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central venous catheter technique

Lane Thaut, Wells Weymouth, Branden Hunsaker, Daniel Reschke
BACKGROUND: Central vein catheter (CVC) placement using the modified Seldinger technique is a common procedure in the emergency department, but can be time consuming due to the multiple pieces of equipment included in central line kits and the number of steps in the procedure. Preassembled devices combine a needle, guidewire, dilator, and sheath into one unit and potentially simplify the process and reduce time required for CVC placement using the accelerated Seldinger technique. OBJECTIVE: Our aim was to evaluate whether the use of combination central line devices and the accelerated Seldinger technique will reduce the time required to place a CVC and increase the ease of the procedure...
November 29, 2018: Journal of Emergency Medicine
Mariela Dore, S Barrena, Paloma Triana Junco, Alba Sánchez Galán, Javier Jimenez Gomez, Leopoldo Martinez
INTRODUCTION:  Central venous port (CVP) placement is traditionally performed under fluoroscopy guidance. However, efforts for radiation dose reduction in children have allowed the introduction of ultrasound guidance (USG) and anatomic landmarks as an alternative technique for CVP placement. The aim of this study is to determine whether intraoperative fluoroscopy (IF) is required to confirm the correct position of the catheter tip in children. PATIENTS AND METHODS:  A prospective, single-center study was performed between July and December 2017...
November 23, 2018: European Journal of Pediatric Surgery
Mathew Wooster, Blake Fernandez, Kelli L Summers, Karl A Illig
BACKGROUND: Subclavian vein stenosis or occlusion at the thoracic outlet is a problem associated with certain anatomic and environmental stresses (venous thoracic outlet syndrome [VTOS]), the presence of central venous catheters, and the high flows associated with arteriovenous (AV) access in the limb. We describe our experience with open and endovascular techniques for restoring patency in highly symptomatic patients. METHODS: A prospectively collected database of patients was queried for patients treated for central venous obstructive disease in the setting of highly symptomatic VTOS and ipsilateral AV access from October 2011 to August 2016...
November 12, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Bruno De Oliveira, Malligere Prasanna, Malcolm Lemyze, Laurent Tronchon, Didier Thevenin, Jihad Mallat
BACKGROUND: Central venous oxygen saturation (ScvO2) is often used to help to guide resuscitation of critically ill patients. The standard gold technique for ScvO2 measurement is the co-oximetry (Co-oximetry_ScvO2), which is usually incorporated in most recent blood gas analyzers. However, in some hospitals, those machines are not available and only calculated ScvO2 (Calc_ScvO2) is provided. Therefore, we aimed to investigate the agreement between Co-oximetry_ScvO2 and Calc_ScvO2 in a general population of critically ill patients and septic shock patients...
2018: PloS One
Rogerio da Hora Passos, Michel Ribeiro, Luis Filipe Miranda Rebelo da Conceição, Joao Gabriel Rosa Ramos, Juliana Caldas Ribeiro, Paulo Benigno Pena Batista, Margarida Maria Dantas Dutra, Jean Jacques Rouby
BACKGROUND: In patients with end-stage renal disease, the use of cuffed, tunneled dialysis catheters for hemodialysis has become integral to treatment plans. Fluoroscopy is a widely accepted method for the insertion and positioning of cuffed dialysis catheters, because it is easy to use, accurate and reliable, and has a relatively low incidence of complications. The purpose of our study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy but with a dynamic ultrasound-imaging-based guided technique...
October 25, 2018: Journal of Vascular Access
Mauro Pittiruti, Giancarlo Scoppettuolo, Laura Dolcetti, Alessandro Emoli
INTRODUCTION: Intracavitary electrocardiogram technique is recognized as a safe, accurate, and inexpensive method for verifying the tip location of central venous access devices. While the technique can be carried out with any standard electrocardiogram monitor, dedicated electrocardiogram monitors specifically designed for the intracavitary electrocardiogram are also available. One of these dedicated monitors is Sherlock-3CG® , characterized by the integration of a magnetic-based tip navigation method with an electrocardiogram-based tip location method...
October 18, 2018: Journal of Vascular Access
Peter W Crooks, Christopher O Thomas, Amy Compton-Phillips, Wendy Leith, Alvina Sundang, Yi Yvonne Zhou, Linda Radler
OBJECTIVES: To assess the association between optimal end-stage renal disease (ESRD) starts and clinical and utilization outcomes in an integrated healthcare delivery system. STUDY DESIGN: Retrospective observational cohort study in 6 regions of an integrated healthcare delivery system, 2011-2013. METHODS: Propensity score techniques were used to match 1826 patients who experienced an optimal start of renal replacement therapy (initial therapy of hemodialysis via an arteriovenous fistula or graft, peritoneal dialysis, or pre-emptive transplant) to 1826 patients who experienced a nonoptimal start (hemodialysis via a central venous catheter)...
October 1, 2018: American Journal of Managed Care
Ufuk Ateş, Nil Yaşam Taştekin, Fuad Mammadov, Ergun Ergün, Gülnur Göllü, Özlem Selvi Can, Tayfun Uçar, Meltem Bingöl-Koloğlu, Aydın Yağmurlu, Tanju Aktuğ
Ateş U, Taştekin NY, Mammadov F, Ergün E, Göllü G, Can ÖS, Uçar T, Bingöl-Koloğlu M, Yağmurlu A, Aktuğ T. Stuck tunneled central venous catheters in children: Four cases removed by angiography assistance. Turk J Pediatr 2018; 60: 221-224. Adherent tunneled catheters can usually be removed by a surgical cut down, but in some cases the line can become stuck to the wall of the central veins. In such cases, forceful traction can cause vascular injury, or fracture of the catheter. We present four cases of fixated cuffed tunneled catheters...
2018: Turkish Journal of Pediatrics
Xiang Ao, Yong Zhong, Xiaohe Yu, Mark Marshall, Tao Feng, Jianping Ning, Qiaoling Zhou
BACKGROUND: Acute kidney injury (AKI) is common in critically ill neonates, and peritoneal dialysis (PD) can be a lifesaving option. In China, however, much of the equipment for PD in neonates is not available. We describe results with a novel system for PD, which has been developed locally to improve access to therapy and care for critically ill neonates requiring PD in China. METHODS: The system comprises a 14-gauge single-lumen central venous catheter serving as a PD catheter, inserted by Seldinger technique, with an adapted twin bag PD system...
October 12, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Alice Luehr
Individuals who require renal replacement therapy overwhelmingly choose outpatient hemodialysis. Appropriate cannulation techniques are an essential element in access preservation and in the prevention of access-related complications. Missed cannulations can result in damage of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Ultrasound-guided cannulation is an effective technique for the placement of peripheral intravenous (IV) catheters and central venous catheters (CVCs) for hemodialysis. The purposes of this project were to determine if ultrasound-guided cannulation of AVFs decreased the number of missed cannulations, to determine staff and patient perceptions regarding cannulation, and to implement a quality incentive program (QIP) to implement an evidence-based ultrasound-guided policy and procedure, training program, and competency evaluation at a hospital-based dialysis facility...
September 2018: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Cory N Criss, Samir K Gadepalli, Niki Matusko, Marcus D Jarboe
BACKGROUND: Use of ultrasound-guidance for central venous access in adults is the standard of care. There is, however, less clarity in the role of routine ultrasound use in obtaining venous access in children. We sought to evaluate safety and efficiency of the placement of central lines utilizing an ultrasound-guided approach compared to the traditional, landmark approach in pediatric patients. STUDY DESIGN: A single-institution retrospective chart review, using CPT codes, was performed for all tunneled central venous catheters in children between 2005 and 2017 by the same pediatric surgery group...
September 13, 2018: Journal of Pediatric Surgery
A B Maldonado-Cárceles, J García-Medina, J J García-Alfonso, J J Árense-Gonzalo, A M Torres-Cantero
PURPOSE: The purpose of this study was to compare patency rates and risk of obstruction of catheter exchange (CE) with that of CE with fibrin sheath angioplasty (CE+FSA) in dysfunctional tunneled central hemodialysis venous catheter (CHVC). MATERIALS AND METHODS: A total of 107 consecutive patients with dysfunctional CHVC were retrospectively included. There were 66 men and 41 women with a mean age of 67.8±12.5 (SD) years (range: 23.0-86.0 years). Seventy-three of 107 patients (68...
September 24, 2018: Diagnostic and Interventional Imaging
Jacob Bell, Munish Goyal, Sallie Long, Anagha Kumar, Joseph Friedrich, Jonathan Garfinkel, Suzi Chung, Shimae Fitzgibbons
BACKGROUND: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. METHODS: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center...
September 19, 2018: Journal of Intensive Care Medicine
Víctor Lorenzo Sellarés
The decision to initiate renal replacement therapy (RRT) implies a wide margin of uncertainty. Glomerular filtration rate (GFR) tells us the magnitude of renal damage. Proteinuria indicates the speed of progression. However, nowadays more than 50% of patients are still initiating RRT hastily, and it is life threatening. HYPOTHESIS: By analysing Emergency Department (ED) frequentation and causes of a hurried initiation, we can better schedule the timing of the start of RRT. METHOD: Retrospective and observational study of all CKD patients in our outpatient clinic...
November 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Stacy Libricz, Ayan Sen, Victor Davila, Jeff Mueller, Alyssa Chapital, Samuel Money
INTRODUCTION: Despite ultrasound use, accidental carotid cannulation is possible during placement of a central venous catheter (CVC), requiring operative repair of the carotid artery and removal of the catheter. CASE PRESENTATION: We report 2 cases-a 59-year-old Hispanic man and an 86-year-old white man-of inadvertent placement of a CVC into the left common carotid artery, removed via a pull-and-pressure technique under real-time ultrasound guidance. No complications occurred and follow-up imaging was negative for fistula creation, hematoma, or cerebral infarcts...
August 2018: WMJ: Official Publication of the State Medical Society of Wisconsin
M E Lacostena-Pérez, A M Buesa-Escar, A M Gil-Alós
OBJECTIVE: To evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal. METHODS: Prospective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate...
September 3, 2018: Enfermería Intensiva
Gil Myeong Seong, Jaechun Lee, Misun Kim, Jay Chol Choi, Su Wan Kim
Air embolism is a rare but mostly iatrogenic complication of medical or surgical procedures and may have a serious outcome. On the removal of a central venous catheter (CVC), minor carelessness can lead to a venous air embolism sometimes accompanied by arterial embolism. We experienced the case of a 61-year-old male who suffered from a paradoxical systemic air embolism while we removed a CVC. Immediate resuscitation and venovenous extracorporeal membrane oxygenation support saved his life. Multiple end-organ damage related to the systemic air embolism was noted, including the kidney, liver, and brain...
July 2018: International Journal of Critical Illness and Injury Science
L Basset, B Lassale, L Succamiele, M Moya-Macchi
Treatment by blood transfusion first requires an intravenous cannula. Professionals remember the optimal diameter for transfusion (16 to 18G). Practices differ according to the department concerned. Neonatology and paediatric wards use precision filters and put in fine cannulas (24G) with the constraint that this restricts transfusion flow rate. In haematology and oncology departments, the state of the patient's veins has to be considered when administering chemotherapy which may be toxic for vascular endothelium and the implantation of a venous port by a critical care anaesthetist may be suggested...
November 2018: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Jon H Salicath, Emily Cy Yeoh, Michael H Bennett
BACKGROUND: Intravenous patient-controlled analgesia (IVPCA) with opioids and epidural analgesia (EA) using either continuous epidural administration (CEA) or patient-controlled (PCEA) techniques are popular approaches for analgesia following intra-abdominal surgery. Despite several attempts to compare the risks and benefits, the optimal form of analgesia for these procedures remains the subject of debate. OBJECTIVES: The objective of this review was to update and expand a previously published Cochrane Review on IVPCA versus CEA for pain after intra-abdominal surgery with the addition of the comparator PCEA...
August 30, 2018: Cochrane Database of Systematic Reviews
Avinash N Medsinge, Fernando A Escobar, Sabri Yilmaz, James K Park, John J Crowley
Mediport (also known as port, portacath or Infusaport) is a commonly placed central venous access in pediatric patients. Fibrin sheath formation around the central venous catheter is a common biological response leading to port malfunction in the form of inability to aspirate but preserved capacity for infusion of fluids. If fibrinolytic therapy fails, percutaneous fibrin sheath stripping via transfemoral route or replacement with a new mediport are routine/conventional treatments for a fibrin sheath. We describe a novel technique for removing a fibrin sheath by exteriorizing the catheter through the neck entry site, stripping the fibrin sheath from the catheter manually under sterile conditions and replacing the catheter via a peel-away sheath introduced through the same skin incision as an alternative to complete port replacement or attempted catheter stripping...
August 29, 2018: Pediatric Radiology
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