جستجوی مقالات مرتبط با کلیدواژه « central venous catheters » در نشریات گروه « پزشکی »

Complete remaining guide wire in the vascular system after CVC is very rare. For which the maximum symptom-free reporting time in studies was five months, and in our case, the patient was symptom-free for one year. The only finding was one session complaining of ear pain and mastoid tenderness two weeks after catheter placement.A 42-year-old male patient with the diagnosis of necrotizing pancreatitis and a retroperitoneal abscess was a candidate for laparotomy after ERCP. The patient was a candidate for central venous catheter insertion through the internal jugular vein before the surgery in the operating room by a third-year anesthesia resident. After one year, discovered that incidentally remaining guide wire during a follow-up MRI before pancreatitis. Which has been asymptomatic during this period. And despite the risk of rupture of the right heart and blood vessels due to possible fibrosis due to a long stay in the cardiovascular system, it is successfully removed by an endovascular surgeon.The main reasons for the incident were the non-observance of scientific and safety principles at the time of catheter insertion and the failure to perform CXR after that.

Central vein catheterization (CVC) is a usual and accepted way for monitoring hemodynamic status or prescribing medication in seriously ill patients. internal jugular catheterization, is one of the most acceptable roots for catheterization, because of its accessibility and ability to compress the vein, but in the standard method explained in Robert and Hedges, clinical procedures textbook, there is significant instruction for needle direction and patient position but in some cases, this method is not successful, especially in beginner and trainer students. So new studies have examined new methods in previous approaches (such as the use of ultrasound guides). This paper is about a modified method of catheterization, with a simple modification in needle direction and patient position, based on emergency medicine specialists experience, without any excessive instruments, this method can be used by other physicians as will be explained subsequently.

This study reports the success rate and complications of a verified method of central vein catheterization (CVC) by emergency medicine specialists.

After preparation and cardiac monitoring, the patient is in a neutral position with the head rotate 20-30 degrees to the other side and feet are in line with the body. Then the needle was inserted from the middle of both ends of the sternocleidomastoid muscle, one centimeter above the clavicle bone while the direction of the needle was toward the foot on the same side and along the internal jugular vein, the angle between the skin and needle was 30-40 degrees. While applying negative pressure (suction), after passing the needle through the skin, it was gently inserted into the site up to the 2.5 centimeter distance of the needle tip. In case of unsuccessful venipuncture, the needle was pulled backward gently to the surface of the skin while maintaining suction. In the case of a blood jet inside a vein, the wire was first passed and then a catheter was inserted. After catheterization, chest X-ray was taken from all patients, and complications were checked.

In this trial, all CVC was successful and 9 CVC were with simple complications such as catheter location in the left ventricle (n=3), in the carotid artery (n=1), pneumothorax and hemothorax (n=1).

 Since the vein is more available in the innovative modified method than the standard method, it may be preferred to the standard conventional method.

Various methods of analgesia can be used to reduce or prevent procedural pain in emergencydepartment (ED). This study aimed to evaluate the effectiveness of topical lidocaine-diclofenac combinationcompared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter(CVC) insertion.

In this randomized clinical trial, 100 adult patients requiring CVC insertion in the EDwere enrolled. These patients were randomly divided into two groups. The site of CVC insertion was coveredwith 2 g of topical Xyla-P cream in the first group, and 2 g of topical lidocaine-diclofenac cream in the secondgroup. The primary outcome was the pain during CVC implantation. The secondary outcomes were physiciansatisfaction and the incidence of side effects.

On the visual analog scale (VAS), the pain score duringCVC insertion was significantly lower in the second group (p = 0.027). However, there was no difference in painscores during lidocaine injection between the two groups (p = 0.386). Also, there was no significant differencein the rate of side effects between the two groups (p = 1.0). The physician’s satisfaction with the first groupwas significantly lower than the second group (p = 0.042).

Although the CVC insertion pain wassignificantly lower in patients who received the topical combination of Lidocaine plus Diclofenac, there wasno clinically important difference between the two groups and both topical anesthetics were effective and safein reducing pain intensity. Also, lidocaine-diclofenac combination cream was more cost-effective than Xyla-Pcream.

 The most important complication of port access catheters (PAC) compared to peripheral lines is a higher incidence of infections.

 This study investigated the frequency of catheter infection and related factors in Dr. Sheikh Children Hospital (SCH).

 This is a retrospective descriptive study at Sheikh children’s hospital, Mashhad, Iran. The data of children with an operation for PAC surgery were gathered from hospital files and completed by calling the parents. The definition of PAC infection was based on clinical signs of catheter infection and any positive blood culture (peripheral or catheter sample) or the resolution of signs of infection after the extraction of the catheter in the absence of positive blood cultures.

 During six years, 70 children received PAC, all of whom (except five) were followed by telephone calls. Forty percent of them were younger than two years, and 71.4% had malignant disease. Catheter infection occurred in 16 (22.8%) cases. Signs of catheter infection were fever and cellulitis over the port in nine (56%) cases (pocket infection), chills and fever during catheter usage (without port infection) in six (37.5%) cases, and persistent fever in one patient (6.2%). Blood culture was positive in 75% (12 cases) of catheter infections, and the responsible organisms were Gram-negative bacilli (five cases), Coagulase-negative staphylococci (three cases), Candida (three cases), and group B streptococci (GBS). The success rate for “medical therapy per se” was 68% in catheter infections. The catheter was removed in 22 (31.4%) patients, which was due to infection in half of them. The mean time to removal was 15.3 months.

 The incidence of catheter infection, especially pocket infection, is high in this population, which necessities revision in all procedures of catheter implantation and care.
 

Venous access in neonates is a basic yet critical component in neonatal intensive care unit (NICU). Central venous access and peripheral intravenous access are mostly preferred for delivering medications and intravenous fluids. This study aimed to compare the risks involved in central venous catheters and peripheral intravenous lines among term neonates.

A prospective cohort study was carried out among 78 term neonates in the NICU of a tertiary care center in puducherry in India. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to demographic and clinical characteristics, cannulation details, indwelling time, and incidence of thrombosis, phlebitis, occlusion, extravasation, and sepsis were collected by direct observation and from case record. Data were analyzed using SPSS software version 21. To analyze the data, descriptive statistics including frequency, percentage, mean, and standard deviation and inferential statistics including Fisher’s exact test were utilized.

Our findings indicated that the risks of thrombosis and phlebitis were significantly higher in peripheral intravenous line group than the central venous group. There was no statistically significant association between the risks and demographic and clinical characteristics in both of the venous access system.

According to our results, the use of central venous catheter among neonates showed lower risks than peripheral intravenous lines. Hence, using central venous catheter may be given priority in the NICUs.

Use of Central Venous Catheters (CVC) can be associated with increased incidence of Catheter‑Related Bloodstream Infections (CRBSIs). The present study assessed the impact of open versus closed catheter access system of CVC on infection prevention in critically sick patients admitted in the Intensive Care Unit (ICU).

After obtaining ethical clearance and consent of relatives of the patients admitted in ICU of our institute, the present study was carried out as a randomized, prospective, double‑blind trial with parallel group design (of 200 patients in each group). In study group (Group I), closed catheter access system (Luer access split septum) was used, while open access (three‑way) system was used in the control group. Among clinical parameters, if any patient developed fever, his/her blood, urine, and tracheal secretions were sent for culture and sensitivity. Collected data were analyzed using descriptive and inferential statistics.

Demographic profile was similar in both the groups. Significant clinical and statistical differences were observed in blood culture values (χ2 = 58.30, df = 1, p < 0.001) as well as Total Leukocyte Counts (TLC) on day 1, 4, and 8 (F2,260 = 80.61, p < 0.001). However, no statistically significant (t 390 = 0.90, p = 0.367) difference was found in the duration of hospital stay among patients in both the groups despite significant differences in various clinical parameter.

Luer access split septum connectors along with appropriate training of the nursing personals decrease CRBSI.

Central vein access is a common procedure in infants and neonates. In this regard, cutdown is a common central venous access technique. However, it is associated with complications, including catheter occlusion, infection, and spontaneous withdrawal. Catheter occlusion is a common complication of the cutdown procedure and causes catheter dysfunction and subsequent catheter removal. In this study, we compared the effect of heparin lock with Taurolock on the maintenance of central vein catheter potency placed in the greater saphenous vein at the saphenofemoral junction and their subsequent complications.

The children admitted to the pediatric hospital who required central vein access between December 2015 and July 2019 were recruited. There were two groups of patients. The first group received 0.5 mL Taurolock solution. The solution contains (cyclo)-taurolidine, heparin 500 IU/mL, and citrate (4%) before the catheter gets locked (Taurolock group). Another group received 0.5 mL heparin (contains 500 IU/mL heparin) before the catheter lock (heparin lock group). After the treatment period, the average duration of catheter usage and heparin-induced bleeding complications were evaluated.

The average duration of catheter function was 13.4 days and 9.3 days in the Taurolock group, and the heparin lock group, respectively. The coagulation tests were performed on 179 patients (33.9%) during hospitalization, no heparin-induced coagulopathies were reported.

Using Taurolock after catheter use could significantly reduce catheter occlusion and increase the duration of catheter function. Taurolock reduces costs, prevents delays in treatment, and decreases pain sensation and discomfort in patients.

Long‑term central venous catheter (CVC) insertion in dialysis patients is an accepted method of hemodialysis. The appropriate CVC tip placement may reduce both early and late complications related to catheter and increase patency rate. This study aimed to evaluate a new, simple, and feasible method based on surface anatomy for the proper placement of tunneled CVC in the left internal jugular vein for hemodialysis or chemotherapy.

The study was carried out as a quasi‑experimental model at Saint Al‑Zahra Education Hospital in 2016. A total of forty patients with an indication of left‑sided (upper) long‑term CVC insertion were enrolled. The length of catheter to be inserted in the left internal jugular vein was considered as the sum of distance from the insertion point of the needle up to sternal notch plus the total distance between the left and right sternoclavicular joint and half‑length of the sternum. The right atrium (RA) or superior vena cava‑RA junction was the correct region for inserting the catheter tip. The collected data were analyzed using Fisher’s exact test and t‑test using SPSS (version 22).

The patients were 63.75 ± 17.96 years of age, weighed 67.33 ± 13.20 kg, and height of 166.92 ± 8.99 cm. Catheters were inserted successfully in 95% of patients (n = 38). No significant relationship was found between the success of new method and age, gender, height, weight, body mass index, and sternum half‑length plus the distance between the right and left sternoclavicular joint.

“The mid – sternal length plus sternoclavicular joints spacing” as a new formula (based on anatomical landmarks) was found practical and safe and could easily be used among adult patients who undergo tunneled CVC in the left internal jugular vein.

 The central venous catheter (CVC) has been shown to increase mortality in hemodialysis (HD) patients compared with the arteriovenous fistula (AVF). However, no study has examined the mortality of HD patients based on the time of conversion from the CVC to AVF. In this study, we investigated the association between patients’ survival and length of time of using each access.

The C5.0 algorithm was used to find rules about the relationship between duration of the different access usage and survival. The cox model was applied to assess the association of the obtained duration categories and mortality.

From 2367 adult patients who received maintenance HD from 2012 to 2014, 705 patients were eligible for the study. Using an AVF for more than 8 months and a CVC for less than 4.2 months had the highest one-year survival rate (91.8% and 87.4%). The hazard ratio (HR) for mortality of less than 2.8 months of AVF usage compared to the longest usage was 6.90 (95% CI: 4.60 - 10.30) before adjustment and 5.03 (95% CI: 3.20 - 8.00) after adjustment for all confounders. For the CVC, the ratio was 8.8 (95% CI: 6.00 - 13.00) when comparing more than 9.2 months of usage with the lowest usage duration before an adjustment and 6.00 (95% CI: 3.80 - 9.41) after adjustment.

Our results presented that regardless of the type of initial vascular access, limiting the length of the time using CVC as well as switching to AVF could significantly improve the survival of HD patients

Blood infections due to intravenous catheters make up about 10\% -- 15\% of hospital infections (1). In 2009, Centers for Disease Control and Prevention (CDC) reported the rate of blood infections related with using central venous catheter in the intensive care unit (ICU) to be 1.65 in 1000 catheters per day (2). Mortality due to infections related to central venous catheters has been reported to be between 12\% and 25\% in different studies. These infections have increased the duration of hospitalization by 12 days (3, 4). Different approaches have been proposed for reducing these infections, among these approaches using aseptic methods, preventive antibiotics, disposable tools, and training the staff can be pointed out (5-7). Among the methods considered in this regard is using catheters coated with antiseptic agents, antibiotics, and metals such as silver and platinum (8). Some studies have suggested using these methods for reducing the mentioned infections and their consequences; however, their use is not currently agreed upon and their effect on reducing the infections caused by intravenous tools is still being studied.

BackgroundCentral venous catheter (CVC) is used for measuring hemodynamic variables, transfusion of blood, fluids and medications when peripheral vascular lack sufficiency. Unfortunately CVC is associated with many complications ranging from anxiety and discomfort for the patient to severe mechanical side effects such as arterial lacerations, pleural and pericardial injury as well as infection and thrombosis. This study aimed to survey of a practical approach to central venous catheterization in pediatric patients.
Materials and MethodsIn this retrospective and descriptive study, rate of success and complications of central venous catheterization by the anesthesia team for the hospitalized children 0-15 years from 2009 to 2016 years at Mofid Children Hospital, Tehran-Iran, were investigated. Advancement of catheters tips in pleural space; peritoneal cavity and pericardium were recognized by rat tail blood flow as a practical approach which was proved by chest X- ray. Successful rate and complications of inserting CVC were collected by researchers using medical records of the patients.
ResultsThere were 2,385 (53%) female and 2,115 (47%) male patients. Patient’s age ranged from 1 month to 10 years, mean 12.25±6.45 months. About 4,500 patients who underwent central venous catheterization were investigated that 815 patients (18%) had improper catheterization in the internal jugular and 374 patients (8%) had accidental arterial injury and 160 patients (3%) had accidental pleural injury. Accidental pleural injury were recognized by rat tail blood flow in the liquid column connected to the catheter to the patient's bedside and all of them was proven by taking control image.
ConclusionUsing rat tail blood flow as a practical approach to central venous catheterization in pediatric patients can be associated with prevention of the plural injury and subsequent pneumothorax and hemothorax.

Iatrogenic injuries of the superior vena cava (SVC) are infrequent but could bring severe complications. Perforation of the SVC may result in massive hemorrhage and hemodynamic instability. We report the case of a 58-year-old female with a right hemothorax after left subclavian central venous catheter (CVC) placement. Penetration of the SVC can be managed by coil embolization through left subclavian CVC. As a result, this injury was successfully managed. To our knowledge, this is the first report of management of SVC penetration using coil embolization.

The central venous catheter (CVC) is broadly used in medical practice. However, its use constitutes an invasive procedure with morbidity.
To assess the role of computed tomographic angiography (CTA) in CVC related complications and the mid-term outcome of dialysis patients after their treatment.
This is a retrospective analysis of prospectively collected data of dialysis patients treated for CVC-related complications and their monitoring during a midterm follow-up.
From 2012 - 2014, eight patients (mean age 59±1.2 years; 6 males) with CVC related complication were treated. All complication were diagnosed and verified by a CTA (100%). Two patients presented with local hematoma, 3 with major bleeding, 2 with a retained guide-wire, and 1 with a disconnected part of a port-catheter. The direct repair of an arterial or venous wall injury was undertaken in 7 patients, with the simultaneous removal of a retained guide-wire in 2 and the removal of a misplaced CVC in 1 of them. One patient had the endovascular approach with the removal of the disconnected part. No death or major complication occurred during the procedures. During the follow-up (range =12 - 24 mon), no re-intervention, clinical episode of venous thromboembolism, or death was recorded.
Invasive treatment of dialysis patients for CVC related complications is effective and durable during mid-term follow up with no re-intervention, clinical episode of VTE or death. CTA is a reliable mean for the diagnosis of CVC related complications.

Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization.
In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation.
114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09.
Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results.

The central venous catheter (CVC) is broadly used in medical practice. However, its use constitutes an invasive procedure with morbidity..
To assess the role of computed tomographic angiography (CTA) in CVC related complications and the mid-term outcome of dialysis patients after their treatment..
This is a retrospective analysis of prospectively collected data of dialysis patients treated for CVC-related complications and their monitoring during a midterm follow-up..
From 2012 - 2014, eight patients (mean age 59 ± 1.2 years; 6 males) with CVC related complication were treated. All complication were diagnosed and verified by a CTA (100%). Two patients presented with local hematoma, 3 with major bleeding, 2 with a retained guide-wire, and 1 with a disconnected part of a port-catheter. The direct repair of an arterial or venous wall injury was undertaken in 7 patients, with the simultaneous removal of a retained guide-wire in 2 and the removal of a misplaced CVC in 1 of them. One patient had the endovascular approach with the removal of the disconnected part. No death or major complication occurred during the procedures. During the follow-up (range =12 - 24 mon), no re-intervention, clinical episode of venous thromboembolism, or death was recorded..
Invasive treatment of dialysis patients for CVC related complications is effective and durable during mid-term follow up with no re-intervention, clinical episode of VTE or death. CTA is a reliable mean for the diagnosis of CVC related complications..

Large vessels injury is a rare but serious complication of percutaneous central venous catheter placement, which can be fatal. Herein a case of right innominate vein perforation during right internal jugular perm- catheter placement - resulted in thoracotomy because of patient’s hemodynamic instability - is reported.

Heparin has long been used to prevent thrombosis in the permanent central venous hemodialysis catheters (PermCath). Other alternatives for heparin with fewer side-effects have recently been considered. We compared normal saline (0.9%) with heparin for flushing PermCath with regards to catheter patency and prevention of heparin complications.

Chronic kidney disease patients who were candidate of PermCath placement were randomly assigned into two groups of heparin and saline. In the heparin group, the PermCath was flushed with heparin (1000 IU), and in the saline group, it was flushed with saline 0.9%. Patients were followed for 24 hours, and outcomes included catheter thrombosis, maneuver needed to maintain catheter patency, and bleeding from catheter site.

Ninety six patients were included (age = 63.1 ± 11.2 years, 54.2% male). No one experienced catheter thrombosis. Two patient (4.2%) in the heparin and three ones (6.1%) in the saline group required catheter manipulation (P = 0.520). Four patients (8.5%) in the heparin and three ones (6.1%) in the saline group experienced bleeding (P = 0.476); differences between heparin and saline groups in the amount of bleeding (225.0 ± 62.4 vs. 200.0 ± 113.5 cc, P = 0.721) and bleeding time (6.5 ± 1.2 vs. 5.3 ± 1.5 min, P = 0.322) were not significant. In the heparin group, no significant increase was observed in PTT over time; baseline 30.9 ± 3.4, 12 h 31.8 ± 3.4, 24 h 31.2 ± 6.6 (P = 0.628).

Flushing PermCath with normal saline 0.9% is as effective as heparin in maintaining patency of the catheter, while it may reduce the risks associated with heparin.

Between September 2010 and January 2012, four patients in our hospital were observed to have permanent dialysis catheters that adhered to either the SVC or right atrium. The first patient underwent intraoperative fluoroscopy and was scheduled for cardiac surgery. Unfortunately due to metabolic disturbances, the patient’s condition deteriorated and she died before surgery. The second patient underwent cardio-thoracic surgery with mid-sternotomy and cardio-pulmonary bypass. The catheter was removed and another access route for hemodialysis was established. The third case was scheduled for interventional venocavagraphic exploration of the adhered Permcath. An endovascular snare was passed through the guide wire, which separated the catheter from the SVC. Finally, the fourth patient was a known case of Von Willebrand disease who was scheduled for interventional angiographic Permcath removal. Unfortunately, a few hours following the attempt at surgical removal of the Permcath, her condition deteriorated and she died.Several methods have been used to manage an adherent Permcath. It is assumed that the longer the catheter is in place, the probability of adhesion to the central veins increases. Histological changes have been demonstrated in the venous wall adjunct to the catheter. Interventional venacavagraphic exploration of the catheter and snaring the adherent site of the catheter seems to be a valuable option.