (Broviac) catheter in the subpericardial space, with minimal intravascular course and a tip placed in the lower right atrium. Using this technique, we potentially eliminated the requirement for percutaneous placement of central venous lines postoperatively as well as potentially decreased the risk of intrapericardial bleeding associated with transthoracic lines...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
Lori A Gurien, Martin L Blakely, Marie C Crandall, Cameron Schlegel, Mallikarjuna R Rettiganti, Marie E Saylors, Daniel J France, Shilo Anders, Sheila L Thomas, Melvin S Dassinger
BACKGROUND: Major health care agencies recommend real-time ultrasound (RTUS) guidance during insertion of percutaneous central venous catheters (CVC) based on studies in which CVCs were placed by non-surgeons. We conducted a meta-analysis to compare outcomes for surgeon-performed RTUS-guided CVC insertion versus traditional landmark technique. METHODS: A systematic review of the literature was performed identifying randomized controlled trials (RCT) and prospective "safety studies" of surgeon-performed CVC insertions comparing landmark to RTUS techniques...
January 4, 2018: Journal of Trauma and Acute Care Surgery
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