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Central venous access

Umit Kervan, Sinan Sabit Kocabeyoglu, Dogan Emre Sert, Emre Aygün, Kemal Kavasoglu, Mehmet Karahan, Ertekin Utku Unal, Mustafa Pac
OBJECTIVES: The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques...
October 14, 2016: Experimental and Clinical Transplantation
Banafsheh Bakhshoude, Hassan Ravari, Gholam Hosein Kazemzadeh, Masoud Pezeshki Rad
INTRODUCTION: Currently, venography is the standard diagnostic method to examine veins before implementing access, which is invasive in nature. Computerized tomography venography (CTV) can simultaneously indicate deep and superficial venous systems in the upper extremity and their relation to the surrounding anatomical structures; however, its diagnostic value in the detection of central venous disease has yet to be defined. The aim of this study was to determine the diagnostic value of CT venography compared to venography in the diagnosis of stenosis and the occlusion of subclavian veins and the superior vena in renal failure patients...
August 2016: Electronic Physician
Christoph F Dietrich, Rudolf Horn, Susanne Morf, Liliana Chiorean, Yi Dong, Xin-Wu Cui, Nathan S S Atkinson, Christian Jenssen
Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach...
September 2016: Journal of Thoracic Disease
Masaaki Murakami, Genichi Sakaguchi, Noriko Mori
OBJECTIVE: In patients with a high risk of fistula immaturity, we created arteriovenous fistulas (AVFs) combined with brachial artery superficialization. With this procedure, the superficialized arteries are used as drawing routes and the AVFs as returning routes. This is a technical report about AVFs combined with brachial artery superficialization. METHODS: Twenty-four consecutive patients with a high risk of fistula immaturity who underwent AVFs with brachial artery superficialization were included in this single-center retrospective study...
October 12, 2016: Journal of Vascular Surgery
S M Johnson, G M Garnett, R K Woo
Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down...
October 14, 2016: Pediatric Surgery International
Thandar Aye, Thanh Trung Phan, Douglas Findlay Muir, Nicholas John Linker, Richard Hartley, Andrew John Turley
AIM: This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. METHOD AND RESULTS: Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion...
October 14, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Max B van Gent, Wendeline J van der Made, Perla J Marang-van de Mheen, Koen E van der Bogt
OBJECTIVE: To analyze the rate of infections and complications after surgeon-performed, largely ultrasound-guided, central venous catheter (CVC) placement in a pediatric population and to identify patients at high risk of complications. METHODS: All children aged between 4 months and 19 years with a percutaneous CVC inserted between January 1, 2000, and July 31, 2013, were included. Patient records were reviewed retrospectively for the occurrence of infection and other complications until CVC removal or the last outpatient clinic visit and compared between patient groups and with the recent literature...
October 14, 2016: Surgical Infections
Silvia Calviño Günther, Carole Schwebel, Rebecca Hamidfar-Roy, Agnès Bonadona, Maxime Lugosi, Claire Ara-Somohano, Clémence Minet, Leïla Potton, Jean-Charles Cartier, Aurelien Vésin, Magalie Chautemps, Lenka Styfalova, Stephane Ruckly, Jean-François Timsit
PURPOSE: To describe all post-insertion complications involving most used intravascular access, and to determine whether the use of a new-generation transparent dressing (3M™ IV Advanced) might reduce their number and impact on ICU patient outcomes. METHODS: Patients older than 18, with an expected length of stay ≥48 h and requiring at least one central venous catheter (CVC), arterial catheter (AC), haemodialysis catheter (HDC), pulmonary arterial catheters (PAC) or peripheral venous catheter (PVC) were randomized into two groups: a new-generation transparent dressing, or the hospital's classical transparent dressing, and were followed daily for any infectious and non-infectious complications...
October 12, 2016: Intensive Care Medicine
Massimo Lodi, Reza Far Ebrahimi, Piera Pezzotti, Luciano Carbonari
The use of the tunneled central venous catheter (CVC) is steadily increasing worldwide as a means of vascular access for hemodialysis. The increased use of these devices, which often outlive the patients, and the extended time they are used are associated with more frequent complications. Among these, one of the emerging complications is that of the "embedded" or stuck catheter. This term refers to when the catheter cannot be removed after detaching the retention cuff. In medical literature, experiences with the removal of stuck catheters are described with the use of several different methods...
September 27, 2016: Journal of Vascular Access
Amanda J Ullman, Marie Cooke, Tricia Kleidon, Claire M Rickard
AIM: To identify the prevalence, management and complications associated with central venous access devices (CVADs) within Australian paediatric facilities, providing a map for clinicians, researchers and managers to focus solutions. METHODS: A point prevalence audit and survey of CVAD practices in Australian tertiary paediatric hospitals between September and November 2015, using validated data collection tools. RESULTS: Across the six sites, 1027 patients were screened with CVADs prevalent in 26...
October 6, 2016: Journal of Paediatrics and Child Health
Carlos A Hinojosa, Javier E Anaya-Ayala, Alejandra Lopez-Mendez, Zeniff Gomez-Arcive, Hugo Laparra-Escareno, Cesar Cuen-Ojeda, Rene Lizola, Adriana Torres-Machorro
Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins...
October 5, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
J Abram, J Klocker, N Innerhofer-Pompernigg, M Mittermayr, M C Freund, N Gravenstein, V Wenzel
Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible...
October 5, 2016: Der Anaesthesist
Suh Min Kim, Seung-Kee Min, Sanghyun Ahn, Sang-Il Min, Jongwon Ha
PURPOSE: This retrospective review aimed to report the outcomes of arteriovenous fistula (AVF) and to evaluate the suitability of AVF as a permanent vascular access in pediatric populations. MATERIALS AND METHODS: Data were collected for all patients aged 0 to 19 years who underwent AVF creation for hemodialysis between January 2000 and June 2014. RESULTS: Fifty-two AVFs were created in 47 patients. Mean age was 15.7±3.2 years and mean body weight was 46...
September 2016: Vascular Specialist International
Arunangshu Chakraborty, Sanjit Agrawal, Taniya Datta, Suparna Mitra, Rakhi Khemka
Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.
October 2016: Journal of Indian Association of Pediatric Surgeons
Christopher J Pannucci, Thomas K Varghese, Kencee K Graves, Ann Marie Prazak
INTRODUCTION: Enoxaparin prophylaxis prevents venous thromboembolism in surgical patients. Real time anti-Factor Xa monitoring for surgical patients on enoxaparin prophylaxis is increasingly common. PRESENTATION OF CASES: We report on three cancer patients with therapeutic or supratherapeutic anti-Factor Xa levels while on prophylactic doses of enoxaparin after surgical procedures. In all cases, elevated anti-Factor Xa levels were the result of blood specimens being removed from a heparinized chemoport...
September 25, 2016: International Journal of Surgery Case Reports
Andrew S Griffin, Shawn M Gage, Jeffrey H Lawson, Charles Y Kim
OBJECTIVE: This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation. METHODS: A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component...
September 26, 2016: Journal of Vascular Surgery
Adam D Jakes, Poonam Jani, Victoria Allgar, Archie Lamplugh, Ahmed Zeidan, Sunil Bhandari
BACKGROUND: Dialysis in elderly patients (>80-years-old) carries a poor prognosis, but little is known about the most effective vascular access method in this age group. An arteriovenous fistula (AVF) is both time-consuming and initially expensive, requiring surgical insertion. A central venous catheter (CVC) is initially a cheaper alternative, but carries a higher risk of infection. We examined whether vascular access affected 1-year and 2-year mortality in elderly patients commencing haemodialysis...
2016: PloS One
Pierpaolo Di Nicolò, Marina Cornacchiari, Marco Mereghetti, Anna Mudoni
As a consequence of the central role of the arteriovenous fistula for dialysis (AVF) in the clinical management of the dialysis patient the necessity to limit the puncture-related complications to extend as much as possible the life of the vascular access. Accordingly, the AVF needling technique has gained growing attention. Alongside the traditional rope ladder (RL) puncture method, the buttonhole technique (BH) is increasingly popular; this technique employs the same cannulation sites of AVF in every dialysis associated with the use of dull needles to minimize vessels damage...
September 27, 2016: Seminars in Dialysis
Justin P McWilliams, Rajesh P Shah, Matthew Quirk, Sarah B White, Stephanie L Dybul, Judy Ahrar, Joseph R Steele, Sharon W Kwan, Jeremy Handel, Ronald S Winokur, Charles A Gilliland, Jeremy C Durack
PURPOSE: To assess adoption and survey-based satisfaction rates following deployment of standardized interventional radiology (IR) procedure reports across multiple institutions. MATERIALS AND METHODS: Standardized reporting templates for 5 common interventional procedures (central venous access, inferior vena cava [IVC] filter insertion, IVC filter removal, uterine artery embolization, and vertebral augmentation) were distributed to 20 IR practices in a prospective quality-improvement study...
September 23, 2016: Journal of Vascular and Interventional Radiology: JVIR
Michelle Ribeiro Viana Taveira, Luciana Santana Lima, Cláudia Corrêa de Araújo, Maria Júlia Gonçalves de Mello
BACKGROUND: Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. PROCEDURE: A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients...
September 26, 2016: Pediatric Blood & Cancer
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