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Stroeder J, Multusch M, Berkel L, Hansen L, Saalbach A, Schulz H, Heinrich MP, Elser Y, Barkhausen J, Sieren MM. Optimizing Catheter Verification: An Understandable AI Model for Efficient Assessment of Central Venous Catheter Placement in Chest Radiography. Invest Radiol 2025; 60:267-274. [PMID: 39724590 DOI: 10.1097/rli.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
PURPOSE Accurate detection of central venous catheter (CVC) misplacement is crucial for patient safety and effective treatment. Existing artificial intelligence (AI) often grapple with the limitations of label inaccuracies and output interpretations that lack clinician-friendly comprehensibility. This study aims to introduce an approach that employs segmentation of support material and anatomy to enhance the precision and comprehensibility of CVC misplacement detection. MATERIALS AND METHODS The study utilized 2 datasets: the publicly accessible RANZCR CLiP dataset and a bespoke in-house dataset of 1006 annotated supine chest x-rays. Three deep learning models were trained: a classification network, a segmentation network, and a combination of both. These models were evaluated using receiver operating characteristic analysis, area under the curve, DICE similarity coefficient, and Hausdorff distance. RESULTS The combined model demonstrated superior performance with an area under the curve of 0.99 for correctly positioned CVCs and 0.95 for misplacements. The model maintained high efficacy even with reduced training data from the local dataset. Sensitivity and specificity rates were high, and the model effectively managed the segmentation and classification tasks, even in images with multiple CVCs and other support materials. CONCLUSIONS This study illustrates the potential of AI-based models in accurately and reliably determining CVC placement in chest x-rays. The proposed method shows high accuracy and offers improved interpretability, important for clinical decision-making. The findings also highlight the importance of dataset quality and diversity in training AI models for medical image analysis.
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Affiliation(s)
- Jonas Stroeder
- From the Department of Radiology and Nuclear Medicine, UKSH Lübeck, Lübeck, Germany (J.S., M.M., L.B., Y.E., J.B., M.M.S.); Institute of Medical Informatics, University of Lübeck, Lübeck, Germany (L.H., M.P.H.); Philips Research Hamburg, Hamburg, Germany (A.S., H.S.); and Institute of Interventional Radiology, UKSH Lübeck, Lübeck, Germany (M.M.S.)
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O'Mahony AT, Coffey A, O'Regan PW, Walsh E, Carey B, Ryan J, Dorney N, O'Connor OJ, Gleeson J, Power SP. Catheter Tip Migration in Female Patients With Breast Cancer: A Retrospective Comparative Study of Right- and Left-Sided Chest Ports. Breast J 2024; 2024:7358397. [PMID: 39742380 PMCID: PMC11681978 DOI: 10.1155/tbj/7358397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 11/26/2024] [Accepted: 12/09/2024] [Indexed: 01/03/2025]
Abstract
Introduction: Chest ports are typically inserted via the right internal jugular vein with the left side being utilized in certain patient populations. The purpose of this study was to evaluate the dynamic position of the chest port and catheter tip, comparing a demographically matched cohort of female breast cancer patients with right- or left-sided chest ports. Methods: 142 female patients with breast cancer requiring chest port insertion for chemotherapy and imaging confirming catheter tip position initially with supine fluoroscopy and follow-up with erect chest radiography over a 5-year period were identified. Data points analyzed were catheter tip-to-carina distance and the distance from the port to the ipsilateral infraclavicular border. Intraprocedural measurements were taken in the supine position during chest port insertion and compared with follow-up erect chest radiography. The catheter tip position was also allocated a zone within the venous system on both image sets to assess for significant retraction to a more proximal zone in the erect position. Imaging within 12-months of chest port insertion was also screened to identify port-related complications. Results: The whole cohort showed significant retraction of the catheter tip (cephalad) (p < 0.001) and protraction of the port (caudal) (p < 0.001). The median tip-to-carina distance decreased from 38.3 mm to 28.6 mm and the port-to-clavicle distance increased from 31.3 mm to 64.6 mm. Right-sided chest ports had increased tip-to-catheter retraction (15 mm) compared with left-sided (6.9 mm) (p=0.310). A complication was identified in 8.5% of the right-sided and 11% of the left-sided ports. Zone migration was significantly associated with the occurrence of a complication in left-sided ports (p=0.023). Conclusion: When assessing chest port catheter tip position between supine and erect radiographic studies in female patients with breast cancer, retraction cephalad will occur and this is more apparent in right-sided ports. Change in catheter tip position was not associated with a significant increase in complication rate unless it occurred in left-sided ports where zone migration was evident.
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Affiliation(s)
- Alexander T. O'Mahony
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Aidan Coffey
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Patrick W. O'Regan
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Emily Walsh
- Department of Medicine, School of Medicine, University College Cork, Cork, Ireland
| | - Brian Carey
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - James Ryan
- Department of Oncology, Cork University Hospital, Cork, Ireland
| | - Niamh Dorney
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Owen J. O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Jack Gleeson
- Department of Oncology, Cork University Hospital, Cork, Ireland
| | - Stephen P. Power
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Ito S, Maki Y, Hatsuda N. Malpositioning of a Central Venous Catheter in the Vertebral Vein Through the Cervical Transverse Foramen: A Case Report. Cureus 2024; 16:e76637. [PMID: 39886730 PMCID: PMC11779562 DOI: 10.7759/cureus.76637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2024] [Indexed: 02/01/2025] Open
Abstract
Central venous catheters (CVCs) are commonly used for multiple clinical purposes. The internal jugular vein (IJV) is preferred among the most frequently used insertion sites due to its higher success rates and lower complication risks. Although CVC placement is generally considered a safe procedure, several complications have been reported. Catheter malpositioning, one of the most common procedural complications, can lead to potentially fatal outcomes if not promptly addressed. Although catheter malpositioning is well-documented in various anatomical locations, accidental CVC cannulation of the vertebral vein is rare and has not been previously reported. We present a case of a 65-year-old man diagnosed with Guillain-Barré syndrome who underwent echo-guided CVC insertion into his right neck. The subsequent X-ray and CT scans revealed that the CVC insertion point was dorsolateral to the right sternocleidomastoid muscle. The catheter was passed dorsally to the right IJV and common carotid artery, passing through the C6 transverse foramen. The catheter's position raised concerns for potential complications, such as a vertebral arteriovenous fistula (AVF) or venous thromboembolism. Consequently, the CVC was removed after confirming the absence of AVF, bleeding, or thromboembolisms. This case is clinically significant, highlighting the potential for CVC malposition in the vertebral vein. It underscores the importance of careful monitoring during CVC insertion and removal, with particular attention to the potential for unexpected hemorrhagic events.
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Affiliation(s)
- Sayaka Ito
- Department of Neurosurgery, Kohka Public Hospital, Kohka, JPN
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Yoshinori Maki
- Department of Neurosurgery, Ayabe Renaiss Hospital, Ayabe, JPN
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
| | - Naoki Hatsuda
- Department of Neurosurgery, Kohka Public Hospital, Kohka, JPN
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Troubil M, Capozzoli G, Mussa B, Hodne M, Hoerauf K, Alsbrooks K. Performance and safety of PowerPICC catheters and accessories: a prospective observational study. BMJ Open 2024; 14:e081288. [PMID: 39349374 PMCID: PMC11448161 DOI: 10.1136/bmjopen-2023-081288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 08/16/2024] [Indexed: 10/02/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the safety and performance of PowerPICC catheters in a real-world setting. DESIGN Prospective, observational, multicentre study. SETTING Nine European countries, involving 14 centres. PARTICIPANTS General patient population. INTERVENTION PowerPICC catheter inserted by the clinician as standard of care with routinely collected outcomes followed through device removal or 180 days postinsertion. PRIMARY AND SECONDARY OUTCOMES MEASURES Safety and performance outcomes were assessed for PowerPICC, PowerPICC SOLO 2 and PowerGroshong PICC. The primary safety endpoint was the incidence of symptomatic venous thrombosis (VT), and secondary safety endpoints included phlebitis, extravasation, vessel laceration, vessel perforation local infection, accidental dislodgment and catheter-related bloodstream infection (CRBSI). The primary performance endpoint was the percentage of patients whose PowerPICC device remained in place through the completion of therapy. The secondary performance endpoints included catheter patency, placement success in a single attempt and usability. RESULTS The enrolled patients (N=451) received either PowerPICC, PowerPICC SOLO 2 or PowerGroshong PICC catheters. Across all devices, 1.6% of patients developed symptomatic VT, and CRBSI occurred in 1.6% of patients. There were no cases of phlebitis or extravasation and only three cases of vein laceration or vein perforation. The catheters showed high success rates in completing therapy (81.8%), maintaining patency (93.9%) and achieving successful placement in a single attempt (90.4%). Clinicians overwhelmingly agreed that both the guidewire and stylet (93.3% and 94.4%, respectively) were easy or very easy to use. CONCLUSIONS This study demonstrates the safety and performance of PowerPICC catheters across diverse settings and patient cohorts in real-world hospital settings across Europe. The findings indicate that these catheters are safe and can be effectively used in the general patient setting and when inserted by a variety of clinicians. The low incidence of complications and high success rates further support the clinical utility of these catheters. TRIAL REGISTRATION NUMBER NCT04263649.
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Affiliation(s)
| | | | | | - Melinda Hodne
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Klaus Hoerauf
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
- Medical University of Vienna, Vienna, Austria
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Hurt RT, Mohamed Elfadil O, Edakkanambeth Varayil J, Bonnes SL, Salonen BR, Mundi MS. Optimizing Intravenous Access for Long-Term Parenteral Nutrition. Curr Nutr Rep 2024; 13:323-330. [PMID: 38696073 DOI: 10.1007/s13668-024-00534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Securing safe and effective intravenous (IV) access is of utmost importance for administering parenteral nutrition (PN). Sustaining this access can indeed pose challenges, especially when dealing with the risk of complications associated with long-term PN. This review emphasizes best practices to optimize intravenous access and reviews the current evidence-based recommendations and consensus guidelines. RECENT FINDINGS An individualized approach when selecting central venous catheters (CVC) is recommended, considering the estimated duration of need for IV access and the number of lumens needed. Established and novel approaches to minimize complications, including infection and thrombosis, are recognized. These include placement and positioning of the catheter tip under sonographic guidance and the use of antimicrobial lock therapies. Moreover, when possible, salvaging CVCs can reduce the risk of vascular access loss. CVC selection for patients requiring PN depends on several factors. Carefully reviewing an individual patient's clinical characteristics and discussing options is important. Given the increased infection risk, CVC lumens should be minimized. For long-term PN beyond 6 months, using CVCs with skin barriers and larger diameters should be considered.
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Affiliation(s)
- Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA.
- Program Director, Home Parenteral Nutrition Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | | | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Bischoff SC, Arends J, Decker-Baumann C, Hütterer E, Koch S, Mühlebach S, Roetzer I, Schneider A, Seipt C, Simanek R, Stanga Z. S3-Leitlinie Heimenterale und heimparenterale Ernährung der Deutschen
Gesellschaft für Ernährungsmedizin (DGEM). AKTUELLE ERNÄHRUNGSMEDIZIN 2024; 49:73-155. [DOI: 10.1055/a-2270-7667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
ZusammenfassungMedizinische Ernährungstherapie, die enterale und parenterale Ernährung umfasst,
ist ein wesentlicher Teil der Ernährungstherapie. Medizinische
Ernährungstherapie beschränkt sich nicht auf die Krankenhausbehandlung, sondern
kann effektiv und sicher auch zu Hause eingesetzt werden. Dadurch hat sich der
Stellenwert der Medizinischen Ernährungstherapie deutlich erhöht und ist zu
einem wichtigen Bestandteil der Therapie vieler chronischer Erkrankungen
geworden. Für Menschen mit chronischem Darmversagen, z. B. wegen Kurzdarmsyndrom
ist die Medizinische Ernährungstherapie sogar lebensrettend. In der Leitlinie
wird die Evidenz für die Medizinische Ernährungstherapie in 161 Empfehlungen
dargestellt. Die Leitlinie wendet sich in erster Linie an Ärzte,
Ernährungsfachkräfte und Pflegekräfte, sie dient der Information für
Pharmazeuten und anderes Fachpersonal, kann aber auch für den interessierten
Laien hilfreich sein.
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Affiliation(s)
- Stephan C. Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart,
Deutschland
| | - Jann Arends
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg,
Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg,
Deutschland
| | - Christiane Decker-Baumann
- Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum
Heidelberg, Heidelberg, Deutschland
| | - Elisabeth Hütterer
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin I,
Wien, Österreich
| | - Sebastian Koch
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie
Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin,
Deutschland
| | - Stefan Mühlebach
- Universität Basel, Institut für Klinische Pharmazie & Epidemiologe,
Spitalpharmazie, Basel, Schweiz
| | - Ingeborg Roetzer
- Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum
Heidelberg, Heidelberg, Deutschland
- Klinik für Hämatologie und Onkologie, Krankenhaus Nordwest, Frankfurt
am Main, Deutschland
| | - Andrea Schneider
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie,
Hepatologie, Infektiologie und Endokrinologie, Hannover,
Deutschland
| | - Claudia Seipt
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie,
Hepatologie, Infektiologie und Endokrinologie, Hannover,
Deutschland
| | - Ralph Simanek
- Gesundheitszentrum Floridsdorf der Österreichischen Gesundheitskasse,
Hämatologische Ambulanz, Wien, Österreich
| | - Zeno Stanga
- Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin
und Metabolismus, Inselspital, Universitätsspital Bern und Universität Bern,
Bern, Schweiz
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Pittiruti M, Bilancia A, Ortiz Miluy G, D'Arrigo S. A comparison between two radiological criteria for verifying tip location of central venous catheters. J Vasc Access 2024; 25:551-556. [PMID: 36203365 DOI: 10.1177/11297298221126818] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Current guidelines recommend intraprocedural methods-such as Intra-Cavitary ECG (IC-ECG) and echocardiography-for verifying the location of the tip of central venous catheters. Nonetheless, there are clinical conditions which may require to verify tip location by less accurate methods such as Chest X-Ray (CXR). We have compared the feasibility and accuracy of two radiological methods for tip location-the Sweet Spot Criterion (SSC) and the Carina Criterion (CC)-using IC-ECG as reference. METHODS In this retrospective multicenter study, we reviewed the radiology databases of three hospitals, examining all CXRs performed on patients after insertion of Peripherally Inserted Central Catheters (PICCs), as long as the tip location had been successfully performed during the procedure by IC-ECG. Tip location was verified using SSC and CC, comparing the two methods in terms of feasibility and accuracy. RESULTS We reviewed the CXR of 1116 PICCs successfully inserted by IC-ECG. CC was not feasible in 0.5% (impossible visualization of the carina) and difficult in 1.5%; in 97.7% of cases, the position of the tip was adequate (1-5 cm below the carina), in 0.6% too high (<1 cm), in 1.2% too low (6-9 cm). On the other hand, because of unclear visualization of radiological landmarks, SSC was not feasible in 0.9% and difficult in 10.5%; though, according to SSC the tip location was always acceptable (in 94.2% the tip was in the middle of the spot, in 2.5% close to the superior border, and in 2.3% close to the inferior border); no tip was visualized outside of the spot. CONCLUSION CC and SSC were similar in terms of feasibility (99.5% vs 99.1%) and accuracy (98.1% vs 100%), though CC was subjectively perceived to be easier and more rapid to perform.
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Affiliation(s)
- Mauro Pittiruti
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | | | - Sonia D'Arrigo
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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Park H, Seo TS, Song MG, Yang WJ. Feasibility and Safety of a Technique Intended to Place the Catheter Tip in the Right Atrium without Abutment Against the Cardiac Wall during Implantation of the Totally Implantable Venous Access Port. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:161-170. [PMID: 38362390 PMCID: PMC10864156 DOI: 10.3348/jksr.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 02/17/2024]
Abstract
Purpose To assess the safety and feasibility of intentionally positioning the catheter tip in the right atrium (RA) without an abutment during implantation of a totally implantable venous access port (TIVAP). Materials and Methods We enrolled 330 patients who had undergone TIVAP implantation between January and December 2016 and postoperative chest CT. The TIVAP was placed using the single-incision technique to access the axillary vein directly from the incision line. To position the catheter tip in the RA without abutment, blood return was checked before cutting. Catheter length and complications were evaluated by retrospectively reviewing medical images and records. Results All patients achieved successful catheter tip positioning without abutment or dysfunction. The median tip position was 15.3 mm distal to the cavoatrial junction (CAJ) on fluoroscopy and 6 mm distal to the CAJ on CT. Catheter tips migrated a median of 10.4 mm cephalically on CT compared to fluoroscopy. Thromboses were detected in the RA and superior vena cava in one patient each. Conclusion Intentional catheter tip positioning in the RA without abutment is a safe and feasible technique with a low incidence of thrombosis and no observed dysfunction.
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Yeh TC, Chen CM, Cheng CH, Sheu CC, Tsai MJ, Chang WA. A modified method for measuring the length of peripherally inserted central catheters to reduce the risk of malposition during catheter insertion. SAGE Open Med 2023; 11:20503121231204488. [PMID: 37829287 PMCID: PMC10566264 DOI: 10.1177/20503121231204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Background Malposition may occur during peripherally inserted central catheter insertion. Accurately measuring the length of a peripherally inserted central catheter is crucial to preventing malposition, including "long peripherally inserted central catheter placement," in which the tip of a peripherally inserted central catheter is deeper than the target position. The traditional method of measuring peripherally inserted central catheter length involves measuring from the insertion site to the parasternal notch and down to the third or fourth intercostal space, which may result in overestimation because of the thickness of the pectoralis major and anterior chest wall. To avoid this overestimation, the authors developed and tested a modified method for reducing long peripherally inserted central catheter placement. Methods This study employed a retrospective design. Chest X-rays were used to examine the peripherally inserted central catheter tip positions in 48 patients in the medical intensive care unit who had undergone peripherally inserted central catheter insertion. The traditional and modified measurement methods were used to measure the peripherally inserted central catheter length in 17 and 31 patients, respectively. Fisher's exact test was used to examine between-group differences in the incidence of different types of peripherally inserted central catheter malposition. Results The peripherally inserted central catheter tip position was near the target position in five patients (29.41%) in the traditional measurement group and 17 patients (54.84%) in the modified measurement group (p = 0.132), whereas long peripherally inserted central catheter placement occurred in six patients (35.29%) in the traditional measurement group and one patient (3.23%) in the modified measurement group (p = 0.006). However, the incidence of other types of peripherally inserted central catheter malposition did not differ significantly between the groups. Conclusions The results of this study that the proposed modified measurement method may be able to reduce the incidence of long peripherally inserted central catheter placement among medical intensive care unit patients. The method must be further evaluated in prospective studies and studies with larger sample sizes in the future.
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Affiliation(s)
- Tung-Chi Yeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chih-Hung Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Wei-An Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
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Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr 2023; 42:411-430. [PMID: 36796121 DOI: 10.1016/j.clnu.2022.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion catheter and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Loris Pironi
- University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS AOUBO, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Kurt Boeykens
- Vitaz Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, University of Paris VII, Clichy, France
| | - Stanislaw Klek
- Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland
| | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), UK
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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12
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Classification of Central Venous Catheter Tip Position on Chest X-ray Using Artificial Intelligence. J Pers Med 2022; 12:jpm12101637. [PMID: 36294776 PMCID: PMC9605589 DOI: 10.3390/jpm12101637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Recent studies utilizing deep convolutional neural networks (CNN) have described the central venous catheter (CVC) on chest radiography images. However, there have been no studies for the classification of the CVC tip position with a definite criterion on the chest radiograph. This study aimed to develop an algorithm for the automatic classification of proper depth with the application of automatic segmentation of the trachea and the CVC on chest radiographs using a deep CNN. This was a retrospective study that used plain chest supine anteroposterior radiographs. The trachea and CVC were segmented on images and three labels (shallow, proper, and deep position) were assigned based on the vertical distance between the tracheal carina and CVC tip. We used a two-stage approach model for the automatic segmentation of the trachea and CVC with U-net++ and automatic classification of CVC placement with EfficientNet B4. The primary outcome was a successful three-label classification through five-fold validations with segmented images and a test with segmentation-free images. Of a total of 808 images, 207 images were manually segmented and the overall accuracy of the five-fold validation for the classification of three-class labels (mean (SD)) of five-fold validation was 0.76 (0.03). In the test for classification with 601 segmentation-free images, the average accuracy, precision, recall, and F1-score were 0.82, 0.73, 0.73, and 0.73, respectively. We achieved the highest accuracy value of 0.91 in the shallow position label, while the highest F1-score was 0.82 in the deep position label. A deep CNN can achieve a comparative performance in the classification of the CVC position based on the distance from the carina to the CVC tip as well as automatic segmentation of the trachea and CVC on plain chest radiographs.
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13
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Cho S. Peripherally inserted central catheter procedure at the bedside by a nephrologist is safe and successful. Kidney Res Clin Pract 2021; 40:153-161. [PMID: 33789388 PMCID: PMC8041643 DOI: 10.23876/j.krcp.20.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/13/2020] [Indexed: 11/21/2022] Open
Abstract
Background Peripherally inserted central catheter (PICC) use among critically ill patients with or without acute kidney injury (AKI) has gradually increased. Ultrasound-guided bedside PICC insertion in intensive care units (ICU) has been reported to be safe and effective. Reports of PICC insertion by a nephrologist without fluoroscopy, however, are relatively rare. Methods This retrospective study included patients (n = 224) who had a PICC inserted by a single nephrologist at Samsung Changwon Hospital from January 2019 to June 2020. Group 1 patients (n = 98) had PICCs inserted under ultrasound guidance, while group 2 patients (n = 126) had PICCs inserted under fluoroscopic guidance. Success rates, multiple puncture rates, and malposition rates were compared between the two groups. Results Underlying comorbidities (sepsis, AKI, ventilator use, and shock) were more common in group 1 than in group 2. Success rates were comparable between the two groups (93.9% vs. 97.6%, p = 0.171). Multiple puncture rate among successful cases (4.1% vs. 0.0%, p = 0.035) was higher in group 1 than group 2. Excluding central vein occlusion cases, malposition occurred only one in group 1. Conclusion Bedside PICC insertion by a nephrologist is easy and safe to perform in comorbid patients who are difficult to move to the angiography room. The success rate of ultrasound-guided PICC insertions was comparable to that of PICC insertion performed under fluoroscopic guidance. In the life-threatening ICU setting, PICCs can be successfully placed by the interventional nephrologists.
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Affiliation(s)
- Seong Cho
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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14
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Koyuncu S, Herdem N, Uysal C, Kahriman G, Kocyigit I, Sipahioğlu M, Tokgoz B, Oymak O. A rare complication following internal jugular vein catheterization to malposition: acute Budd Chiari syndrome. BMC Nephrol 2020; 21:525. [PMID: 33272229 PMCID: PMC7713328 DOI: 10.1186/s12882-020-02182-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2025] Open
Abstract
Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.
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Affiliation(s)
- Sumeyra Koyuncu
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Nevzat Herdem
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Cihan Uysal
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Guven Kahriman
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ismail Kocyigit
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murat Sipahioğlu
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bulent Tokgoz
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Oktay Oymak
- Department of Internal Medicine, Division of Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
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15
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Sosa Barrios RH, Lefroy D, Ashby D, Duncan N. Central venous catheters and arrhythmia: Two unusual cases. J Vasc Access 2020; 22:319-321. [PMID: 32339060 DOI: 10.1177/1129729820915326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Jugular Tesio lines (TesioCaths; MedCOMP, Harleysville, PA, USA) are frequently used as permanent vascular accesses in haemodialysis patients. During the insertion procedure, arrhythmias are a relatively common complication, usually related to an excessively advanced catheter tip, without major consequences. We present two cases of life-threatening arrhythmias triggered by the Tesio catheter eccentric high-velocity jet of blood resolved after reposition of the catheter without further episodes, despite both lines being inserted under real-time ultrasound and fluoroscopic guidance. We believe dialysis lines should be checked for tip position even when long-standing to prevent relevant complications due to catheter sliding.
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Affiliation(s)
| | - David Lefroy
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Damien Ashby
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Neill Duncan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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16
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Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN guideline on home parenteral nutrition. Clin Nutr 2020; 39:1645-1666. [PMID: 32359933 DOI: 10.1016/j.clnu.2020.03.005] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Kurt Boeykens
- AZ Nikolaas Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, Clichy, University of Paris VII, France
| | | | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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17
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Kwon S, Son SM, Lee SH, Kim JH, Kim H, Kim JY, Kim JI, Moon IS. Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution. Acute Crit Care 2020; 35:31-37. [PMID: 32131579 PMCID: PMC7056959 DOI: 10.4266/acc.2019.00731] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bedside insertion of peripherally inserted central catheters (PICCs) has higher rates of malposition than fluoroscopic-guided PICC placement. This study evaluated the success rate of bedside PICC placement, variations in tip location, and risk factors for malposition. METHODS This retrospective study included patients who underwent bedside PICC placement from January 2013 to September 2014 in a single institution. The procedure was conducted under ultrasound guidance or by a blind method. After PICC placement, tip location was determined by chest X-ray. RESULTS The overall venous access success rate with bedside PICC placement was 98.1% (1,302/ 1,327). There was no significant difference in the venous access success rate between ultrasound-guided placement (868/880, 98.6%) and a blind approach placement (434/447, 97.1%). Optimal tip position was achieved on the first attempt in 1,192 cases (91.6%). Repositioning was attempted in 65 patients; 60 PICCs were repositioned at the bedside, two PICCs were repositioned under fluoroscopic guidance, and three PICCs moved to the desired position without intervention. Final optimal tip position after repositioning was achieved in 1,229 (94.4%). In logistic regression analysis, five factors associated with tip malposition included female sex (Exp(B), 1.687; 95% confidence interval [CI], 1.180 to 2.412; P=0.004), older age (Exp(B), 1.026; 95% CI, 1.012 to 1.039; P<0.001), cancer (Exp(B), 0.650; 95% CI, 0.455 to 0.929; P=0.018), lung disease (Exp(B), 2.416; 95% CI, 1.592 to 3.666; P<0.001), and previous catheter insertions (Exp(B), 1.262; 95% CI, 1.126 to 1.414; P<0.001). CONCLUSIONS Bedside PICC placement without fluoroscopy is effective and safe in central venous catheters. Potential risk factors associated with catheter tip malposition include older age, female sex, cancer, pulmonary disease, and previous central vein catheterizations.
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Affiliation(s)
- Sukyung Kwon
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Mi Son
- Division of Vascular and Transplant Surgery, Department of Nursing, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seul Hee Lee
- Division of Vascular and Transplant Surgery, Department of Nursing, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joung Hee Kim
- Division of Vascular and Transplant Surgery, Department of Nursing, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyangkyoung Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - In Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Yu Y, Yuan L. The electrocardiographic method for positioning the tip of central venous access device. J Vasc Access 2019; 21:589-595. [PMID: 31512961 DOI: 10.1177/1129729819874986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The electrocardiogram-based insertion method is non-radiative, allowing real-time positioning verification and reducing the need for postoperative repositioning. METHODS Relevant databases published from January 1990 to January 2019 in PubMed, Web of Knowledge, Medline and Ovid's database were searched, comparing the effectiveness of electrocardiogram-guided catheter tip positioning (electrocardiogram-guided group) and the landmarks-guided insertion plus chest X-ray confirmation (landmarks-guided group). The primary outcome was accurate catheter tip placement and the secondary outcomes were complications. RESULTS A total of 13 studies were finally included with a total of 4988 patients, of whom 2789 cases were in the electrocardiogram-guided group and 2199 cases received landmarks-guided insertion plus chest X-ray. Compared with the landmarks-guided group, our meta-analysis showed that the electrocardiogram-guided group had a higher success rate of tip placement (odds ratio = 0.21, 95% confidence interval = 0.14-0.34, p < 0.00001) and fewer total complications (odds ratio = 0.10, 95% confidence interval = 0.04-0.23, p < 0.000001). CONCLUSION Based on our findings, electrocardiogram-guided tip placement for central venous access device was more accurate and safer than landmarks-guided positioning, which may be considered as an alternative method to the standard radiological control of tip placement.
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Affiliation(s)
- Yanfen Yu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Lingling Yuan
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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19
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Moureau NL, Carr PJ. Vessel Health and Preservation: a model and clinical pathway for using vascular access devices. ACTA ACUST UNITED AC 2019; 27:S28-S35. [PMID: 29683752 DOI: 10.12968/bjon.2018.27.8.s28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of intravenous devices for the delivery of medical treatment spans all healthcare facilities ranging from hospitals to clinics and home care. Clinical pathways are processes used by healthcare providers to integrate and illustrate the best evidence and approach to care for a specific area of practice. The Vessel Health and Preservation (VHP) model is a framework and pathway process, consisting of four quadrants, to guide initiation and management of treatment requiring intravenous access. The pathway is designed to promote preservation of the vasculature of patients from admission through discharge with a focus on acute care. This article describes the model and pathway process. Moving through the quadrants of assessment/selection, insertion, management and evaluation of outcomes the clinician receives vascular access education to establish an understanding of the key principles and is then better able to provide care to the patient. Research on the VHP model has found that patients, clinicians and healthcare facilities benefit from the evidence integrated within the VHP model for improved outcomes, greater success with insertion, time saved through improved efficiency, risk reduced through appropriate device discontinuation, and greater patient satisfaction.
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Affiliation(s)
- Nancy L Moureau
- Chief Executive Officer, PICC Excellence Inc, Hartwell, Georgia, and Vascular Access Specialist, Greenville Memorial Hospital, South Carolina, USA, and Adjunct Associate Professor and member of Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia
| | - Peter J Carr
- Lecturer/Researcher, Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Australia
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20
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Ling G, Zhiwen W, Guorong W, Shaomei S, Xue W. Guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheterization in adults: A systematic review and meta-analysis. J Vasc Access 2019; 21:564-572. [PMID: 31422729 DOI: 10.1177/1129729819868044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM To assess the effectiveness and safety of guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheter placement in adults. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched the main electronic databases (Cochrane Library, the Joanna Briggs Institute Library, Embase, PubMed, CINAHL, China National Knowledge Infrastructure, and Wanfang) with articles published from inception up to March 2018. References of important articles were also screened for relevant studies. We used a structured search strategy and did not apply any search limitations. REVIEW METHODS Randomized, controlled trials, quasi-experimental studies or studies using a within-subject design, evaluating guide wire electrode versus liquid electrode for intravascular electrocardiography-guided central venous catheter placement in adults, were eligible for inclusion. Risk of bias assessment was performed using the Cochrane Collaboration's tool and meta-analysis was performed using RevMan 5.3. RESULTS In total, six studies with a total of 2176 participants were included. Meta-analysis showed that there was no statistically significant difference in accuracy of tip location placement between guide wire and liquid electrodes. Use of guide wire electrode had a higher risk of complications which were transient and there were an insufficient number of studies using the same parameters to evaluate intravascular electrocardiography signal quality. CONCLUSION Due to the small number and low quality of identified studies, it is difficult to draw definitive conclusions on the relative effectiveness and safety of guide wire versus liquid electrodes for the placement of central venous catheters in adults. More well-designed studies are needed in the future.
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Affiliation(s)
- Guo Ling
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wang Zhiwen
- Peking University School of Nursing, Beijing, China.,Evidence-Based Nursing Center, Peking University Health Science Center, Beijing, China
| | - Wang Guorong
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shang Shaomei
- Peking University School of Nursing, Beijing, China.,Evidence-Based Nursing Center, Peking University Health Science Center, Beijing, China
| | - Wu Xue
- Peking University School of Nursing, Beijing, China.,Evidence-Based Nursing Center, Peking University Health Science Center, Beijing, China
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21
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Rocky Versus Drago, Luke Versus Vader…Chest Radiograph Versus Ultrasound? Crit Care Med 2019. [PMID: 28622222 DOI: 10.1097/ccm.0000000000002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Kim HJ, Jung CY, Bae JM. Clinical Characteristics of Peripherally Inserted Central Catheter in Critically Ill Patients. JOURNAL OF ACUTE CARE SURGERY 2019. [DOI: 10.17479/jacs.2019.9.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyoung-Joo Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Chang-Yeon Jung
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jung-Min Bae
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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23
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Calabrese M, Montini L, Arlotta G, La Greca A, Biasucci DG, Bevilacqua F, Antoniucci E, Scapigliati A, Cavaliere F, Pittiruti M. A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients. J Vasc Access 2018; 20:516-523. [DOI: 10.1177/1129729818819422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction:The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable P wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called f waves as a surrogate of the P wave.Methods:We studied 18 atrial fibrillation patients requiring simultaneously a central venous catheter and a trans-esophageal echocardiography. An intracavitary electrocardiographic trace was recorded with the catheter tip in three different positions defined by trans-esophageal echocardiography imaging: in the superior vena cava, 2 cm above the cavo-atrial junction; at the cavo-atrial junction; and in the right atrium, 2 cm below the cavo-atrial junction. Three different criteria of measurement of the f wave pattern in the TQ tract were used: the mean height of f waves (method A); the height of the highest f wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).Results:There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the f waves was significantly higher than in the other two positions. All three methods were effective in discriminating the tip position at the cavo-atrial junction, though method B proved to be the most accurate.Conclusion:A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the f waves is an accurate indicator of the location of the tip at the cavo-atrial junction.
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Affiliation(s)
- Maria Calabrese
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Montini
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Arlotta
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio La Greca
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniele G Biasucci
- Department of Intensive Care and Anesthesia, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bevilacqua
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrica Antoniucci
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Scapigliati
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Cavaliere
- Department of Cardiovascular Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, “A. Gemelli” University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy
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24
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Ahn JH, Kim IS, Yang JH, Lee IG, Seo DH, Kim SP. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres' formula or a radiological landmark-based approach: a prospective randomized single-centre study. Br J Anaesth 2018; 118:215-222. [PMID: 28100525 DOI: 10.1093/bja/aew430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lower superior vena cava (SVC), near its junction with the right atrium (RA), is considered the ideal location for the central venous catheter tip to ensure proper function and prevent injuries. We determined catheter insertion depth with a new formula using the sternoclavicular joint and the carina as radiological landmarks, with a 1.5 cm safety margin. The accuracy of tip positioning with the radiological landmark-based technique (R) and Peres' formula (P) was compared using transoesophageal echocardiography. METHODS Real-time ultrasound-guided central venous catheter insertion was done through the right internal jugular or subclavian vein. Patients were randomly assigned to either the P group (n=93) or the R group (n=95). Optimal catheter tip position was considered to be within 2 cm above and 1 cm below the RA-SVC junction. Catheter tip position, abutment, angle to the vascular wall, and flow stream were evaluated on a bicaval view. RESULTS The distance from the skin insertion point to the RA-SVC junction and determined depth of catheter insertion were more strongly correlated in the R group [17.4 (1.2) and 16.7 (1.5) cm; r=0.821, P<0.001] than in the P group [17.3 (1.2) and 16.4 (1.1) cm; r=0.517, P<0.001], with z=3.96 (P<0.001). More tips were correctly positioned in the R group than in the P group (74 vs 93%, P=0.001). Abutment, tip angle to the lateral wall >40°, and disrupted flow stream were comparable. CONCLUSIONS Catheter tip position was more accurate with a radiological landmark-based technique than with Peres' formula. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp KCT0001937.
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Affiliation(s)
- J H Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Woncheon-Dong, Yeongtong-Gu, Suwon, Gyeonggi-Do 443-721, Republic of Korea
| | - I S Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - J H Yang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - I G Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - D H Seo
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 150 Sungan-ro, Gangdong-gu, Seoul 134-701, Republic of Korea
| | - S P Kim
- Department of Cardiovascular Surgery, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Republic of Korea
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Makary MS, Lionberg A, Khayat M, Lustberg MB, AlTaani J, Pan XJ, Layman RR, Raman SV, Layman RM, Dowell JD. Advanced stage breast cancer is associated with catheter-tip thrombus formation following implantable central venous port placement. Phlebology 2018; 34:107-114. [PMID: 29771187 DOI: 10.1177/0268355518774442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Catheter-tip associated thrombosis is not uncommon in patients with implantable central venous ports; however, the prevalence and clinical impact of this complication on patient management is unclear. This study aims to identify risk factors for thrombus formation in a large population receiving serial echocardiograms (echo) following port placement. METHODS A total of 396 female breast cancer patients underwent internal jugular vein chest port placement between 2007 and 2013 and received echo studies every third month. Catheter tip position was measured from chest radiography and catheter associated thrombus was identified by echo. RESULTS Sixteen out of 396 patients (4%) had catheter-tip thrombus. No patients were symptomatic or prophylactically anticoagulated. Patients with thrombus were significantly younger than those without (46.4 years versus 53.4 years, respectively, p = 0.02) and had higher stage breast cancer with 75% versus 44.7% having stage III or IV cancer ( p = 0.017). Thrombus was identified after a median of 91 days. No significant difference was identified in anatomic ( p = 0.1) or measured ( p = 0.15) tip position, port laterality ( p = 0.86), or number of port lumens ( p = 0.65). CONCLUSIONS In this large cohort, younger patients and those with more advanced stage breast cancer were more associated with catheter-tip-related thrombus after port placement.
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Affiliation(s)
- Mina S Makary
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Lionberg
- 2 Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
| | - Mamdouh Khayat
- 3 Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryam B Lustberg
- 4 Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jamal AlTaani
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xueliang J Pan
- 5 Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard R Layman
- 6 Division of Diagnostic Imaging, Department of Imaging Physics, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Subha V Raman
- 7 Division of Cardiovascular Medicine, Department of Internal Medicine, Richard R. Ross Heart Hospital and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel M Layman
- 8 Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joshua D Dowell
- 1 Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,9 Northwest Radiology, St. Vincent Health, Indianapolis, IN, USA
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Nakamuta S, Nishizawa T, Matsuhashi S, Shimizu A, Uraoka T, Yamamoto M. Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy. J Vasc Access 2018; 19:609-614. [DOI: 10.1177/1129729818765057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.
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Affiliation(s)
- Soshi Nakamuta
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Cardiology, JCHO Tokyo Takanawa Hospital, Tokyo, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | - Arata Shimizu
- Division of Cardiology, JCHO Tokyo Takanawa Hospital, Tokyo, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masato Yamamoto
- Division of Cardiology, JCHO Tokyo Takanawa Hospital, Tokyo, Japan
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Desruennes E, Gomas F. [Central venous access for cancer chemotherapy]. Presse Med 2018; 47:320-330. [PMID: 29567048 DOI: 10.1016/j.lpm.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 11/28/2022] Open
Abstract
The tip of a long term central venous access should be located at the junction of the superior vena cava with the right atrium in order to reduce the incidence of dysfunction and venous thromboses. Picc-lines have their place for treatments of less than 6 months with obvious advantages in terms of discretion and comfort. Long-term sequential chemotherapy is an indisputable indication of an implantable port, while long-term parenteral nutrition is an indication of a tunneled cuffed catheter. In case of mediastinal compression, the risk-benefit ratio favors femoral access. Catheter related venous thrombosis or infection do not necessarily require the withdrawal of the device. A device that is no longer used should be removed when the likelihood of recurrence of the disease is low or too far.
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Affiliation(s)
- Eric Desruennes
- Gustave Roussy Cancer Campus, département d'anesthésie, rue Édouard-Vaillant, 94800 Villejuif, France; CHRU, hôpital Jeanne-de-Flandre, clinique d'anesthésie pédiatrique, avenue Eugène-Avinée, 59000 Lille, France.
| | - Frédéric Gomas
- Gustave Roussy Cancer Campus, département d'anesthésie, rue Édouard-Vaillant, 94800 Villejuif, France
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28
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Biffi R, Pittiruti M, Gillet JP, Fobe D, Hermanne JP, Pescio M, Gourlia A, Collet K, Battelli C, Cenciarelli S. Valved Central Venous Catheter Connected to Subcutaneous Port: A Multicenter Phase IV Study Based on a Cohort of 50 Oncology Patients. J Vasc Access 2018; 3:147-53. [PMID: 17639477 DOI: 10.1177/112972980200300403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Since technical aspects and clinical features of central venous valved catheters are far from being completely understood, a multinational group of investigators has decided to assess a new distally-valved catheter connected to a port, in the clinical setting of oncology patients undergoing chemotherapy, in an attempt to verify its safety and viability, while also investigating its practical features. Methods Our project was structured as a phase IV multicenter study. Hospitalized adults (ages 18–80 years) who had solid tumors and were candidate for intravenous chemotherapy met the criteria to enter the study. One single type of port was used (made of titanium, plastic and silicone) connected to a silicone, distally valved catheter (as manufactured by B. Braun Aesculap). A case report form was provided for each treated case; all relevant data regarding implantation and follow-up were entered into the form, mailed to a coordinating center (G. Chevillon, B. Braun Medical, France) and stored in a software database for statistical analysis. Results 50 patients (from 6 participating centers) were included in this study. No major complications occurred at insertion. The most frequent clinical problem during follow-up was inability to draw blood samples (9% during the first chemotherapy cycle; 8% after the second cycle); blood obtained from the device was defined “unsuitable for hematology test” in 9% of the cases at first chemotherapy cycle and in 23% of the cases after the second cycle. No catheter obstruction occurred. Conclusion The distally valved catheter port tested in this study was reliable, safe and practical for long-term treatment of an oncology patients’ population undergoing chemotherapy. As most other reports and clinical trials dealing with other types of distally valved catheters pointed out, inability to draw viable blood samples (so called withdrawal occlusion) is a major concern in their clinical use. Mechanisms underlying this technical problem are still unclear.
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Affiliation(s)
- R Biffi
- Division of General Surgery, European Institute of Oncology, Milano - Italy
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29
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Transitioning from anatomic landmarks to ultrasound guided central venous catheterizations: guidelines applied to clinical practice. J Vasc Access 2017; 18:328-333. [DOI: 10.5301/jva.5000756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Centrally inserted central catheter (CICC) insertion is a commonly performed procedure that may give rise to different complications. Despite the suggestion of guidelines to use ultrasound guidance (USG) for vascular access, not all centers use it systematically. The aim of this study is to illustrate the experience with ultrasound in CICC placement at a high-volume oncological center, in a country where the landmark technique is standard. Methods Retrospective analysis of a prospective database was performed on CICC placement under USG in the Central Venous Catheter Unit of Instituto Português de Oncologia de Lisboa Francisco Gentil, from 2012 to 2015. Results Three thousand five hundred and seventy-two procedures were recorded. From 2728 CICC placements, 1187 (43.5%) were done using USG. The majority of CICC placements were successful without immediate complications (96.1%). In 55 cases (4.6%), more than three attempts were necessary to puncture the vein. Pneumothorax occurred in 5 cases (0.4%) and arterial puncture was registered in 41 cases (3.5%). An increasing use of USG for placing CICCs was planned and observed over the years and, in the last year of the study, 67.3% of the CICC placements were with USG. Conclusions CICC placement with USG is a safe and effective technique. Despite some resistance that is observed, these results support that it is worth following the guidelines that advocate the use of the USG in the placement of CICC.
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Tomaszewski KJ, Ferko N, Hollmann SS, Eng SC, Richard HM, Rowe L, Sproule S. Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:115-125. [PMID: 28223832 PMCID: PMC5304969 DOI: 10.2147/ceor.s121230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The Sherlock 3CG™ Tip Confirmation System (TCS) provides real-time peripherally inserted central catheter (PICC) tip insertion information using passive magnetic navigation and patient cardiac electrical activity. It is an alternative tip confirmation method to fluoroscopy or chest X-ray for PICC tip insertion confirmation in adults. The purpose of this study was to evaluate time and cost of the Sherlock 3CG TCS and blind insertion with chest X-ray tip confirmation (BI/CXR) for PICC insertions. METHODS A cross-sectional, observational Time and Motion study was conducted. Data were collected at four hospitals in the US. Two hospitals used Sherlock 3CG TCS and two hospitals used BI/CXR to place/confirm successful PICC tip location. Researchers observed PICC insertions, collecting data from the beginning (ie, PICC kit opening) to catheter tip confirmation (ie, released for intravenous [IV] therapy). An economic model was developed to project outcomes for a larger population. RESULTS A total of 120 subjects were enrolled, with 60 subjects enrolled in each arm and 30 enrolled at each of the four US hospitals. The mean time from initiation of the PICC procedure to the time to release for IV therapy was 33.93 minutes in the Sherlock 3CG arm and 176.32 minutes in the BI/CXR arm (p < 0.001). No malpositions were observed for PICC insertions using the Sherlock 3CG TCS, while 20% of subjects in the BI/CXR arm had a malposition. BI/CXR subjects had significantly more total malpositions (mean 0.23 vs. 0, p < 0.001). For a hypothetical population of 1,000 annual patients, adoption of Sherlock 3CG TCS was predicted to be cost saving compared with BI/CXR in all three analysis years. CONCLUSION The results from this study demonstrate that Sherlock 3CG TCS, when compared with BI/CXR, is a superior alternative with regard to time to release subject to therapy, malposition rates, and minimization of X-ray exposure.
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Affiliation(s)
| | - Nicole Ferko
- Cornerstone Research Group, Inc., Burlington, ON, Canada
| | | | - Simona C Eng
- Department of Hospitalist/Inpatient Services, Peninsula Regional Medical Center, Salisbury, MD, USA
| | - Howard M Richard
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Lynn Rowe
- Department of Research, Florida Hospital, Maitland, FL, USA
| | - Susan Sproule
- Department of Diagnostic Imaging, Unity Hospital, Rochester, NY, USA
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Krzywda EA, Andris DA. Twenty-five Years of Advances in Vascular Access: Bridging Research to Clinical Practice. Nutr Clin Pract 2017; 20:597-606. [PMID: 16306296 DOI: 10.1177/0115426505020006597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Vascular access has become a key component for a multitude of IV therapies, including parenteral nutrition. Access of the central venous system has been long recognized for its associated complications of infection, thrombosis, and occlusion. Over the past 25 years, clinical practice based on research and innovation has attempted to decrease complication rates and therefore improve the safety of vascular access. This article highlights the research and its influence on catheter care procedures, technology, and education that has led to advances in vascular access. An improved understanding of the pathophysiology associated with catheter-related complications and an ongoing evaluation of new treatment modalities has provided clinicians today with new options for improved patient care and the ability to preserve vascular access options for patients.
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Affiliation(s)
- Elizabeth A Krzywda
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016; 35:247-307. [PMID: 26944585 DOI: 10.1016/j.clnu.2016.01.020] [Citation(s) in RCA: 474] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF. METHODS The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%. CONCLUSIONS CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | | | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lyn Gillanders
- Nutrition Support Team, Auckland City Hospital, (AuSPEN) Auckland, New Zealand
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA; Oley Foundation for Home Parenteral and Enteral Nutrition, Albany, NY, USA
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael Staun
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - André Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Stéphane Michel Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
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Abstract
The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.
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Peroperative Electrocardiographic Control of Catheter Tip Position during Implantation of Femoral Venous Ports. J Vasc Access 2015; 16:294-8. [DOI: 10.5301/jva.5000386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Electrocardiographic (ECG) guidance has been shown to be as effective than fluoroscopy to position the tip of central venous devices close to the superior vena cava (SVC)–right atrium (RA) junction. When SVC access is contraindicated, a femoral access may be used. The aim of this prospective study is to evaluate the effectiveness of ECG guidance to position the tip of femoral ports at inferior vena cava (IVC)–RA junction. Methods Inclusion criterion was the need for femoral port implantation. After insertion of the dilator in the femoral vein, the catheter with the guide wire inside was introduced and the ECG signal collected at the tip of the guide (Celsite™ ECG, B. Braun, Germany) or via saline injected in the catheter (Nautilus™, Perouse, France). Fluoroscopy was performed at each change of the P-wave from IVC to RA. A final X-ray was performed after withdrawing the catheter 2 cm below the first P-wave change. Results A total of 18 patients were included between December 2011 and June 2013. The P-wave was most often negative in IVC, biphasic when the catheter entered RA and giant and positive at the top of RA. When the catheter was withdraw 2 cm below the first biphasic P-wave the tip was just below the IVC–RA junction in 17 patients. In one patient P-wave changes were not significant and the final position was adjusted under fluoroscopy. Conclusions ECG guidance is effective to assess catheter tip position during femoral port placement and avoids the need for radiological methods.
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Proper Tip Position of Central Venous Catheter in Pediatric Patients. J Vasc Access 2015; 16:399-402. [DOI: 10.5301/jva.5000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/20/2022] Open
Abstract
Background In this study, we analyzed the thin-section pulmonary computed tomographic (CT) angiogram scans of pediatric patients to determine the normative length of superior vena cava (SVC) and the distance between carina and cephalad of SVC or cavocatrial junction. Methods Consecutive child patients, under 13 years of age in whom the central catheters were inserted under ultrasound guidance from December 2004 to April 2005 were evaluated retrospectively. Results In the 14 cases, the mean age was 7.2 ± 4.21 years. The mean length and diameter of the SVC in the pediatric patients were 45.6 ± 23.03 and 13.7 ± 3.62 mm, respectively. The distance from the carina to the cavoatrial junction was 22.0 ± 9.98 mm. The mean distance from the superior margin of the SVC to the carina was 23.7 ± 16.70 mm. The mean distance from the carina to the catheter tip was 38.9 ± 18.60 mm. In no case was the cavoatrial junction cephalad with respect to the carina. Carina to cavoatrial junction junction was significantly associated with age, height, and weight, respecitively (r = 0.750; p = 0.005, r = 0.763; p = 0.004; r = 0.777; p = 0.003). Conclusions The carina is a good landmark for the upper border of the cavoatrial junction. Length of carina to cavoaterial juction was associated with age. The rates of malposition and re-intervention and the patient's exposure to radiation can be reduced by using ultrasound during the catheter insertion.
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Pittiruti M, Lamperti M. Late Cardiac Tamponade in Adults Secondary to Tip Position in the Right Atrium: An Urban Legend? A Systematic Review of the Literature. J Cardiothorac Vasc Anesth 2015; 29:491-5. [DOI: 10.1053/j.jvca.2014.05.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 11/11/2022]
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The Intracavitary ECG Method for Insertion of a Tunneled Dialysis Catheter without using Fluoroscopy. J Vasc Access 2015; 16:285-8. [DOI: 10.5301/jva.5000378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Recently, there have been many reports that exact central vein catheter tip positioning was possible using intracardiac electrocardiographic (ECG) monitoring. Ultrasonic guidance in combination with intracardiac ECG monitoring may allow for a tunneled dialysis catheter to be inserted at the bedside without using fluoroscopy. Therefore we report on the intracavitary ECG method for insertion of a tunneled dialysis catheter with ultrasound guidance and the feasibility, safety, effectiveness, complications and limitations of this method. Methods From April 2012 to June 2014, we evaluated 142 hemodialysis (HD) patients who were dialyzed by a tunneled dialysis catheter that was inserted using intracardiac ECG monitoring without fluoroscopic usage. We checked the intracardiac P wave and the point at which it gradually rose to the highest P wave morphology, we stopped inserting the catheter. Results Catheter flow during dialysis was adequate in 139 cases. There were three cases where it malfunctioned. Catheter malposition occurred in 6 out of 142 cases. The correct matching rate between the intracardiac ECG and chest posteroanterior (PA) view was 98.5%. No significant complications developed. Conclusions To conclude, in this single-center study, the intracavitary ECG method for assessing the position of the tip of tunneled dialysis catheter was proven to be safe and feasible in virtually all adult patients who had an evident P wave at the basal ECG tracking.
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Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3:80-94. [PMID: 25374804 PMCID: PMC4220141 DOI: 10.5492/wjccm.v3.i4.80] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
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Qiu XX, Guo Y, Fan HB, Shao J, Zhang XB. Incidence, risk factors and clinical outcomes of peripherally inserted central catheter spontaneous dislodgment in oncology patients: A prospective cohort study. Int J Nurs Stud 2014; 51:955-63. [DOI: 10.1016/j.ijnurstu.2013.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/21/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
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El Gharib M, Niazi G, Hetta W, Makkeyah Y. Transhepatic venous catheters for hemodialysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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FRYKHOLM P, PIKWER A, HAMMARSKJÖLD F, LARSSON AT, LINDGREN S, LINDWALL R, TAXBRO K, ÖBERG F, ACOSTA S, ÅKESON J. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2014; 58:508-24. [PMID: 24593804 DOI: 10.1111/aas.12295] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
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Affiliation(s)
- P. FRYKHOLM
- Department of Surgical Sciences; Anaesthesiology and Intensive Care Medicine; University Hospital; Uppsala University; Uppsala Sweden
| | - A. PIKWER
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
| | - F. HAMMARSKJÖLD
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
- Division of Infectious Diseases; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - A. T. LARSSON
- Department of Anaesthesiology and Intensive Care Medicine; Gävle-Sandviken County Hospital; Gävle Sweden
| | - S. LINDGREN
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. LINDWALL
- Department of Clinical Sciences; Division of Anaesthesiology and Intensive Care Medicine; Karolinska Institute; Danderyd University Hospital; Stockholm Sweden
| | - K. TAXBRO
- Department of Anaesthesiology and Intensive Care Medicine; Ryhov County Hospital; Jönköping Sweden
| | - F. ÖBERG
- Department of Anaesthesiology and Intensive Care Medicine; Karolinska University Hospital Solna; Stockholm Sweden
| | - S. ACOSTA
- Department of Clinical Sciences Malmö; Vascular Centre; Skåne University Hospital; Lund University; Malmö Sweden
| | - J. ÅKESON
- Department of Clinical Sciences Malmö; Anaesthesiology and Intensive Care Medicine; Skåne University Hospital; Lund University; Malmö Sweden
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Kong H, Chen S, Wen X. Suture of the right internal jugular vein catheter in a mitral valve replacement: a case report. J Med Case Rep 2014; 8:129. [PMID: 24779707 PMCID: PMC4031929 DOI: 10.1186/1752-1947-8-129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/17/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Central venous catheterization can be necessary for patients undergoing a cardiac operation. Accidental suturing of the catheter to the heart is a rare complication that is difficult to correct; excessive traction force on the central venous catheter can lead to heart breakage or even death. Case presentation We describe the case of a 56-year-old Han Chinese woman who was scheduled to undergo mitral valve replacement. The central venous catheter placed into her right internal jugular vein was accidentally sutured to the left atrial suture line during the operation. The stuck catheter was successfully removed without having to perform a cardiopulmonary bypass. Conclusions Attaching a catheter to the heart by cardiac sutures can occur when the tip of the catheter locates directly above the atrial-caval junction. Care should be taken when closing the cephalad end of a left atrial incision in a mitral valve replacement. Although rare, accidental suturing of the central venous catheter must be kept in mind, and an approach should be chosen to remove the catheter that best avoids additional insult to the heart function.
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Affiliation(s)
- Haiying Kong
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, PR China.
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Early-onset Thrombosis of Internal Jugular Vein Associated with Introducer Catheter for Heart Catheterization in Cardiac Surgery. J Vasc Access 2014; 16:57-63. [DOI: 10.5301/jva.5000303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose In cardiac surgery, Swan-Ganz catheter (SGC) is often necessary and is inserted before the intervention through an introducer catheter. Catheter-related thrombosis (CRT) is a frequent complication of this procedure and often remains subclinical. The aims of this prospective cohort study were to determinate the incidence of CRT after positioning an SGC through an introducer and to identify factors relating to their occurrence. Methods One-hundred and sixteen cardiac surgery patients underwent ultrasound examination of the thoracic-cervical vessels, before and after introducer catheter removal. Data about drugs infused through the introducer catheter were also collected. Results The incidence of internal jugular vein CRT was 26.7%, corresponding to 70.5 cases per 1,000 catheter days. The incidence of “fibrin sleeve” was 28.4%. All introducer catheter tips lay in the brachiocephalic vein or in the upper third of the superior vena cava. The incidence of CRT was not associated with duration of the placement of the introducer catheter (average 3.9±2 days) or the SGC (average of 2.4±1.7 days). Infusion of total parenteral nutrition and dextran showed a significantly increased risk of thrombosis in both univariate and multivariate analyses. An overly proximal position of the introducer catheter tip was strongly associated with CRT incidence. Conclusions The presence of an introducer catheter for SGC, even for a short time, is associated with a high incidence of early-onset CRT. This incidence is significantly related to the catheter tip being positioned in the brachiocephalic vein and to its use as a central venous access.
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The Role of Saline Flush Injection Rate in Displacement of CT-Injectable Peripherally Inserted Central Catheter Tip During Power Injection of Contrast Material. AJR Am J Roentgenol 2014; 202:W13-8. [DOI: 10.2214/ajr.13.10625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Impact of phase of respiration on central venous catheter tip position. J Vasc Access 2013; 14:383-7. [PMID: 23599138 DOI: 10.5301/jva.5000135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the impact of the phase of respiration on CVC tip position using cross-sectional imaging. METHODS We retrospectively analyzed the CT scans of 24 consecutive patients (eight men and 16 women, mean age 56.3 years, range 18-79) who underwent a CT scan protocol that includes both imaging of the thorax in inspiration and expiration. Only patients with a central venous catheter and absence of any substantial pulmonary pathology that might affect lung volumes were included. Measurements of the catheter tip location and central venous structures were obtained from inspiratory and expiratory phase images in each patient and compared using the paired <i>t</i> test. RESULTS The length of the SVC and superior mediastinum were significantly longer during inspiration compared to expiration (9 mm and 7 mm respectively, P<0.001 for both). The distance between the superior and inferior cavo-atrial junction did not change significantly with respiration. The catheter tip location moved on average 9 mm (range 0-25 mm) cephalad during inspiration compared to expiration (P=0.001) in relation to the superior cavoatrial junction. The amount of catheter tip movement correlated significantly with the degree of diaphragmatic excursion with respiration (R=0.58). During inspiration, the cavo-atrial junction was on average 11 mm inferior to the right cardiomediastinal angle observed on radiography, but was nearly identical during expiration (R=0.78, P<0.001). CONCLUSIONS The central catheter tip position varied significantly with respiratory motion, with a mean excursion of 9 mm. The right cardiomediastinal border demonstrated a strong correlation with the actual location of the superior cavo-atrial junction in expiration, but not in inspiration.
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The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study. J Vasc Access 2013; 13:357-65. [PMID: 22328361 DOI: 10.5301/jva.2012.9020] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters. METHODS A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray. RESULTS The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position. CONCLUSIONS Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device.
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Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68:529-44. [PMID: 23415017 DOI: 10.1016/j.crad.2012.10.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022]
Abstract
Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques.
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Agrawal S, Payal YS, Sharma JP. A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India. J Emerg Trauma Shock 2012; 5:304-8. [PMID: 23248498 PMCID: PMC3519042 DOI: 10.4103/0974-2700.102369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/18/2012] [Indexed: 11/18/2022] Open
Abstract
Background: Malpositions after central venous cannulation are frequently encountered and may need a change in catheter. The incidence of malpositions are varied according to various studies and depend on the experience of the operator performing the cannulation. Aim: To access the incidence of malpositions and related complications associated with landmark-guided central venous cannulation in a 15-bedded medical surgical ICU over a period of three years. Settings and Design: Retrospective analysis of records of all the central venous cannulation done in a 15- bedded medical- surgical ICU over the period of three years (April 2008 to June 2011) were evaluated for the site and side of insertion, number of attempts of puncture, arterial puncture as well as the malpositions on post procedural chest X-ray. The records were also evaluated for the experience of the operator performing cannulation and relationship between experience of operator to malpositions of catheter. Statistical Analysis: Analysis was done using SPSS v 17.0 for Windows. Chi-square test was applied to evaluate the statistical significance. P > 0.05 was significant. Results: Records of 696 cannulations were evaluated. Malpositions occurred in 40 patients. Subclavian vein cannulation resulted in increased malpositions in relation to internal jugular vein cannulation. More common with left sided cannulation. Experience of operator had positive correlation with malpositions and arterial puncture. Arterial puncture was common in 6%, while more than one attempt for cannulation was taken in 100 patients. Conclusion: Incidence of malpositions was low. We conclude that experience of operator improves successful catheterization with lesser number of complications.
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Affiliation(s)
- Sanjay Agrawal
- Department of Anaesthesiology Intensive Care and Pain Management, Himalayan Institute of Medical Sciences, HIHT University, Dehradun, India
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Goossens GA, Stas M, Moons P. Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 Years of clinical experience. Eur J Oncol Nurs 2012; 16:465-71. [DOI: 10.1016/j.ejon.2011.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 11/15/2011] [Accepted: 11/26/2011] [Indexed: 11/25/2022]
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Imaging review of procedural and periprocedural complications of central venous lines, percutaneous intrathoracic drains, and nasogastric tubes. Pulm Med 2012; 2012:842138. [PMID: 22970363 PMCID: PMC3437305 DOI: 10.1155/2012/842138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/29/2012] [Accepted: 04/18/2012] [Indexed: 01/12/2023] Open
Abstract
Placements of central venous lines (CVC), percutaneous intrathoracic drains (ITDs), and nasogastric tubes (NGTs) are some of the most common interventional procedures performed on patients that are unconscious and in almost all intensive care/high dependency patients in one form or the other. These are standard procedures within the remit of physicians, and other trained health professionals. Procedural complications may occur in 7%–15% of patients depending upon the intervention and experience of the operator.
Most complications are minor, but other serious complications may add significantly to morbidity and even mortality of already compromised patients. Imaging findings are the key to the detection of misplaced lines, and tubes and their prompt recognition are vital to avoid harm to the patient. It is, therefore, pertinent that healthcare professionals who perform these procedures are familiar with imaging complications of these procedures. Here, we present the imaging characteristics of procedural complications.
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