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Central venous access devices

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
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
Aurelia B Fu, Erica I Hodgman, Lorraine S Burkhalter, Rachel Renkes, Tamra Slone, Adam C Alder
BACKGROUND: Central venous access devices (CVADs) play an important role in the management of pediatric oncology patients; unfortunately, they are also associated with potentially serious complication rates. We hypothesized that, despite the significantly different disease courses typical of acute lymphoblastic leukemia and acute myelogenous leukemia, there would be identifiable risk factors for premature CVAD removal. METHODS: We retrospectively studied clinical characteristics and procedure records for all patients admitted with a leukemia diagnosis at our institution from May 2009 to July 2014...
October 2016: Journal of Surgical Research
Daniel Putensen, David Leverett, Bhavika Patel, Jasmin Rivera
BACKGROUND: The majority of reports regarding general vascular access choices for apheresis procedures argue that peripheral venous access should be considered first. However, the clinical reality appears to be different. While some procedures mandate central vascular access (e.g., therapeutic apheresis procedures in critically ill patients) and in some cases it is the patient's preference, we propose that the majority of elective procedures can be successfully performed peripherally...
September 15, 2016: Journal of Clinical Apheresis
Tehsina F Devji, Arin L Madenci, Elizabeth Carpino, Izabela C Leahy, Mihail Samnaliev, Jennifer L Dearden, Brent R Weil, Christopher B Weldon, Joseph Cravero
PURPOSE: The current emphasis on fiscally responsible health spending in the era of the Affordable Care Act and other health care reform necessitates cost-conscious delivery of care. "Value" in health care is defined as the quality of care divided by the cost. As such, health systems optimize value by providing the most cost-effective care possible without sacrificing safety or outcomes. Elective, minimal risk surgical procedures in children may be value-enhanced by moving from an operating room (OR) to a more cost-efficient setting...
November 2016: Journal of Pediatric Surgery
Marlene Biermayr, Barbara Brunner, Kathrin Maurer, Rudolf Trawoeger, Ursula Kiechl-Kohlendorfer, Vera Neubauer
BACKGROUND: Thrombosis in neonates is commonly a central venous access device (CVAD) associated complication. Furthermore, a patent foramen ovale (PFO) is frequently seen in preterm infants. Even though a coincidence of both is not unusual, detaching of the thrombus and organisation of an aortic embolism has not been described until now. Treatment recommendations of CVAD-associated thrombosis in neonates do not consider frequently seen complications of preterm infants e.g. intraventricular haemorrhage...
2016: BMC Pediatrics
Stefano Avanzini, Leila Mameli, Nicola Disma, Clelia Zanaboni, Andrea Dato, Giovanni Montobbio, Luigi Montagnini, Michela Bevilacqua, Filomena Pierri, Massimo Conte, Loredana Amoroso, Giovanna Pala, Sara Pestarino, Elio Castagnola, Angelo Claudio Molinari, Concetta Micalizzi, Giuseppe Morreale, Girolamo Mattioli, A Pini Prato
BACKGROUND: Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children. METHODS: All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC...
August 31, 2016: Pediatric Blood & Cancer
A L Casey, T J Karpanen, P Nightingale, S Chaganti, T S J Elliott
The use of a positive-displacement needleless intravenous access device was associated with lower microbial contamination rates compared with a neutral-displacement device when used on central venous catheters in hemato-oncology patients. In addition, rates of central line-associated bloodstream infection did not differ when either device was used.
August 24, 2016: American Journal of Infection Control
Jessica C Roediger, Alexander C Outhred, Bruce Shadbolt, Philip N Britton
AIM: We aimed to describe the clinical epidemiology of Staphylococcus aureus bacteraemia (SAB) at a large, tertiary/quaternary children's hospital in Australia. METHODS: We performed a retrospective chart review of SAB cases at the Children's Hospital at Westmead (CHW) over 5 years; 2006-2011. We compared frequency, clinical profile and outcomes of SAB with published data from CHW; 1994-1998. We compared health-care associated with community-associated (HCA-SAB and CA-SAB; defined epidemiologically) and methicillin-resistant with methicillin susceptible S...
August 27, 2016: Journal of Paediatrics and Child Health
C M Rickard, M Edwards, A J Spooner, G Mihala, N Marsh, J Best, T Wendt, I Rapchuk, S Gabriel, B Thomson, A Corley, J F Fraser
PURPOSE: To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. MATERIALS AND METHODS: Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU; control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU)...
June 21, 2016: Journal of Critical Care
Yuehong Shen, Xin Ping Zhang, Feng Ge, Hui Huang, Li Li
BACKGROUND: The totally implantable port is a common central venous access device. The cost of implantation and maintenance however is very expensive. At present, the biggest problem regarding the promotion and the use of implantable ports in China is lack of well trained professional healthcare providers. Furthermore, maintenance of totally implantable ports by nurses is poor and patients may easily get complications. AIMS/OBJECTIVES: This project aimed to reduce the incidence of complications among general surgery patients with implantable ports, and improve healthcare safety and the care process, strictly in compliance with current evidence-based criteria...
April 2016: JBI Database of Systematic Reviews and Implementation Reports
Mauro Pittiruti, Sergio Bertoglio, Giancarlo Scoppettuolo, Roberto Biffi, Massimo Lamperti, Alberto Dal Molin, Nicola Panocchia, Nicola Petrosillo, Mario Venditti, Carla Rigo, Enrico DeLutio
BACKGROUND: The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT - the Italian group for venous access devices - has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters). METHOD: After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients...
August 1, 2016: Journal of Vascular Access
Julien Maizel, Marie-Anaïs Bastide, Jack Richecoeur, Eric Frenoy, Christian Lemaire, Bertrand Sauneuf, Hervé Dupont, Fabienne Tamion, Saad Nseir, Damien Du Cheyron
BACKGROUND: The ultrasound (US)-guided technique has been recommended for central venous catheter (CVC) placement in critical care. However, several surveys have shown that the majority of physicians continue to perform landmark procedures. In our region, we have implemented special courses to promote the use of US with formal training and simulators. Ultrasound machines have also been installed in almost every ICU in our area. We designed a survey to investigate whether the training program established for years and the widespread of ultrasound devices in the ICU of our region will be associated with a high rate of physicians performing US procedures...
December 2016: Annals of Intensive Care
Vinay Narasimha Krishna, Joseph B Eason, Michael Allon
Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS...
August 1, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mirela Mery, Stéphanie Palengat, Romaric Loffroy, Magali Vernet, Pascal Matet, Violaine Cherblanc
Distal embolization of a fractured indwelling central catheter is a rare complication. The pinch-off syndrome (POS) should be known, prevented and early detected. We present a case in which further radiological exams were required to find the fragmented catheter with an atypical migration, requiring local surgery for removing. After chest and abdominal CT scan, neck X-ray, and heart echography, the catheter was found on the lower limbs X-ray on the internal side of right knee corresponding to a location of saphenous vein...
June 2016: Quantitative Imaging in Medicine and Surgery
Daniel Z Adams, Andrew Little, Charles Vinsant, Sorabh Khandelwal
BACKGROUND: Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost...
September 2016: Journal of Emergency Medicine
Jenelle Izer, Ronald Wilson, Krista Hernon, Akif Ündar
OBJECTIVE: To describe an ultrasound-guided approach for venous and arterial vascular access and catheterization in anesthetized adult Yorkshire cross-bred pigs. STUDY DESIGN: Prospective experimental study. ANIMALS: Ten adult female Yorkshire cross-bred pigs, weighing 78.4 ± 5.6 kg (mean ± standard deviation). METHODS: Using 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...
July 4, 2016: Veterinary Anaesthesia and Analgesia
K Vepsäläinen, R Lassila, M Arola, P Huttunen, S Koskinen, R Ljung, P Lähteenmäki, M Möttönen, P Riikonen
INTRODUCTION: Currently the most serious treatment complication of haemophilia is the inhibitor development (ID), i.e. neutralizing antibody development. AIM: This nationwide multicentre study in Finland evaluated the incidence and risk factors of ID in previously untreated patients (PUPs) with severe haemophilia A (FVIII:C < 0.01 IU mL(-1) ). METHODS: We enrolled all PUPs (N = 62) born between June 1994 and May 2013 with at least 75 exposure days (EDs) to screen ID during follow-up extending to September 2013...
September 2016: Haemophilia: the Official Journal of the World Federation of Hemophilia
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