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Sample records for catheter insertion length

  1. Bedside prediction of right subclavian venous catheter insertion length

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    Yoon Ji Choi

    2014-12-01

    Full Text Available Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC, via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively. Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89. The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm = -0.037 + 0.036 × Height (cm + 0.903 × I-T-IC (cm (adjusted r2 =0.64. Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

  2. How correct is the correct length for central venous catheter insertion

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    Kujur Rash

    2009-01-01

    Full Text Available Background and Aim: Central venous catheters (CVC are important in the management of critically ill patients. Incorrect positioning may lead to many serious complications. Chest radiograph is a convenient means of determining the correct position of the catheter tip. The present study was designed to evaluate the depth of CVC placed through the right and left internal jugular vein (IJV in order to achieve optimum placement of the catheter tip. Materials and Methods: A total of 107 patients in whom CVCs were put through either the right or left IJV through a central approach were included in this prospective study. Catheter tip position was observed in the post procedure chest radiograph. It was considered correct if the tip was just below the carina in the left-sided catheters and just above carina in the right-sided catheters. The catheters were repositioned based on the chest radiographs. The catheter depth leading to optimum tip placement was noted. Results: In males, catheter repositioning was required in 13 of 58 patients (22.41% in the right IJV catheters, whereas in 2 of 13 patients (15.38% in the left IJV catheters. In females, repositioning was required in 12 of 25 patients (48% in the right IJV catheters and 2 of 11 patients (18.18% in the left IJV catheters. Repositioning rate was higher in females (14/36 compared with males (15/71, which was statistically significant ( P = 0.05, 95% CI. Repositioning rates were significantly higher in females (12/25 as compared with males (13/58 in the right IJV catheters ( P = 0.019, 95% CI. Conclusion: By cannulating the IJV through a central approach, the catheters can be fixed at a length of 12-13 cm in males and 11-12 cm in females in the right IJV and at a length of 13-14 cm in males and 12-13 cm in females in the left IJV in order to achieve correct positioning.

  3. Pneumothorax as a complication of central venous catheter insertion.

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    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

  4. Nelaton catheter assisted versus standard nasogastric tube insertion: a randomized, clinical trial.

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    Ghaemi, M; Mousavinasab, N; Jalili, S

    2014-01-09

    It is sometimes difficult to insert a nasogastric tube in an anaesthetized patient. We evaluated the benefit of reinforcing the distal portion of the nasogastric tube with a Nelaton catheter: 8 and 10 French Nelaton catheters were inserted into 16 and 18 French nasogastric tubes respectively through the first proximal holes of tubes up to their tips. The patients anaesthetized were randomly allocated into either the control or the Nelaton groups, and nasogastric tube was inserted as deeply as the catheter length, then the catheter was withdrawn and the tube was inserted farther to reach the stomach. Eighty patients (40 in each group) were included in this study. The success rate of nasogastric tube insertion was 90% in the Nelaton group and 57% in the control group (P = 0.001). The mean insertion time was 80 (SD 43) and 92 (SD 35) seconds in the Nelaton and the control groups respectively.

  5. Pulmonary artery catheter insertion in a patient of dextrocardia with anomalous venous connections

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    Tripathi Mukesh

    2004-08-01

    Full Text Available In a young adult patient having situs solitus with dextrocardia the attempted pulmonary artery catheter placement for emergency mitral valve replacement required an unduly long length (50cm of catheter insertion to get into right ventricle and then into pulmonary artery. Although catheter coiling was suspected initially, chest x-ray taken after successfully placement revealed an uncommon congenital anomalous venous connection i.e. right internal jugular opening into left sided superior vena cava then into inferior vena cava after running all along the left border of the heart. With the result, it required to pass 50cm of PA catheter to get into right ventricle in our patient. This emphasizes the need to look for abnormal venous connections during echocardiography and x-ray screening in congenital heart disease. Fluoroscopy is recommended when an unusual length of pulmonary artery catheter insertion is required to enter the pulmonary artery.

  6. Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

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    Ahmed M Hasanin

    2017-01-01

    Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

  7. Open Surgical Insertion of Tenkchoff Straight Catheter Without Guide Wire

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    Shi-feng Yang; Wu-jun Xue; Ai-ping Yin; Li-yi Xie; Wan-hong Lu

    2013-01-01

    Objective To compare the clinical outcomes of open surgical peritoneal dialysiscatheter(PDC) insertion with guide wireand the outcomesof PDC insertion without guide wire.Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed.The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire wereenrolled into group B.The incidences of post-operative complications (catheter obstruction,catheter displacement, bloody dialysate, and dialysate leakage), catheter survival, and patientsurvival rates were compared between the 2 groups.Results The baseline characteristics (gender, age, body mass index, prothrombin time,activated partialthromboplastin time,platelet count,serum creatinine,follow-up time,primarydiseases, and outcomes) of the 2 groups were comparable (allP>0.05). In post-operativecomplications, only the incidence of early bloody dialysate showed significant difference, being16.2% in groupA and 7.4% in group B (P=0.04). Catheter and patient survival rates werenot significantly different between the two groups. Overweight patientsshowed a higherincidence of catheter obstruction compared with normal weight patients [16.0% (4/25) vs. 3.3% (7/213),P=0.02], but no differencesin post-operative complications werefound among overweight patientsbetween the 2 groups.Conclusions Open surgical Tenkchoff straightcatheterinsertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternativeoption when guide wire is not available.

  8. Imaging of the complications of peripherally inserted central venous catheters

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    Amerasekera, S.S.H. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)], E-mail: steve.amerasekera@nhs.net; Jones, C.M.; Patel, R.; Cleasby, M.J. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)

    2009-08-15

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  9. Imaging of the complications of peripherally inserted central venous catheters.

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    Amerasekera, S S H; Jones, C M; Patel, R; Cleasby, M J

    2009-08-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  10. Placement peripherally inserted central catheters (PICC): the upper arm approach

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    Choo, In Wook; Choo, Sung Wook; Choi, Dong Il; Yoon, Jung Hwan; Hwang, Jae Woong; Lim, Jae Hoon [Samsung Medical Center, Seoul (Korea, Republic of); Andrews, James C. [Mayo Clinic, Lansing (United States); Williams, David M.; Cho, Kyung J. [University of Michigan Hospital, Lansing (United States)

    1995-10-15

    To evaluate a recently developed technique to place a medium-duration (weeks to months) central venous access. Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter (PICC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5-French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients (2.5%), acute thrombosis of the subclavian vein in 3 (0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. The PICC system is an excellent option for medium-duration central venous access. Patients were able to carry on normal activities with the catheters in place.

  11. NURSING CARE IN PATIENTS NEONATES WITH PERIPHERALLY INSERTED CENTRAL CATHETER

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    Anacilda Oliveira Vieira

    2013-12-01

    Full Text Available Introduction: The PICC (peripherally inserted central catheter is a long flexible catheter which is inserted through a peripheral vein, progresses through a needle introducer until the final portion of the vena cava, acquiring characteristics of a central catheter. Objective: To point out the main theoretical and scientific ideas that demonstrate the reliability, competence and ability of nurses to perform the PICC. Methodology: Systematic review of articles, which were found by searching the database scientific journals and bibliographies area. Results: The success of integration depends on the patient assessment and choice of venous access where the catheter will be positioned, and its tip should be in the middle third of the superior vena cava, or the middle third of the inferior vena cava. In neonates, which are used more frequently, proper positioning of the catheter is through nursing care in making the dressing, and the first 24 hours it should be compressive. Ideally, the PICC remains in the vein for periods longer than seven days or until the end of treatment, thus decreasing invasive procedures. Conclusion: According to the Federal Board of Nursing (COFEN, it is lawful for the insertion of PICC nurses, provided it has undergone professional training.

  12. Central venous catheter insertion problem solving using intravenous catheter: technical communication

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    Alemohammad M

    2013-02-01

    Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

  13. [Neonatology nurses' knowledge about Peripherally Inserted Central Venous Catheter].

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    Belo, Marcela Patricia Macêdo; Silva, Roberta Albuquerque Mello de Castro; Nogueira, Isis Larissa Maia; Mizoguti, Daniele Pereira; Ventura, Claudiane Maria Urbano

    2012-01-01

    The Peripherally Inserted Central Catheter (PICC) has been used as a safe venous access for infants at risk. The aim of this study was to describe the knowledge and practice of nurses from the five public Neonatal Intensive Care Units, of Recife-PE, Brazil, about the use of the PICC. The sample was comprised by 52 nurses; data were collected from January to February/2010. It was found that 64,8% of nurses did not have license for insertion of the PICC. Only two units routinely used the PICC. About the indication of the access, the accuracy was above 70%. In unit B only 8,3% of nurses reported adequate initial location of the catheter tip. It was concluded that is necessary greater incentives to train nurses to use the PICC.

  14. Can femoral dialysis catheter insertion cause a life threatening complication?

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    Nurkay Katrancıoğlu

    2014-09-01

    Full Text Available Venous catheter (VC insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion. J Clin Exp Invest 2014; 5 (3: 472-474

  15. A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters.

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    Wald, Martin; Happel, Christoph M; Kirchner, Lieselotte; Jeitler, Valerie; Sasse, Michael; Wessel, Armin

    2008-11-01

    This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.

  16. Analysis of the Sherlock II tip location system for inserting peripherally inserted central venous catheters.

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    Lelkes, Valdis; Kumar, Abhishek; Shukla, Pratik A; Contractor, Sohail; Rutan, Thomas

    2013-01-01

    Peripherally inserted central catheters (PICCs) are frequently placed at the bedside. The purpose of our study was to evaluate the efficacy of the Sherlock II tip location system (Bard Access Systems, Salt Lake City, UT), which offers electromagnetic detection of the PICC tip to assist the operator in guiding the tip to a desired location. We performed a retrospective review of patients who had a bedside PICC using the Sherlock II tip location system. Three hundred seventy-five of 384 patients (97.7%) had the catheter tip positioned appropriately. Our results suggest that the Sherlock II tip location system is an efficacious system for bedside PICC placement.

  17. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns

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    Arnts, I.J.J.; Bullens, L.M.; Groenewoud, J.M.M.; Liem, K.D.

    2014-01-01

    OBJECTIVE: To compare the complication rates between umbilical central venous catheters and peripherally inserted central venous catheters in newborns and to investigate whether other variables might increase complication rates. DESIGN: A retrospective observational study. SETTING: A Level III neona

  18. Comparison of three peripherally-inserted central catheters: pilot study.

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    Di Giacomo, Michele

    Peripherally-inserted central catheters (PICCS) are non-tunnelled, central catheters inserted through a peripheral vein of the arm. They are 50-60 cm long and are usually made of either silicone or second-third generation polyurethane. PICCs can be used for prolonged, continuous or intermittent infusion therapies (up to 3 months) both in hospitalized patients and in patients treated as outpatients, in a hospice, or at home. When establishing a vascular service it is key to select a PICC that meets the requirements of safety, cost-effectiveness, high resistance (ability to take increasing fluid volumes with high pressure devices) and durability, and low complications rate. The complications and dwell times of three different PICCs were studied: coated polyurethane, valved silicone and power-injectable. The study was conducted at the chemotherapy suite at the author's hospital with the aim of selecting the right PICC based on low incidence of complications, resistance and enhanced dwell time. Results show a low incidence of complications and long dwell time among patients with the power-injectable PICC. Furthermore, this study demonstrated a reduction on the rate of occlusion and rupture with power-injectable PICCs, which makes them safer to use for administration of chemotherapy and other vesicant agents, as well as for the management of patients in critical care.

  19. Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure

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    Bergey, E.A.; Kaye, R.D.; Reyes, J.; Towbin, R.B. [Department of Radiology, Children`s Hospital of Pittsburgh, PA (United States)

    1999-01-01

    Introduction. Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins. Materials and methods. Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred. Discussion. Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage. Conclusion. Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins. (orig.) With 2 figs., 7 refs.

  20. Malposition of a Peripherally Inserted Central Venous Catheter in the Graft Hepatic Vein.

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    Ersoy, Zeynep; Araz, Coşkun; Taşkın, Duygu; Moray, Gökhan; Torgay, Adnan

    2015-11-01

    Central venous catheters are used for delivering medications and parenteral nutrition, measuring hemodynamic variations, and providing long-term intravenous access. In our clinic, during liver transection using a living-liver donor, peripherally inserted central venous catheters are generally preferred because they involve a less invasive technique with a lower risk of complications. In this report, we present the case of a 36-year-old male liver donor into whom we peripherally inserted a central venous catheter from his left basilic vein. After transecting the hepatic vein, the surgeon found foreign material inside the venous lumen, which turned out to be the distal segment of the catheter.

  1. An adverse event of suprapubic catheter SPC insertion. A call for updating the existing guidelines.

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    Jalil, Rozh; Mukundan, Chandrika; Bhatti, Tahir S

    2012-11-15

    The suprapubic catheter (SPC) is a useful and widely used tool in urological practice. However, complications can arise from its insertion or ongoing care. We add to the literature a case of an adverse event of its insertion where it has gone through a vascular graft and recommending updating the SPC insertion guidelines.

  2. Complications Associated with Insertion of Intrauterine Pressure Catheters: An Unusual Case of Uterine Hypertonicity and Uterine Perforation Resulting in Fetal Distress after Insertion of an Intrauterine Pressure Catheter

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    Kara M. Rood

    2012-01-01

    Full Text Available Insertion of intrauterine pressure catheters is a routine procedure performed in labor and delivery departments, with few associated complications. There are several reports of maternal and neonatal morbidity associated with the use of intrauterine pressure catheters and their rare adverse outcomes. We report an unusual case of uterine hypertonicity resulting in fetal distress, immediately after the placement of an intrauterine pressure catheter. An emergent Cesarean section was performed for fetal distress and revealed a 5 cm vertical rent in the posterior lower uterine segment. The uterine perforation was repaired intraoperatively. Mother and infant did well and were discharged home on postoperative day four.

  3. Complications associated with insertion of intrauterine pressure catheters: an unusual case of uterine hypertonicity and uterine perforation resulting in fetal distress after insertion of an intrauterine pressure catheter.

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    Rood, Kara M

    2012-01-01

    Insertion of intrauterine pressure catheters is a routine procedure performed in labor and delivery departments, with few associated complications. There are several reports of maternal and neonatal morbidity associated with the use of intrauterine pressure catheters and their rare adverse outcomes. We report an unusual case of uterine hypertonicity resulting in fetal distress, immediately after the placement of an intrauterine pressure catheter. An emergent Cesarean section was performed for fetal distress and revealed a 5 cm vertical rent in the posterior lower uterine segment. The uterine perforation was repaired intraoperatively. Mother and infant did well and were discharged home on postoperative day four.

  4. Central vein perforation during tunneled dialysis catheter insertion: principles of acute management.

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    Pua, Uei

    2014-10-01

    Central venous perforation during dialysis catheter insertion is a potentially fatal complication. Prompt recognition and judicious initial steps are important in optimizing the outcome. The purpose of this manuscript is to illustrate the imaging features and steps in initial management.

  5. A Rare And Life Threatening Complication Of Percutaneously Inserted Central Venous Catheters: Cardiac Tamponade.

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    seyma Kayali

    2016-09-01

    Full Text Available Percutaneously inserted central venous catheters are commonly used to provide parenteral nutrition for premature neonates. This study presents report of two preterm neonates who developed pericardial effusion resulting from osmotic damage of parenteral nutrition. When a neonate with percutaneously inserted central venous catheter clinical status worsens a high index of clinical suspicion for diagnosing pericardial effusion and immediate treatment might be life saving. [J Contemp Med 2016; 6(3.000: 226-230

  6. Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: a study protocol

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    Hagen Sander M

    2011-12-01

    Full Text Available Abstract Background Peritoneal dialysis (PD is an effective treatment for end-stage renal disease. It allows patients more freedom to perform daily activities compared to haemodialysis. Key to successful PD is the presence of a well-functioning dialysis catheter. Several complications, such as in- and outflow obstruction, peritonitis, exit-site infections, leakage and migration, can lead to catheter removal and loss of peritoneal access. Currently, different surgical techniques are in practice for PD-catheter placement. The type of insertion technique used may greatly influence the occurrence of complications. In the literature, up to 35% catheter failure has been described when using the open technique and only 13% for the laparoscopic technique. However, a well-designed randomized controlled trial is lacking. Methods/Design The LOCI-trial is a multi-center randomized controlled, single-blind trial (pilot. The study compares the laparoscopic with the open technique for PD catheter insertion. The primary objective is to determine the optimum placement technique in order to minimize the incidence of catheter malfunction at 6 weeks postoperatively. Secondary objectives are to determine the best approach to optimize catheter function and to study the quality of life at 6 months postoperatively comparing the two operative techniques. Discussion This study will generate evidence on any benefits of laparoscopic versus open PD catheter insertion. Trial registration Dutch Trial Register NTR2878

  7. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

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    Priscila Costa

    2015-06-01

    Full Text Available OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points, moderate (4 to 8 points, and high (≥ 9 points. Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

  8. Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

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    Hasanin, Ahmed M.; Mokhtar, Ali M.; Amin, Shereen M.; Sayed, Ahmed A.

    2017-01-01

    Background and Aims: Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations. Subjects and Methods: Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups. Results: Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75], P = 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2], P = 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5], P = 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 s P = 0.00). Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method. PMID:28217056

  9. Establishing learning curve for Tenckhoff catheter insertion by interventional nephrologist using CUSUM analysis: how many procedures and in which situation?

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    Goh, Bak Leong; Ganeshadeva Yudisthra, M; Lim, Teck Onn

    2009-01-01

    Peritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single-center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure rate (i.e., catheter malfunction within 1 month of insertion) was defined at >40% and acceptable performance was defined at CUSUM chart showed the learning curve of a trainee in acquiring new skill. As the trainee became more skillful with training, the CUSUM curve flattened. Technical proficiency of the trainee nephrologist in performing peritoneoscope Tenckhoff catheter insertion (CUSUM charting as described to monitor primary catheter dysfunction (i.e., failure of catheter function within 1 month of insertion), primary leak (i.e., within 1 month of catheter insertion), and primary peritonitis (i.e., within 2 weeks of catheter insertion).

  10. Percutaneously inserted long-term central venous catheters in pigs of different sizes.

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    Larsson, N; Claesson Lingehall, H; Al Zaidi, N; Claesson, J; Jensen-Waern, M; Lehtipalo, S

    2015-07-01

    Pigs are used for long-term biomedical experiments requiring repeated injections, infusions and collections of blood samples. Thus, it is necessary for vascular catheters to be indwelling to avoid undue stress to the animals and the use of restraints. We propose a refined model of percutaneous insertion of long-term central venous catheters to minimize the surgical trauma and postoperative complications associated with catheter insertion. Different sizes of needles (18 Ga versus 21 Ga) for initial puncture of the veins were compared. In conventional pigs weighing less than 30 kg, catheter insertion may be facilitated by using a microintroducer set with a 21 Ga needle. In pigs weighing 50 kg, a standard 18 Ga needle may be preferable.

  11. Evaluation of the Sherlock 3CG Tip Confirmation System on peripherally inserted central catheter malposition rates.

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    Johnston, A J; Holder, A; Bishop, S M; See, T C; Streater, C T

    2014-12-01

    Peripherally inserted central catheters are often positioned blindly in the central circulation, and this may result in high malposition rates, especially in critically ill patients. Recently, a new technology has been introduced (Sherlock 3CG Tip Positioning System) that uses an electro-magnetic system to guide positioning in the superior vena cava, and then intra-cavity ECG to guide positioning at the cavo-atrial junction. In this observational study, we investigated how the Sherlock 3CG Tip Positioning System would affect peripherally inserted central catheter malposition rates, defined using a post-insertion chest radiograph, in critically ill patients. A total of 239 catheters positioned using the Sherlock 3CG Tip Positioning System were analysed. When an adequate position was defined as low superior vena cava or cavo-atrial junction, 134 catheters (56.1%; 95% CI 50-62%) were malpositioned. When an adequate position was defined as mid/low superior vena cava, cavo-atrial junction or high right atrium (≤ 2 cm from cavo-atrial junction), 49 (20.5%; 95% CI 16-26%) catheters were malpositioned. These malposition rates are significantly lower than our own historical data, which used a 'blind' anthropometric technique to guide peripherally inserted central catheter insertion.

  12. Complications Related to Insertion and Use of Central Venous Catheters (CVC)

    Science.gov (United States)

    Hodzic, Samir; Golic, Darko; Smajic, Jasmina; Sijercic, Selma; Umihanic, Sekib; Umihanic, Sefika

    2014-01-01

    ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion. PMID:25568558

  13. Severe Intraperitoneal Haemorrhage following Suprapubic Catheter Insertion in a Patient Treated with Iloprost

    Directory of Open Access Journals (Sweden)

    R. A. J. Spence

    2013-01-01

    Full Text Available Suprapubic catheter (SPC insertion is a common urological procedure, performed both in the elective and emergency settings. The authors present an unusual case of severe intraperitoneal bleeding following the insertion of an SPC under direct vision, where the use of prostacyclin analogue may have been a contributing factor.

  14. Epidural fibrosis after permanent catheter insertion and infusion.

    Science.gov (United States)

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  15. [Complications with peripherally inserted central catheters - observations and nursing experiences at one medical center in Chengdu].

    Science.gov (United States)

    Yue, Zhi-Ying; Li, Jun-Ying; Yu, Chun-Hua; Zhao, Shu-Zhen; Fu, Yan

    2010-06-01

    Its peripheral vein puncture point, safe insertion procedure and high rate of success have made the peripherally inserted central catheter (PICC) a particularly suitable medical device for cancer patients who require long-term intravenous chemotherapy. PICC can help avoid the pain of repeat punctures as well as reduce incidence of cytotoxic drug extravasation-induced phlebitis and tissue necrosis. With PICC, patient activity is not limited, which improves quality of life. This paper reported on complications and subsequent nursing care provided to 400 cancer patients who received PICC in our center between September 2007 and October 2008. A total of 395 cases had successful PICC insertion on the first attempt and 5 cases achieved success immediately following the second insertion attempt (overall success rate: 98.8%). The average catheter dwell-in time was 122 days (range 2-350 days), during which time no patient required repeat puncture. During the insertion process, arrhythmia occurred in 1.5% (6/400), difficult catheter propelling in 3.75% (15/400), and excessive oozing of blood in 0.3% (1/400) of subjects. During the catheter dwell-in period, sensitizing dermatitis occurred in 8% (38/400), mechanical phlebitis in 7.5% (30/400), catheter occlusion in 9.5% (38/400) (including 2% [8/400] complete and 7.5% [30/400] partial occlusions), catheter associated hematogenous infection in 3% (12/400) and venous thrombosis in 2% (8/400) of subjects. All complications were well controlled with active and effective management. In conclusion, the safety of PICC can be maximized and complications reduced when nurses fully evaluate patients prior to their operation, strictly adhere to PICC operating guidelines, detect complications early, and manage problems promptly.

  16. Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

    Energy Technology Data Exchange (ETDEWEB)

    Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

    2012-09-15

    Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

  17. Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies

    NARCIS (Netherlands)

    R.F.M. Jansen (Ruud); T. Wiggers (Theo); B.N. van Geel (Bert); W.L.J. van Putten (Wim)

    1990-01-01

    textabstractOne hundred and twenty-three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were

  18. Insertion of an intrathecal catheter following accidental dural puncture : a meta-analysis

    NARCIS (Netherlands)

    Heesen, M.; Kloehr, S.; Rossaint, R.; Walters, M.; Straube, S.; van de Velde, M.

    2013-01-01

    Background: Inserting an intrathecal catheter after accidental dural puncture in parturients to prevent postdural puncture headache is becoming increasingly popular. We aimed to identify relevant published articles investigating this intervention and subject data to a meta-analysis. Methods: A syste

  19. An unknown complication of peripherally inserted central venous catheter in a patient with ventricular assist device

    Directory of Open Access Journals (Sweden)

    Parikh M

    2011-01-01

    Full Text Available We report an unknown complication of peripherally inserted central venous catheter in a patient with Ventricular Assist Device. This rare complication led to the failure of the right ventricular assist device, which could be detrimental in patients with dilated cardiomyopathy.

  20. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis

    NARCIS (Netherlands)

    van den Hoogen, Agnes; Brouwer, Mieke J.; Gerards, Leo J.; Fleer, Andre; Krediet, Tannette G.

    2008-01-01

    Background: Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of r

  1. Application of intravenous electrocardiography for insertion of central veins dialysis catheters

    Directory of Open Access Journals (Sweden)

    Beigi Ali

    2009-01-01

    Full Text Available One fifth of the inserted dialysis catheters in the internal jugular or subclavian veins may be misplaced. Appropriate positioning of the catheter tip is sometimes difficult. We attempted to use intravenous electrocardiography (ECG to guide catheter tip positioning in 30 hemodialysis patients (17 (57% were men, and the mean age was 43 ± 12 years. who required vascular accesses for dialysis by insertion of double lumen temporary catheters via the jugular veins. Before cathe-terization, standard ECG on the long lead D II was performed and P-wave height was recorded. P-wave voltage was also measured via the blue (venous and red (arterial lumens, using the guide wire as an electrical conductor. After confirmation of the appropriate position of the catheter tip at the superior vena cava (SVC-right atrial junction using chest radiography, the ECG lead corres-ponding to the right hand was connected to the guide wire lodged inside the lumen of the blue catheter. P-wave height in the long lead D II was recorded. The guide wire was withdrawn so as to bring its tip tangent to the tip of the red catheter. ECG was performed on the long lead D II in a similar manner, and the P-wave height was recorded. The mean P-wave voltage in normal ECG and intravenous ECG (red and blue catheter tips measured 1.27 ± 0.38 mm, 3.10 ± 0.95 mm, and 5.42 ± 1.76 mm, respectively. The difference between the mean P-wave voltages measured in standard and intravenous ECG (blue and red catheter tips was statistically significant (P< 0.05. We conclude that the dialysis catheter tip can be positioned appropriately via the measurement of the P-wave height by intravenous ECG and using the sinoatrial node as an accurate landmark. This method can complement the chest radiography in the appropriate placement of the central vein catheters.

  2. Placement of a peripherally inserted central catheter into the azygous vein

    Energy Technology Data Exchange (ETDEWEB)

    Franklin, Iain, E-mail: iain.franklin@health.qld.gov.au; Gilmore, Christopher [The Prince Charles Hospital, Brisbane, Queensland (Australia)

    2015-06-15

    Peripherally inserted central catheters (PICC) are used for a variety of infusion therapies. They are indicated in patients requiring long-term venous access. Incorrect positioning of the insertion of a PICC line is one of the known complications when inserting the device in clinical practice. Radiographers once performing imaging will commonly check if the tip of a PICC has entered the superior vena cava. This case study will report on a lesser known incorrect placement of a PICC line into the azygous vein and how this can be detected on radiographic imaging. This outcome for the patient can be detrimental as it has an increased risk of perforation, thrombus, and fistula formation.

  3. Exchange of peripherally inserted central catheters is associated with an increased risk for bloodstream infection.

    Science.gov (United States)

    McCoy, Michael; Bedwell, Susan; Noori, Shahab

    2011-06-01

    It is not uncommon that the peripherally inserted central catheter (PICC) needs to be replaced either due to blockage or migration to a peripheral position. In such circumstances, there are two methods of PICC placement: new-site insertion and exchange by using the old PICC as a guide wire. Our objective was to investigate risk of infection associated with the exchange method. In this retrospective study, data on all PICC insertions in the neonatal intensive care unit in 2004 to 2008 were obtained. In the population who needed removal of existing PICC and insertion of a new one, we compared central line-associated bloodstream infection (CLABSI) within 1 week of insertion between the two insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61 exchange insertions) were performed after removal of a blocked/malpositioned PICC and therefore comprised the study population. The rate of CLABSI was higher in the exchange method (9.8% versus 1%, P exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P = 0.01). In infants, insertion of PICCs using the exchange method carries an increased risk of bloodstream infection.

  4. The Forgotten Guide Wire: A Rare Complication of Hemodialysis Catheter Insertion

    Directory of Open Access Journals (Sweden)

    Said Abuhasna

    2011-01-01

    Full Text Available A rare complication of a hemodialysis catheter insertion is the loss of the complete guide wire into the circulation. A complete guide wire in the circulation may not necessarily produce symptoms, and it may remain unnoticed for a significant period of time. We present a rare case where a complete guide wire was lost into the circulation during insertion of a hemodialysis catheter into the right femoral vein in a 19-year-old female with systemic lupus erythromatosis. The patient remained asymptomatic through two plasmapheresis treatments over a period of 2 days. The guide wire was eventually retrieved without complications. The factors leading to the wire being forgotten will be reviewed, and the measures initiated to prevent any future occurrence will be addressed.

  5. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations

    DEFF Research Database (Denmark)

    Westergaard, B; Classen, V; Walther-Larsen, S

    2013-01-01

    in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search......Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices...

  6. Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

    Energy Technology Data Exchange (ETDEWEB)

    Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

    2009-08-15

    Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

  7. Sherlock 3CG(®) Tip Confirmation System for Placement of Peripherally Inserted Central Catheters: A NICE Medical Technology Guidance.

    Science.gov (United States)

    Dale, Megan; Higgins, Ailish; Carolan-Rees, Grace

    2016-02-01

    In current clinical practice, peripherally inserted central catheters (PICCs) are typically inserted using external anatomical measurements and a confirmatory chest X-ray, or using fluoroscopy. The Sherlock 3CG(®) Tip Confirmation System (TCS) allows magnetic tracking of the PICC tip during insertion and confirmation of the final location using ECG, meaning that most patients will not require a chest X-ray or fluoroscopy. The Sherlock 3CG(®) TCS was evaluated in 2014 by the UK National Institute for Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme. The company (C.R. Bard Ltd) identified four abstracts, one paper pending publication and questionnaire data from NHS users of the Sherlock 3CG(®) TCS. None of the evidence included a comparator arm. Placement accuracy of PICCs using the Sherlock 3CG(®) TCS where a chest X-ray was also used ranged from 79.5 to 100 %. The company reported that 9 out of 16 NHS centres that used the Sherlock 3CG(®) TCS were no longer using chest X-rays to routinely confirm PICC tip location. The evidence did not report the need for catheter repositioning, re-insertion, staff time savings, treatment delays, length of stay, quality of life outcomes or complications. The company's model found that the Sherlock 3CG(®) TCS was cost saving by GBP25.67 per patient compared to blind bedside PICC insertion. The External Assessment Centre (EAC) adapted the company's model to test alternative assumptions for nurse time, theatre cost, malposition rate and reinsertion method, and found that the Sherlock 3CG(®) TCS was cost incurring by GBP9.37 per patient compared to blind bedside PICC insertion. The use of the Sherlock 3CG(®) TCS in the UK NHS compared to blind PICC insertion using a confirmatory chest X-ray appears to hover around being cost neutral. Staff time and accuracy were key drivers in the model: evidence for these is sparse and the reality will vary in different situations. If evidence became

  8. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    Directory of Open Access Journals (Sweden)

    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  9. Inserting central venous catheter in emergency conditions in coagulopathic patients in comparison to noncoagulopathic patients

    Directory of Open Access Journals (Sweden)

    Mohammad Nasr-Esfahani

    2016-01-01

    Full Text Available Background: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC insertion under ultrasound guidance in patients with and without coagulopathy. Materials and Methods: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times. Results: There was no significant difference in the terms of demographic features, catheter lumen size (P = 0.43, and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] = 0.36–15.3, P = 0.39 between two groups. Seven out of 59 patients suffered from complications (11.9% that the complications in coagulopathic patients were oozing (5.7% and superficial hematoma (8.6% while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09–3.07, P = 0.767. Conclusion: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

  10. A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

    Science.gov (United States)

    Johnson, S M; Garnett, G M; Woo, R K

    2017-01-01

    Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited

  11. Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bouzad, Caroline, E-mail: caroline.bouzad@gmail.com [Percy Military Teaching Hospital, Radiology Department (France); Duron, Sandrine, E-mail: duronsandrine@yahoo.fr [GSBdD, Military Centre for Epidemiology and Public Health (CESPA) (France); Bousquet, Aurore, E-mail: aurorebousquet@yahoo.fr [Begin Military Teaching Hospital, Bacteriology Department (France); Arnaud, François-Xavier, E-mail: fxa0160@hotmail.com [Percy Military Teaching Hospital, Radiology Department (France); Valbousquet, Laura, E-mail: laura.valbousquet@gmail.com [Begin Military Teaching Hospital, Radiology Department (France); Weber-Donat, Gabrielle, E-mail: weberdonatgabrielle@yahoo.fr; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Baccialone, Jacques, E-mail: jacques.baccialone@wanadoo.fr; Potet, Julien, E-mail: potet-julien@yahoo.fr [Percy Military Teaching Hospital, Radiology Department (France)

    2016-03-15

    PurposeTo determine the incidence and the risks factors of peripherally inserted central catheter (PICC)-related infectious complications.Materials and MethodsMedical charts of every in-patient that underwent a PICC insertion in our hospital between January 2010 and October 2013 were reviewed. All PICC-related infections were recorded and categorized as catheter-related bloodstream infections (CR-BSI), exit-site infections, and septic thrombophlebitis.ResultsNine hundred and twenty-three PICCs were placed in 644 unique patients, mostly male (68.3 %) with a median age of 58 years. 31 (3.4 %) PICC-related infections occurred during the study period corresponding to an infection rate of 1.64 per 1000 catheter-days. We observed 27 (87.1 %) CR-BSI, corresponding to a rate of 1.43 per 1000 catheter-days, 3 (9.7 %) septic thrombophlebitis, and 1 (3.2 %) exit-site infection. Multivariate logistic regression analysis showed a higher PICC-related infection rate with chemotherapy (odds ratio (OR) 7.2–confidence interval (CI) 95 % [1.77–29.5]), auto/allograft (OR 5.9–CI 95 % [1.2–29.2]), and anti-coagulant therapy (OR 2.2–95 % [1.4–12]).ConclusionChemotherapy, auto/allograft, and anti-coagulant therapy are associated with an increased risk of developing PICC-related infections.Clinical AdvanceChemotherapy, auto/allograft, and anti-coagulant therapy are important predictors of PICC-associated infections. A careful assessment of these risk factors may be important for future success in preventing PICC-related infections.

  12. Intraoperative precautionary insertion of external ventricular drainage catheters in posterior fossa tumors presenting with hydrocephalus

    Directory of Open Access Journals (Sweden)

    Hosam A.M. Habib

    2014-12-01

    Conclusion: Intra-operative insertion of EVD catheter during surgery of posterior fossa tumors, as it allows better control of the ICT during surgery if needed, provides a life saving emergency CSF drainage outlet if tumor resection fails to resolve HC or for the occurrence of de novo HC, and finally it provides adequate control of CSF leak in cases with supratentorial ventriculomegaly, where the use of lumbar drains may be hazardous. Intraoperative drainage prevents possible complications met with early CSF diversion. But the application of this technique should better be restricted to midline posterior fossa tumors related to the ventricular system.

  13. Risk factors for development of complication following peripherally inserted central catheters: A retrospective analysis of 850 patients

    OpenAIRE

    Aydın, Hakan; Korfalı, Gülsen; Gören, Suna; Efe, Esra Mercanoğlu; Moustafa, Bachri Ramadan; Yazıcı, Tolga

    2014-01-01

    Objectives: Peripherally inserted central venous catheters (PICCs) are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia Methods: ‘Central Venous Catheterization Forms\\' filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009 and Mar...

  14. Risk factors for development of complication following peripherally inserted central catheters: A retrospective analysis of 850 patients

    OpenAIRE

    Aydın, Hakan; Korfalı, Gülsen; Gören, Suna; Efe, Esra Mercanoğlu; Moustafa, Bachri Ramadan; Yazıcı, Tolga

    2015-01-01

    Objectives: Peripherally inserted central venous catheters (PICCs) are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia Methods: ‘Central Venous Catheterization Forms\\' filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009...

  15. Ultrasound-guided central line insertion and standard peripherally inserted catheter placement in preterm infants: Comparing results from prospective study in a single-center

    Directory of Open Access Journals (Sweden)

    Dany Antanios Al Hamod

    2016-01-01

    Full Text Available Background: Among preterm infants, the peripherally inserted central catheter (PICC is the standard line for central venous access; however, its placement exposes them to hypothermia and pain. Ultrasound (US-guided central line insertion may be less morbid than standard PICC line. Aims: To determine the ease, success rate, and morbidity associated with US-guided central line insertion in the internal jugular vein (IJV by comparing it to the standard PICC line placement. Materials and Methods: This is a single-center nonrandomized prospective study evaluating preterm infants between October 2013 and June 2014. Patients were allocated into two groups: The standard group (control group who underwent blind PICC line insertion and the intervention group who underwent a percutaneous US-guided central line insertion in the IJV. The epicutaneo-cava-catheter was used in both groups. Results: Fifty neonates were enrolled on study. A statistically difference in favor of US-IJV insertion was noted concerning the rate of successful first attempt (P < 0.001, insertion (P = 0.001, and procedure duration (P < 0.001 and number of trials (P < 0.001 compared to PICC. No difference in complications (P = 1.000 was noted. Conclusion: US guided catheterization of the IJV technique is faster than PICC line insertion with higher rates of successful first attempt and insertion, less procedure duration and fewer number of trials compared to PICC line insertion. There were no differences in complications.

  16. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies.

    Science.gov (United States)

    Sakai, Toshiro; Kohda, Kyuhei; Konuma, Yuichi; Hiraoka, Yasuko; Ichikawa, Yukari; Ono, Kaoru; Horiguchi, Hiroto; Tatekoshi, Ayumi; Takada, Kouichi; Iyama, Satoshi; Kato, Junji

    2014-12-01

    Central venous catheter-related blood stream infections (CR-BSIs) are a serious complication in patients with hematological malignancies. However, it remains unclear whether there is a difference in the rate of CR-BSI associated with the conventional type of central venous catheters (cCVCs) and peripherally inserted CVCs (PICCs) in such patients. To address this question, we retrospectively investigated the incidence of CR-BSIs associated with PICCs versus cCVCs in patients with hematological malignancies. We used PICCs in all consecutive patients requiring CVC placement between February 2009 and February 2013. We compared the CR-BSI rate in patients with PICCs with that in patients with cCVCs treated between September 2006 and January 2009 (control group). Eighty-four patients received PICCs and 85 received cCVCs. The most common reason for removal due to catheter-related complications was CR-BSI. The CR-BSI rate in the PICC group was significantly lower than that in the cCVC group (PICCs: 1.23/1000 catheter days; cCVCs: 5.30/1000 catheter days; P Catheter-related complications other than CR-BSIs occurred at an extremely low rate in the PICC group. The median catheter-related complication-free survival duration was significantly longer in the PICC group than in the cCVC group. Our study shows that PICCs are useful in patients with hematological malignancies.

  17. High risk of deep vein thrombosis associated with peripherally inserted central catheters in lymphoma

    Science.gov (United States)

    Li, Chao-Feng; Wang, Yu; Liu, Pan-Pan; Bi, Xi-Wen; Sun, Peng; Lin, Tong-Yu; Jiang, Wen-Qi; Li, Zhi-Ming

    2016-01-01

    Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients. Although PICC is a convenient tool, its use is associated with an obvious increase in the incidence of venous thrombosis. The risk factors for deep vein thrombosis associated with the use of PICCs in cancer patients are largely unexplored. This study aimed to investigate the incidence of PICC-associated thrombosis in lymphoma compared with its incidences in other types of cancer. A total of 8028 adult cancer patients inserted with PICC between June 2007 and June 2015 were included in this study. A total of 249 of the 8028 included patients (3.1%) inserted with PICC developed upper extremity deep vein thrombosis (PICC-UEDVT). Patients with lymphoma were more likely to have PICC-UEDVT than those with other types of malignancies (7.1% vs. 2.80%; P < 0.001). Logistic analysis revealed that a lymphoma diagnosis was a risk factor for UEDVT in cancer patients inserted with PICC (OR: 3.849, 95% CI: 2.334–6.347). Patients with lymphoma may be more predisposed to developing PICC-UEDVT than those with other types of malignancies. Identifying the mechanism underlying the relationship between PICC-UEDVT and lymphoma requires further study. PMID:27078849

  18. Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion

    Directory of Open Access Journals (Sweden)

    Aloka Samantaray

    2014-01-01

    Full Text Available Background and Aim: Central venous catheter (CVC insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Methods: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 μg/kg or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points. Results: The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7] and at the end of procedure (5 [4-5], which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively. The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008. Conclusions: Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose.

  19. Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

    Directory of Open Access Journals (Sweden)

    Valter Perilli

    2014-01-01

    Full Text Available Background: The use of suction catheter (SC has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA insertion in expert users. Aims: The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT in anaesthetised non-paralysed patients. Methods: In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years, undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m 2 , laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron′s criteria ≥2 and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group or SC (SC-group. Statistical Analysis: Chi-square test with Yates′ correction, Mann-Whitney U-test or Student′s t-test were carried-out as appropriate. Results: The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109 versus 74.4% (n = 99 respectively (P = 0.002. Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001. There were no differences in insertion time, post-operative airway morbidity and complications. Conclusion: The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.

  20. Radiographic inguinal curl may indicate paraspinal misplacement of percutaneously inserted central venous catheters: report of three cases

    Energy Technology Data Exchange (ETDEWEB)

    Chedid, Faris [Al Tawam Hospital, Department of Paediatrics, Al Ain, Abu Dhabi (United Arab Emirates); Abbas, Adil [Royal Children' s Hospital, Department of Clinical Haematology/Oncology, Brisbane (Australia); Morris, Lloyd [Women' s and Children' s Hospital, Department of Medical Imaging, Adelaide (Australia)

    2005-07-01

    Misplacement of percutaneously inserted central venous catheters (PCVCs) into the paraspinal venous plexus can result in devastating outcomes. Several cases have been reported in the literature together with an explanation of the mechanism. To describe three premature babies with their PCVCs inserted through the left saphenous vein that ended up in the lumbar spinal dural venous plexus. Plain radiographs obtained to check positions showed an unusual 360 curl of the PCVC in the left inguinal area. We believe that misplacement of the catheter into the paraspinal venous plexus could be diagnosed with great accuracy if such a curl is seen. (orig.)

  1. Evaluation of the usefulness of coronary catheters and 4 Fr insertion sets for transradial access coronarography in comparison with catheters and 5 Fr sets

    Science.gov (United States)

    Chodór, Piotr; Sulik-Gajda, Sylwia; Ramus, Nela; Kowalczyk, Jacek; Honisz, Grzegorz; Wilczek, Krzysztof; Średniawa, Beata; Kalarus, Zbigniew

    2013-01-01

    Introduction Application of transradial arterial access during coronarography, besides pain, means faster patient mobilization and fewer complications. During those procedures, vascular sheaths and 5/6 Fr catheters, and lately 4 Fr catheters, are used. Aim To assess the usefulness of 4 Fr catheters and sheaths in comparison to 5 Fr in diagnostic coronarography. Material and methods In the period from 5.12.2010 to 27.02.2012, a group of patients who had coronarography with a 4 Fr catheter (n = 20) and a 5 Fr catheter (n = 20) were studied. Technical issues and potential problems related to the use of each catheter were analyzed. Morphology, biochemical parameters, and local complications were analyzed. The assessment included pain intensification during catheter removal and insertion in the VAS/numerical (0–10)/verbal scales and the quality of image obtained during the coronarography. Results All the angiograms obtained during all the interventions were of diagnostic value and in invasive cardiologists’ opinions, they did not differ statistically in clarity. Moreover, there were no statistically significant differences in radiation/fluoroscopy time, amount of contrast medium, or morphological and biochemical parameters. The size of hematomas in the 4 Fr group was 17.55 ±14.6 cm2, and in the 5 Fr group 31.07 ±32.11 cm2, p = 0.12. The average intensity of pain felt during the intervention/at the time of its removal and insertion in the numerical scale was in the 4 Fr group 0.65 ±0.93/0.55 ±0.94 and in the 5 Fr group 1.88 ±1.64/1.42 ±1.61, p < 0.05. Conclusions Application of 4 Fr catheters allows one to perform a diagnostic procedure with a small number of local and hemorrhagic complications comparable with 5 Fr catheters. Due to reduced pain, it is appropriate to continue studies with the use of 4 Fr catheters and sheaths. PMID:24570748

  2. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    Science.gov (United States)

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  3. [Peripherally inserted central catheters (PICC) in onco-hematology. PICC line in onco-hematology].

    Science.gov (United States)

    Kabsy, Y; Baudin, G; Vinti, H; Novellas, S; Mannone, L; Chevallier, P; Mounier, N

    2010-09-01

    Peripherally inserted central catheters (PICC) have the advantage of limiting the risk of accidents during installation and are easy to remove. Its use in oncology remains debated because of possible infectious complications. We analyzed 52 PICC in patients with hematological tumor from Nice Hospital. An installation failure was noted in 5.8% of cases. After a follow-up of 15 months, the complication rate was 26.9%, mainly mechanical complications: obstruction (13.5%) or accidental removal (9.6%). The organic complications such as infection or thrombophlebitis represented 3.8%. The median duration was 26 days [2-291]. The longest duration was associated with PICC for chemotherapy (median: 58 days). Frequent blood samples (above: 2 week) were associated with lower duration (median: 23 days). In conclusion, PICC represent a simple and effective alternative to intra-venous central devices in onco-hematology. However, physicians have to focus on short-course treatment.

  4. Comparison of complications between pediatric peripherally inserted central catheter placement techniques

    Energy Technology Data Exchange (ETDEWEB)

    Dasgupta, Niloy; Lungren, Matthew P. [Lucile Packard Children' s Hospital Stanford, Department of Radiology, Palo Alto, CA (United States); Patel, Manish N.; Racadio, John M.; Johnson, Neil D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2016-09-15

    Peripherally inserted central catheter (PICC) is among the most common procedures performed in children in the hospital setting. PICC insertion can be simplified with the use of a sheathed needle as an alternative to the modified Seldinger technique. To retrospectively evaluate PICC placement for the technique used and the incidence of complications at a large pediatric tertiary care center. We retrospectively reviewed all PICC placements at a single institution over a 4-year period. We reviewed patient records for demographic data, PICC placement technique, catheter size and number of lumens, and the incidence of complications (i.e. multiple attempted puncture sites, phlebitis and vessel thrombosis). We analyzed complication rates between two placement techniques using a chi-square test. We identified 8,816 successful PICC placements, 4,749 (53.9%) in males and 4,067 (46.1%) in females. The average age of the patients for which a line was placed was 5.6 years (range 1 day to 45 years). A direct sheathed needle puncture technique was used in 8,362 (94.9%) placements and a modified Seldinger technique was used in 454 (5.1%). Complications occurred in 312 (3.7%) of direct sheathed needle puncture placements versus 17 (3.7%) of modified Seldinger placements (P = 0.99). Multiple puncture sites were required in 175 (2.1%) attempted direct sheathed needle puncture placements compared with 8 (1.7%) attempted modified Seldinger placements (P = 0.63). Phlebitis occurred in 94 (1.1%) direct sheathed needle puncture lines versus 5 (1.1%) modified Seldinger placed lines (P = 0.96). Vessel thrombosis occurred in 43 (0.5%) direct sheathed needle puncture lines versus 4 (0.9%) modified Seldinger placed lines (P = 0.30). The direct peel-away sheathed needle vessel puncture technique and the modified Seldinger technique used to place PICC lines in children have similar complication rates. (orig.)

  5. Outcome of tunneled infusion catheters inserted via the right internal jugular vein

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sung Wook; Do, Young Soo; Choo, Sung Wook; Yoo, Wi Kang; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jae Hyung [Sanggye Paik Hospital, Inje University, Seoul (Korea, Republic of)

    2003-03-01

    To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheter were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted, namely the one case of thrombophlebitis. Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

  6. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters.

    Science.gov (United States)

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ≥1 risk factor was 10.34% (12/116), in those with ≥2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis.

  7. Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle

    NARCIS (Netherlands)

    K. Helder MScN (Onno); R.F. Kornelisse (René); C. van der Starre (Cynthia); D. Tibboel (Dick); C.W.N. Looman (Caspar); R.M.H. Wijnen (René); M.J. Poley (Marten); E. Ista (Erwin)

    2013-01-01

    textabstractBackground: Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requir

  8. Analysis of risk factors and the establishment of a risk model for peripherally inserted central catheter thrombosis

    Institute of Scientific and Technical Information of China (English)

    Fang Hu; Ruo-Nan Hao; Jie Zhang; Zhi-Cheng Ma

    2016-01-01

    Objective: To investigate the main risk factors of peripherally inserted central catheter (PICC) related upper extremity deep venous thrombosis and establish the risk predictive model of PICC-related upper extremity deep venous thrombosis. Methods: Patients with PICC who were hospitalized between January 2014 and July 2015 were studied retrospectively; they were divided into a thrombosis group (n ¼ 52), with patients who had a venous thrombosis complication after PICC, and a no-thrombosis group (n ¼ 144), with patients without venous thrombosis. To compare between the two groups, significantly different variables were selected to perform multivariate logistic regression to establish the risk-predictive model. Results: The PICC catheter history, catheter tip position, and diameter of blood vessel were the key factors for thrombosis. The logistic regression predictive model was as follows:Y ¼ 3.338 þ 2.040 ? PICC catheter history þ1.964? catheter tip position ?1.572? diameter of vessel. The area under the receiver operating characteristic curve for the model was 0.872, 95%CI (0.817e0.927). The cut-off point was 0.801, the sensitivity of the model was 0.832, and the specificity was 0.745. Conclusions: The PICC catheterization history, catheter tip position, the diameter of blood vessel were the key factors for thrombosis. The logistic regression risk model based on these factors is reliable for predicting PICC-related upper extremity deep venous thrombosis.

  9. Voice prosthesis insertion after endoscopic balloon-catheter dilatation in case of a stenotic hypopharyngo-oesophageal junction.

    Science.gov (United States)

    Móricz, Péter; Gerlinger, Imre; Solt, Jeno; Somogyvári, Krisztina; Pytel, József

    2007-12-01

    Stenosis of the hypopharyngo-oesophageal junction can be a rare complication of laryngectomy and/or partial pharyngectomy and makes the insertion of voice prosthesis extremely difficult. This study describes the authors' experiences gained by endoscopic balloon-catheter dilatation of hypopharyngo-oesophageal stenoses prior to implantation of voice prostheses in four cases. In two patients a single balloon-catheter dilatation resulted in wide enough pharyngo-oesophageal lumen on the long run. The average prosthesis wearing-times were 6.8 months in case 1 and 4.6 months in case 2, corresponding to the published literature data. In case 3, repeated dilatation of the pharyngo-oesophageal transition had proved to be unsuccessful despite taking every effort with the endoscopic balloon-catheter method. Having excised the stenotic segment, reconstruction with pectoralis major myocutaneous flap (PMMF) was indicated. Eighteen months later, a repeated restenosis was observed and a free jejunal flap needed to be performed as a final solution. In case 4, the insertion was carried out into a previously dilated jejunal free flap, which became gradually ischemic and stenotic since the major head-and neck procedure was carried out that resulted in prosthesis rejection after just 1 week. The authors emphasize that correct indication of pedicled and free flaps in head and neck reconstruction is a prerequisite from the aspect of prevention of pharyngo-oesophageal strictures. Endoscopic balloon-catheter dilatation is a safe and established method for dilatating hypopharyngo-oesophageal stenoses of different origin. The procedure provides maximum patient benefit with minimal trauma and morbidity; moreover, facilitates insertion of voice prostheses. However, a single balloon-catheter dilatation cannot always result in wide enough oesophageal lumen on the long run (case 3). Insertion of a voice prosthesis into a previously dilated ischemic jejunal segment is challenging and avoidable due

  10. Catheter Angiography

    Medline Plus

    Full Text Available ... an artery through a small incision in the skin. Once the catheter is guided to the area ... small incision (usually a few millimeters) in the skin where the catheter can be inserted into an ...

  11. Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: A randomized controlled trial

    NARCIS (Netherlands)

    J. Kwakman (Jan); M.C. Müller (Marcella); J.M. Binnekade (Jan); J.P. van den Akker (Johannes); C.A. de Borgie (Corianne); M.J. Schultz (Marcus); S.A.J. Zaat (Sebastiaan)

    2012-01-01

    textabstractIntroduction: Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for

  12. Complications Involving Central Venous Catheter Insertion in Newborns Admitted to the Neonatal Intensive Care Unit (NICU

    Directory of Open Access Journals (Sweden)

    Torkaman

    2016-04-01

    Full Text Available Background Developments in the use of central venous catheters have improved the treatment of critically ill newborns. Objectives The aim of this retrospective study was to evaluate the rate of catheter-related complications and associated risk factors in newborns. Patients and Methods This cross sectional study evaluated 60 infants with indications for central venous catheters who were selected by census from 2007 to 2014 in Baqiyatallah Hospital in Tehran, Iran. The catheters were Broviac numbers 14 - 16. Results Ultimately, 60 cases (17 males and 43 females with a mean age of 26.25 ± 20.09 days (Min = 1 day and Max = 153 days underwent analysis. The most common reasons for venous catheter placement (98.3% were prolonged hospitalization and lack of peripheral vessels. The most common complication was catheter-related infection, which occurred in 20 patients (33.3%. Death occurred in 24 patients (40.0%, but only 3 deaths (5% were due to complications from the central venous catheter. A significant relationship was evident between infection and catheterization duration (P = 0.02. Conclusions Most of the catheter-related deaths were due to severe sepsis and hemothorax, and a significant relationship was noted between infection and both the mortality rate and catheterization duration. A significant relationship was also evident between birth weight and infection rates.

  13. Sonographic guidance for tunneled central venous catheters insertion in pediatric oncologic patients:guided punctures and guide wire localization

    Institute of Scientific and Technical Information of China (English)

    Gehad T. Meselhy; Kareem R. Sallam; Maged M. Elshafiey; Amal Refaat; Ahmad Samir; Alaa A. Younes

    2012-01-01

    Objective: Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper position vary among different centers. The article presented different techniques for sonographic guided puncture of the target central vein and confirmation of the proper position of tunneled catheters. Methods: This was an observational study with a single crossover phase, in which operators initially used the open cut down technique and subsequently converted to the ultrasound guided technique. Internal jugular vein (IJV) was used in all cases. Results: In ultrasound guided group, TIDs were inserted in 121cases while ETCs were inserted in 13 cases. Ultrasound was successful in guiding IJV puncture from the first trial in all cases and in guide-wire localization in the right atrium in 132 cases. There were no reported cases of hematoma, pneumothorax,hemothorax, catheter malposition or surgical-site infection (SSI) in the perioperative period. In the open cut down group, TIDs were inserted in 119 cases. Two patients developed post operative hematoma and one of them developed SSI. The mean time of ultrasound guided TIDs was (30.04 ± 1.1) minutes which was significantly lower than the mean time of cases done by theopen cut down technique (45.4 ± 3.1) minutes (P < 0.0001). Conclusion: Ultrasound guidance is helpful for insertion of TIDs and ETCs in the IJV in pediatric oncologic patients. It minimizes the need for open cut downs and fluoroscopy.

  14. [Efficacy of educational intervention for patients wearing peripherall inserted central catheter. A pilot study].

    Science.gov (United States)

    Fusco, Federica; Armando, Tiziana; Storto, Silvana; Mussa, Maria Valentina

    2016-01-01

    Introduzione: Il Peripherally Inserted Central Catheter (PICC) è un catetere venoso centrale adatto per pazienti in regime di Day Hospital. Il suo utilizzo è considerato vantaggioso ma comporta degli oneri di gestione a carico della persona. E' bene formare il paziente ad una corretta gestione domiciliare del presidio attraverso un'educazione strutturata. Obiettivo: In un gruppo di pazienti portatori di PICC, valutare l'efficacia di un intervento educativo mirato attraverso la comparazione di: colloquio informativo, opuscolo cartaceo, video informativo. Metodo: Studio clinico randomizzato e controllato monocentrico, schema comparativo semplice a tre bracci. Popolazione: tutti i pazienti sottoposti all'impianto di PICC nel periodo di osservazione tra Ottobre 2013 e Febbraio 2014 presso l'Unità Operativa Day Hospital Oncologico e Breast Unit, presidio Molinette di Torino. L'intervento educativo standard è erogato attraverso un colloquio con l'infermiere che esegue l'impianto. Il team di impiantatori è costituito da due infermieri con comprovata esperienza in ambito oncologico ed in possesso di Master di I Livello "Gestione degli accessi venosi". I pazienti eleggibili, dopo randomizzazione, sono stati divisi in tre gruppi: gruppo A colloquio informativo; gruppo B opuscolo; gruppo C video. I pazienti dei gruppi B e C hanno ricevuto informazioni standard inte- grate con informazioni audiovisive oppure cartacee, in base al braccio al quale erano stati destinati; il grado di conoscenza raggiunto è stato indagato attraverso la somministrazione di questionari costruiti ad hoc, non vali- dati in quanto non presenti in letteratura. Risultati: Adesione allo studio di 40 pazienti, campione di convenienza costituito da persone di età compresa tra 18 e 75 anni, consenzienti e risiedenti al proprio domicilio. L'analisi delle conoscenze apprese in seguito all'intervento educativo mostra una differenza statisticamente significativa in diversi ambiti necessari per la

  15. Alginate Dressing Application in Hemostasis After Using Seldinger Peripherally Inserted Central Venous Catheter in Tumor Patients.

    Science.gov (United States)

    Yang, Qun; Lei, Sanlin

    2015-12-01

    The aim of this study is to observe hemostatic effects of alginate dressing after using seldinger PICC catheter in tumor patients. Sixty tumor patients with PICC receiving chemotherapy were divided into the test group (30 cases) and the control group (30 cases) randomly. The test group was treated with alginate dressing and oppressed by the puncture point, while the control group was treated with gauze of the same size. PICC transparent films were used in both groups. Finally, dressing ooze blood soaked states on the puncture points and dressing change times were observed in the two groups for 1 week. Moreover, local infection rate and incidence of catheter leak were also evaluated. The results showed that the oozing of blood and the changing frequency in the test group were obviously less than that in the control group, and there has a statistical difference (P seldinger PICC catheter-induced hemorrhage.

  16. Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis.

    Science.gov (United States)

    He, Mingliang; Ouyang, Leping; Wang, Shengwen; Zheng, Meiguang; Liu, Anmin

    2016-09-01

    OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

  17. Clinical effect of peripherally inserted central catheters based on modified seldinger technique under guidance of vascular ultrasound

    Science.gov (United States)

    Wang, Qingguo; Wang, Ni; Sun, Yuzhen

    2016-01-01

    Objective: To observe and analyze the application effect of ultrasound-guided modified Seldinger technique (MST) in Peripherally Inserted Central Catheter (PICC) catheterization. Methods: Two hundred patients treated with PICC catheterization from January 2013 to December 2015 were selected and randomly divided into two groups, namely, observation group and control group. The observation group adopted ultrasound-guided MST for catheterization while the control group applied traditional puncture technique for catheterization. Then efficacy of catheterization, success rate of catheterization and incidence rates of complications were compared between two groups. Results: Various indicators of catheterization effects of the observation group were better than those of the control group, and the differences were statistically significant (Psatisfaction and comfort level of patients. PMID:27882017

  18. Comparison of outcomes between surgically placed and percutaneously placed peritoneal dialysis catheters: A retrospective study

    Science.gov (United States)

    Sivaramakrishnan, R.; Gupta, S.; Agarwal, S. K.; Bhowmik, D.; Mahajan, S.

    2016-01-01

    There is lack of adequate data on comparison of outcomes between percutaneously placed peritoneal dialysis (PD) catheters inserted by nephrologists and PD catheters placed by surgeons. The aim of this study is to retrospectively analyze the outcomes of PD catheters inserted by surgeons (by open surgical or laparoscopic technique) and compare them with those inserted by nephrologists among ESRD patients who underwent elective PD catheter insertions between January 2009 and December 2012. The primary outcome measure was the proportion of catheters removed because of primary nonfunction. The secondary outcome measures were catheter survival, patient survival, and incidence of complications of catheter insertion. A total of 143 PD catheter insertions (88 by surgeons and 55 by nephrologists) performed in 132 patients were considered for the analysis. The primary nonfunction rate of PD catheter insertions in both groups was comparable (18.2% and 7.3%, P = 0.08). Break-in period was shorter in Group N (p = <0.001). No differences were noted in patient or catheter survival. Percutaneously placed PD catheters performed by nephrologists have comparable outcomes with surgically placed PD catheters among selected cases and have the advantage of lower costs, avoidance of operation theater scheduling issues, smaller incision length, and shorter break-in period. Therefore, more nephrologists should acquire the expertise on percutaneous PD catheter placement as it leads to lesser waiting times and better utilization of PD. PMID:27512299

  19. Iatrogenic acute cardiac tamponade during percutaneous removal of a fractured peripherally inserted central catheter in a premature neonate.

    Science.gov (United States)

    Minghui, Zou; Hujun, Cui; Li, Ma; Weidan, Chen; Yanqin, Cui; Xinxin, Chen

    2015-01-01

    Acute cardiac tamponade (ACT) is a life-threatening complication associated with a peripherally inserted central catheter (PICC) in premature neonates. We present a case of ACT in a 4-day-old male infant. On the second admission day, a PICC was inserted. After 2.5 months, chest radiography showed PICC fracture, and its distal portion had migrated into the right pulmonary artery. Percutaneous removal through cardiac catheterization was attempted. However, right ventriculography demonstrated intrapericardial spillage of contrast agents, and iatrogenic ACT was confirmed. Cardiopulmonary resuscitation (CPR) was immediately started with open-chest cardiac massage. Further surgical exploration revealed right atrial appendage perforation. After 25-min CPR, the patient restored spontaneous circulation, and removal of the foreign bodies was performed. The post-operative course was uneventful. PICC fracture is an uncommon complication, but may be life-threatening. Precaution should be taken to avoid ACT during removal of a broken PICC. Once the tamponade is diagnosed, immediate interventions are mandatory.

  20. Transaortic Intra-Aortic Balloon Pump Catheter Insertion through a Separate Saphenous Vein Graft in Patients with Severe Aortoiliac Disease

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    Faruk Toktas

    2014-01-01

    Full Text Available Background. Intra-aortic balloon pump (IABP is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0±13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.

  1. Improving Nurses' Peripheral Intravenous Catheter Insertion Knowledge, Confidence, and Skills Using a Simulation-Based Blended Learning Program

    Science.gov (United States)

    Keleekai, Nowai L.; Schuster, Catherine A.; Murray, Connie L.; King, Mary Anne; Stahl, Brian R.; Labrozzi, Laura J.; Gallucci, Susan; LeClair, Matthew W.; Glover, Kevin R.

    2016-01-01

    Introduction Peripheral intravenous catheter (PIVC) insertion is one of the most common invasive procedures performed in a hospital, but most nurses receive little formal training in this area. Blended PIVC insertion training programs that incorporate deliberate simulated practice have the potential to improve clinical practice and patient care. Methods The study was a randomized, wait-list control group with crossover using nurses on three medical/surgical units. Baseline PIVC knowledge, confidence, and skills assessments were completed for both groups. The intervention group then received a 2-hour PIVC online course, followed by an 8-hour live training course using a synergistic mix of three simulation tools. Both groups were then reassessed. After crossover, the wait-list group received the same intervention and both groups were reassessed. Results At baseline, both groups were similar for knowledge, confidence, and skills. Compared with the wait-list group, the intervention group had significantly higher scores for knowledge, confidence, and skills upon completing the training program. After crossover, the wait-list group had similarly higher scores for knowledge, confidence, and skills than the intervention group. Between the immediate preintervention and postintervention periods, the intervention group improved scores for knowledge by 31%, skills by 24%, and decreased confidence by 0.5%, whereas the wait-list group improved scores for knowledge by 28%, confidence by 16%, and skills by 15%. Conclusions Results demonstrate significant improvements in nurses' knowledge, confidence, and skills with the use of a simulation-based blended learning program for PIVC insertion. Transferability of these findings from a simulated environment into clinical practice should be further explored. PMID:27504890

  2. Complications of peripherally inserted central venous catheters in neonates: Lesson learned over 2 years in a tertiary care centre in India

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    Amit Singh

    2014-01-01

    Full Text Available Background: The objective of this study was to assess the complications of peripherally inserted central venous catheters (PICC in neonates admitted to neonatal surgical intensive care unit (NSICU. Patients and Methods: Retrospective analysis of 237 neonates admitted to NSICU from January 2010 to December 2011 was done. Results: Mean age at presentation was 5.8 days and mean weight was 1.94 kg. Mean number of attempts was 1.14, mean duration of insertion 8.4 min and mean duration of patency of catheter 3.14 days. Most common site of catheter insertion was upper extremity (basilic followed by cephalic. Overall complications were seen in 47 (23% cases. Infectious complications were seen in 22 (10.7% and non-infectious in 25 (12.2% cases. Significant correlation existed between non-infective complications and insertion site (P = 0.03 and duration of PICC (P = 0.04. Conclusion: Precautions should be taken and position must be confirmed during and after PICC insertion to avoid undue complications.

  3. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited

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    Gaurav Singh Tomar

    2013-01-01

    Full Text Available The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required.

  4. Modeling insertional mutagenesis using gene length and expression in murine embryonic stem cells.

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    Alex S Nord

    Full Text Available BACKGROUND: High-throughput mutagenesis of the mammalian genome is a powerful means to facilitate analysis of gene function. Gene trapping in embryonic stem cells (ESCs is the most widely used form of insertional mutagenesis in mammals. However, the rules governing its efficiency are not fully understood, and the effects of vector design on the likelihood of gene-trapping events have not been tested on a genome-wide scale. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we used public gene-trap data to model gene-trap likelihood. Using the association of gene length and gene expression with gene-trap likelihood, we constructed spline-based regression models that characterize which genes are susceptible and which genes are resistant to gene-trapping techniques. We report results for three classes of gene-trap vectors, showing that both length and expression are significant determinants of trap likelihood for all vectors. Using our models, we also quantitatively identified hotspots of gene-trap activity, which represent loci where the high likelihood of vector insertion is controlled by factors other than length and expression. These formalized statistical models describe a high proportion of the variance in the likelihood of a gene being trapped by expression-dependent vectors and a lower, but still significant, proportion of the variance for vectors that are predicted to be independent of endogenous gene expression. CONCLUSIONS/SIGNIFICANCE: The findings of significant expression and length effects reported here further the understanding of the determinants of vector insertion. Results from this analysis can be applied to help identify other important determinants of this important biological phenomenon and could assist planning of large-scale mutagenesis efforts.

  5. Prevention and nursing status of peripherally inserted central catheter occluded%PICC导管堵塞的预防和护理现状

    Institute of Scientific and Technical Information of China (English)

    彭敏敏; 张玉麟

    2016-01-01

    the central venous catheter (Peripherally inserted central catheter, PICC) is a basilic vein, median cubital vein and cephalic vein peripheral vein catheter infusion liquid[1], used for long-term treatment, with less trauma, indwelling advantages of long time, provides a painless intravenous therapy a safe and convenient for patients. But with the wide application of PICC in clinical, the related complications such as phlebitis, catheter blockage, catheter displacement and catheter rupture have become a major problem that plagued the development and application of PICC in which the incidence of catheter blockage can reach 21.3%[2], and with the treatment cycle, blood sampling frequency and the extension tube time and a significant increase. Severely shortened PICC catheterization time, resulting in non health care costs[3] normal extubation increased. In this paper, the prevention of PICC catheter blockage and related nursing measures are summarized as follows.%中心静脉导管(Peripherally inserted central catheter ,PICC)是由贵要静脉、肘正中静脉、头静脉等外周静脉穿刺插管[1],用于长期输注液体治疗,具有创伤小,留置时间长等优点,为患者提供了一条安全、便捷的无痛性静脉治疗途径。但随着PICC在临床的广泛应用,其相关的并发症如静脉炎、导管堵塞、导管移位、导管破裂等问题成为困扰PICC发展和应用的主要难题,其中,导管堵塞发生率可达21.3%[2],并且随着治疗周期、采血频率和置管时间的延长而显著增加,严重缩短了PICC置管时间,进而导致非正常拔管所增加的医疗成本[3]。本文就PICC导管堵塞的预防和相关的护理措施综述如下。

  6. A comparative study of landmark-based topographic method versus the formula method for estimating depth of insertion of right subclavian central venous catheters

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    Tejesh C Anandaswamy

    2016-01-01

    Full Text Available Background and Aims: Subclavian central venous catheterisation (CVC is employed in critically ill patients requiring long-term central venous access. There is no gold standard for estimating their depth of insertion. In this study, we compared the landmark topographic method with the formula technique for estimating depth of insertion of right subclavian CVCs. Methods: Two hundred and sixty patients admitted to Intensive Care Unit requiring subclavian CVC were randomly assigned to either topographic method or formula method (130 in each group. Catheter tip position in relation to the carina was measured on a post-procedure chest X-ray. The primary endpoint was the need for catheter repositioning. Mann–Whitney test and Chi-square test was performed for statistical analysis using SPSS for windows version 18.0 (Armonk, NY: IBM Corp. Results: Nearly, half the catheters positioned by both the methods were situated >1 cm below the carina and required repositioning. Conclusion: Both the techniques were not effective in estimating the approximate depth of insertion of right subclavian CVCs.

  7. A single-center experience of 2153 tunneled-cuffed catheter insertions radiologically placed via the internal jugular vein: An evaluation of technical success and complication rates relative to underlying disease conditions

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan; Yim, Nm Yeol; Kim, Yong Tae; Noh, Hoon; Ki, So Yeon; Kim Jae Kyu; Kim, Hyoung Ook; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2015-01-15

    To evaluate the technical success and complication rates of tunneled-cuffed catheter insertions radiologically placed via the internal jugular vein in patients with different types of underlying diseases. A total of 2153 tunneled-cuffed catheter insertions performed in 1926 patients between January 2008 and December 2012 were retrospectively reviewed. All procedures were conducted using sonography and fluoroscopy. The number of catheter maintenance days, technical success rates, and complication rates were analyzed based on radiologic and medical records. A total of 204809 catheter maintenance days (mean, 95.35 days; range, 0-1710 days) were recorded. Technical success was achieved in 2148 insertions (99.77%). A total of 185 complications (8.61%, 0.903/1000 catheter days) were observed, including 22 procedure-related complications (1.02%). A total of 143 catheters (6.66%) were removed due to complications. Significant differences in complication rates were observed between patients with or without underlying hematologic diseases (11.65% vs. 7.02%, respectively; p = 0.000). Significant differences in catheter thrombosis were observed between patients in which right-sided or left-sided venous approaches were used (0.81% vs. 2.70%, respectively; p = 0.010). The very high technical success rates and very low procedure-related complication rates indicate insertion of a tunneled-cuffed catheter radiologically placed via the internal jugular vein is safe and effective.

  8. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants

    NARCIS (Netherlands)

    Hemels, Marieke A. C.; van den Hoogen, Agnes; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2011-01-01

    Objectives: Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagula

  9. Central venous catheter - flushing

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - dressing change Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/22/2016 Updated by: ...

  10. A pilot study to assess adductor canal catheter tip migration in a cadaver model.

    Science.gov (United States)

    Leng, Jody C; Harrison, T Kyle; Miller, Brett; Howard, Steven K; Conroy, Myles; Udani, Ankeet; Shum, Cynthia; Mariano, Edward R

    2015-04-01

    An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.

  11. Research and nursing progress of peripherally inserted central catheter associated contact dermatitis%PICC相关接触性皮炎的研究及护理进展

    Institute of Scientific and Technical Information of China (English)

    周淑玲

    2016-01-01

    经外周置入中心静脉导管(peripherally inserted central catheter,PICC)是一种安全、有效的静脉输注方法。由于导管、敷贴及胶布等相关因素会导致接触性皮炎,不仅影响导管的使用,而且增加患者痛苦及医疗负担,故临床护理中需要提高对接触性皮炎的认识。本文系统阐述PICC 置管后接触性皮炎的发生原因、临床表现及护理干预措施,旨在为临床护理提供依据。%PICC (peripherally inserted central catheter) is a safe and effective approach for venous infusion. But contact dermatitis not only affects the usage of catheter , but also increases the pain and burden of patients, which is evoked by factors such as catheter, surgical dress and bandage. We should improve the understanding of contact dermatitis in clinical nursing. This article analyzes the cause , clinical manifestation and nursing measures of contact dermatitis associated with PICC for guidance of clinical care.

  12. Characterization of full-length sequenced cDNA inserts (FLIcs from Atlantic salmon (Salmo salar

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    Lunner Sigbjørn

    2009-10-01

    Full Text Available Abstract Background Sequencing of the Atlantic salmon genome is now being planned by an international research consortium. Full-length sequenced inserts from cDNAs (FLIcs are an important tool for correct annotation and clustering of the genomic sequence in any species. The large amount of highly similar duplicate sequences caused by the relatively recent genome duplication in the salmonid ancestor represents a particular challenge for the genome project. FLIcs will therefore be an extremely useful resource for the Atlantic salmon sequencing project. In addition to be helpful in order to distinguish between duplicate genome regions and in determining correct gene structures, FLIcs are an important resource for functional genomic studies and for investigation of regulatory elements controlling gene expression. In contrast to the large number of ESTs available, including the ESTs from 23 developmental and tissue specific cDNA libraries contributed by the Salmon Genome Project (SGP, the number of sequences where the full-length of the cDNA insert has been determined has been small. Results High quality full-length insert sequences from 560 pre-smolt white muscle tissue specific cDNAs were generated, accession numbers [GenBank: BT043497 - BT044056]. Five hundred and ten (91% of the transcripts were annotated using Gene Ontology (GO terms and 440 of the FLIcs are likely to contain a complete coding sequence (cCDS. The sequence information was used to identify putative paralogs, characterize salmon Kozak motifs, polyadenylation signal variation and to identify motifs likely to be involved in the regulation of particular genes. Finally, conserved 7-mers in the 3'UTRs were identified, of which some were identical to miRNA target sequences. Conclusion This paper describes the first Atlantic salmon FLIcs from a tissue and developmental stage specific cDNA library. We have demonstrated that many FLIcs contained a complete coding sequence (cCDS. This

  13. Nursing of Peripherally Inserted Central Catheter in Elderly Patients%老年患者PICC置管护理

    Institute of Scientific and Technical Information of China (English)

    赵爱华

    2016-01-01

    目的:对47例中心静脉置管老年患者护理效果进行分析,总结相关护理体会。方法通过分析47例中心静脉导管(PICC)置管老年患者护理情况,总结老年患者在B超引导下经外周静脉置入中心静脉导管的护理效果。结果提出置管前后对患者的护理措施。结论良好的护理可以延长管道使用时间,提高老年患者的生活质量,并减少并发症的发生。%Objective To analyze the nursing effect of 47 cases of central venous catheter in elderly patients,and summarized the relevant nursing experience. MethodsBy analyzing 47 cases of central venous catheters(PICC)in elderly patients with catheter care to summarize the nursing effect of the elderly patients with the central venous catheter under the guidance of B ultrasound.Results The nursing measures of patients before and after the intubation were put forward.Conclusion Good nursing care can extend the pipeline use of time, improve the quality of life of elderly patients, and reduce the incidence of complications.

  14. Indwelling urethral catheters in adults

    OpenAIRE

    Calleja, Edward

    2012-01-01

    This article focuses on indwelling urethral catheters in adults, their indications for the short and long term use, the types of urinary catheters available in Malta, an overview of the basic structure of a catheter, and the complications of urinary catheter insertion and maintenance. An attempt has been made to address in some depth the most common complication of indwelling catheterscatheter associated urinary tract infection in terms of pathophysiology and its management. Simple but cru...

  15. A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique.

    Science.gov (United States)

    Kim, E; Kim, B G; Lim, Y J; Jeon, Y T; Hwang, J W; Kim, H C; Choi, Y H; Park, H P

    2016-09-01

    In clinical practice, both a thin-walled introducer needle and catheter-over-needle technique can be used to allow insertion of a guidewire during central venous catheterisation using the Seldinger technique. We compared the incidence of catheterisation-related complications (arterial puncture, haemothorax, pneumothorax, haematoma and catheter tip malposition) and insertion success rate for these two techniques in patients requiring right-sided subclavian central venous catheterisation. A total of 414 patients requiring infraclavicular subclavian venous catheterisation were randomly allocated to either a thin-walled introducer needle (needle group, n = 208) or catheter-over-needle technique (catheter group, n = 206). The catheterisation-related complication rate was lower in the needle group compared with the catheter group (5.8% vs. 15.5%; p = 0.001). Overall insertion success rates were similar (97.1% and 92.7% in the needle and catheter groups respectively; p = 0.046), although the first-pass success rate was higher in the needle group (62.0% vs. 35.4%; p technique for right-sided infraclavicular subclavian venous catheterisation.

  16. Typing and clustering of Yersinia pseudotuberculosis isolates by restriction fragment length polymorphism analysis using insertion sequences.

    Science.gov (United States)

    Voskresenskaya, E; Savin, C; Leclercq, A; Tseneva, G; Carniel, E

    2014-06-01

    Yersinia pseudotuberculosis is an enteropathogen that has an animal reservoir and causes human infections, mostly in temperate and cold countries. Most of the methods previously used to subdivide Y. pseudotuberculosis were performed on small numbers of isolates from a specific geographical area. One aim of this study was to evaluate the typing efficiency of restriction fragment length polymorphism of insertion sequence hybridization patterns (IS-RFLP) compared to other typing methods, such as serotyping, ribotyping, and multilocus sequence typing (MLST), on the same set of 80 strains of Y. pseudotuberculosis of global origin. We found that IS100 was not adequate for IS-RFLP but that both IS285 and IS1541 efficiently subtyped Y. pseudotuberculosis. The discriminatory index (DI) of IS1541-RFLP (0.980) was superior to those of IS285-RFLP (0.939), ribotyping (0.944), MLST (0.861), and serotyping (0.857). The combination of the two IS (2IS-RFLP) further increased the DI to 0.998. Thus, IS-RFLP is a powerful tool for the molecular typing of Y. pseudotuberculosis and has the advantage of exhibiting well-resolved banding patterns that allow for a reliable comparison of strains of worldwide origin. The other aim of this study was to assess the clustering power of IS-RFLP. We found that 2IS-RFLP had a remarkable capacity to group strains with similar genotypic and phenotypic markers, thus identifying robust populations within Y. pseudotuberculosis. Our study thus demonstrates that 2IS- and even IS1541-RFLP alone might be valuable tools for the molecular typing of global isolates of Y. pseudotuberculosis and for the analysis of the population structure of this species.

  17. Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2011-01-01

    Full Text Available When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1 Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2 Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3 Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

  18. Inadvertent arterial insertion of a central venous catheter: delayed recognition with abrupt changes in pressure waveform during surgery -A case report-.

    Science.gov (United States)

    Choi, Yong Sun; Park, Ji Young; Kwak, Young Lan; Lee, Jong Wha

    2011-01-01

    We present a case of inadvertent arterial insertion of a central venous catheter, identified during a pericardiectomy procedure after observing abrupt changes in pressure waveform and confirmed via arterial blood gas analysis and transesophageal echocardiography. Central venous pressure measurement was initially 20 mmHg in supine, and then elevated to 30-40 mmHg in right lateral decubitus, presumably resulting from constrictive physiology of pericarditis. The pressure waveforms, however, abruptly changed from a venous to an arterial waveform during surgery. When visual discrimination between arterial and venous blood regurgitation is unreliable, anesthesiologists should confirm that using all the available methods one has on the scene, especially after at least two unsuccessful attempts or in patients with advanced age or clinical conditions resulting in jugular venous dilation. To prevent arterial catheterization, one should limit the leftward rotation of the head by <40° and consider using ultrasound-guided method after more than two unsuccessful attempts.

  19. Central venous catheter - dressing change

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - flushing Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/17/2016 Updated by: ...

  20. 乳腺癌患者携带PICC化疗并发导管败血症的诊治探讨%Diagnosis and treatment of peripherally inserted central catheters (PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Lei Xing; Vishnu Prasad Adhikari; Lingquan Kong; Hongyuan Li; Guosheng Ren; Feng Luo; Kainan Wu

    2012-01-01

    Objective: The aim of our research was to study the incidence, clinical diagnosis and treatment of peripherally inserted central catheters (PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy. Methods: The data of the incidence, diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August, 2009 to September, 2011 were analyzed retrospectively. Results: 216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days, (median catheterization duration, 88.9 days, range 1-212 days). Among those, 3 (1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29, 73 and 108 catheter-days (median 70 d), with a rate of 0.16 per 1000 catheter-days. Conclusion: Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible. Careful observation of relevant symptoms and signs, early diagnosis and treatment, not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.

  1. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  2. Insertion of Introns: A Strategy to Facilitate Assembly of Infectious Full Length Clones

    DEFF Research Database (Denmark)

    Johansen, Ida Elisabeth; Lund, Ole Søgaard

    2008-01-01

    Some DNA fragments are difficult to clone in Escherichia coli by standard methods. It has been speculated that unintended transcription and translation result in expression of proteins that are toxic to the bacteria. This problem is frequently observed during assembly of infectious full-length vi...

  3. IS1630 of Mycoplasma fermentans, a Novel IS30-Type Insertion Element That Targets and Duplicates Inverted Repeats of Variable Length and Sequence during Insertion

    Science.gov (United States)

    Calcutt, Michael J.; Lavrrar, Jennifer L.; Wise, Kim S.

    1999-01-01

    A new insertion sequence (IS) of Mycoplasma fermentans is described. This element, designated IS1630, is 1,377 bp long and has 27-bp inverted repeats at the termini. A single open reading frame (ORF), predicted to encode a basic protein of either 366 or 387 amino acids (depending on the start codon utilized), occupies most of this compact element. The predicted translation product of this ORF has homology to transposases of the IS30 family of IS elements and is most closely related (27% identical amino acid residues) to the product of the prototype of the group, IS30. Multiple copies of IS1630 are present in the genomes of at least two M. fermentans strains. Characterization and comparison of nine copies of the element revealed that IS1630 exhibits unusual target site specificity and, upon insertion, duplicates target sequences in a manner unlike that of any other IS element. IS1630 was shown to have the striking ability to target and duplicate inverted repeats of variable length and sequence during transposition. IS30-type elements typically generate 2- or 3-bp target site duplications, whereas those created by IS1630 vary between 19 and 26 bp. With the exception of two recently reported IS4-type elements which have the ability to generate variable large duplications (B. B. Plikaytis, J. T. Crawford, and T. M. Shinnick, J. Bacteriol. 180:1037–1043, 1998; E. M. Vilei, J. Nicolet, and J. Frey, J. Bacteriol. 181:1319–1323, 1999), such large direct repeats had not been observed for other IS elements. Interestingly, the IS1630-generated duplications are all symmetrical inverted repeat sequences that are apparently derived from rho-independent transcription terminators of neighboring genes. Although the consensus target site for IS30 is almost palindromic, individual target sites possess considerably less inverted symmetry. In contrast, IS1630 appears to exhibit an increased stringency for inverted repeat recognition, since the majority of target sites had no

  4. 个体化涤纶套中央静脉导管置入方法的安全性及成功率分析%The safety and success rate of different Individual cuffed catheter central venous catheter insert methods

    Institute of Scientific and Technical Information of China (English)

    李康峰; 严连喜; 周玉坤; 石平; 汤小芳; 张玉强

    2013-01-01

    Objective To observe the safety and success rate of different individual cuffed catheter central venous catheter insert methods. Methods 46 patients of cuffed central venous catheters insert were divided into group A used avulsion sheath catheter method, group B by jugular vein insert cuffed central venous catheter and group C by the way of non-avulsioninsert cuffed central venous catheters method. Intraoperative,postoperative complications were observed, Kt/V values were calculated. Dialysis blood flow, venous pressure were recorded. Results Groups B and group C comparing with the classic avulsion sheath insert,classic avulsion sheath cathete method was one-time success,and hemorrhage was than that of the other two groups. All three groups showed subcutaneous tunnel hemorrhage after the operation. There was no statistically difference in dialysis venous pressure,blood flow,and Kt/V values among group A, groups B and group C. Catheter lifetime of non-avulsioninsert method less than avulsion sheath catheter method(P<0. 05). The overall failure rate of groups B and group C operations (24. 14%) was higher than classic avulsion sheath insert method. Conclusion Classic avulsion sheath catheter method was as the preferred for cuffed catheter central venous catheter insert method, and it was a safety and a higher success rate method with fewer complications.%目的 观察不同带涤纶套中央静脉导管置入方法的安全性及手术成功率.方法 46例患者行带涤纶套中央静脉导管置入术,分为A组(经撕脱鞘方法置管)、B组(经颈外静脉入路置管)和C组(非撕脱鞘方式置管).观察3组患者手术成功率和术中、术后并发症情况,记录透析中血流量、静脉压指标,计算尿素清除指数(Kt/V),B、C两组与经典撕脱鞘方法置管相对比.结果 经典撕脱鞘置管患者均一次性成功,但术中出血量多于另外两组.术后3组均表现为皮下隧道渗血.3组患者透析中静脉压、血流量及Kt

  5. How effective is tetracaine 4% gel, before a peripherally inserted central catheter, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial [ISRCTN75884221

    Directory of Open Access Journals (Sweden)

    Blanchard Colline

    2006-05-01

    Full Text Available Abstract Background Procedural pain relief is sub-optimal in infants, especially small and vulnerable ones. Tetracaine gel 4% (Ametop®, Smith-Nephew provides pain relief in children and larger infants, but its efficacy in smaller infants and for peripherally inserted central catheters (PICC remains uncertain. The objective of this trial was to assess the safety and efficacy of tetracaine gel on the pain response of very low birth weight (VLBW infants during insertion of a PICC. Methods Medically stable infants greater than or equal to 24 weeks gestation, requiring a non-urgent PICC, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. The PICC was inserted according to a standard protocol. Pain was assessed using the Premature Infant Pain Profile (PIPP. A 3-point change in the pain score was considered clinically significant, leading to a sample size of 54 infants, with 90% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. Results Fifty-four infants were included, 27 +/- 2 weeks gestation, 916 +/- 292 grams and 6.5 +/- 3.2 days of age. Baseline characteristics were similar between groups. The mean PIPP score in the first minute was 10.88 in the treatment group as compared to 11.74 in the placebo group (difference 0.86, 95% CI -1.86, 3.58. Median duration of crying in non-intubated infants was 181 seconds in the tetracaine group compared to 68 seconds in the placebo group (difference -78, 95% CI -539, 117. Local skin erythema was observed transiently in 4 infants (3 in the treatment and 1 in the placebo group. No serious harms were observed. Conclusion Tetracaine 4% when applied for 30 minutes was not beneficial in decreasing procedural pain associated with a PICC in very small infants.

  6. Influence of length of direct insert on safety of motion of cars on contiguous switches laid according to the second scheme

    Directory of Open Access Journals (Sweden)

    K.V. Moyseyenko

    2012-08-01

    Full Text Available Results of an experimental research of influence of length of a direct insert between adjacent switches, laid according to the second scheme, on traffic safety of cars (by a criterion of derailment resistance.

  7. Utilização da veia ilíaca externa recanalizada para implante de cateter de longa permanência para hemodiálise Using recanalized external iliac vein for tunneled hemodialysis catheter insertion

    Directory of Open Access Journals (Sweden)

    Ricardo Wagner da Costa Moreira

    2008-06-01

    Full Text Available O uso de cateteres venosos cervicais para hemodiálise leva freqüentemente à oclusão dessas veias. Como alternativa, os acessos venosos femorais são válidos, porém o seu uso também está associado à oclusão dessas veias e a um maior índice de infecção. Vias alternativas são cada vez mais utilizadas na impossibilidade dos acessos previamente mencionados. Descrevemos neste relato de caso uma alternativa para o implante de cateter de longa permanência para hemodiálise usando a veia ilíaca externa recanalizada. Comentamos os detalhes da técnica utilizada, suas vantagens e desvantagens.The frequent insertion of cervical venous catheters for hemodialysis is closely related to venous stenosis or occlusion. As an alternative, femoral catheter insertions are helpful but are also associated with femoral vein occlusion and an even higher infection rate. Alternative venous accesses have been increasingly used when the aforementioned accesses are not feasible. We report a case in which a recanalized external iliac vein was used for hemodialysis tunneled catheter insertion. The technique approach is discussed, focusing on its advantages and disadvantages.

  8. The relationship of sealing catheter with different concentration of heparin sodium and obstruction after percutaneous insertion of subclavian venous catheters%不同浓度肝素钠溶液封管与锁骨下静脉导管堵塞的关系

    Institute of Scientific and Technical Information of China (English)

    吕小红; 廖新颖; 陈志玲; 陆静佳; 黄萍; 黄带仙; 谢镕蔚; 磨细芳

    2010-01-01

    Objective To investigate the relationship of sealing catheter with different concentration of heparin sodium and obstruction after percutaneous insertion of subclavian venous catheters.Methods A total of 889 cases of tumor with percutaneous insertion of subclavian venous catheters were individed into two groups, group A was flushed with (50 U/ml) 5 ml heparin sodium before and after infusion,and group B were flushed with (50 U/ml) 5 ml heparin sodium before and after infusion.Results 5.55% (25/889) of catheter obstruction in group A were occurred and 1.13% (5/889) of catheter obstruction in group B were occurred, there wss signification difference between the two groups (P <0.05) .Conclusions There is an obvious relationship of sealing catheter with different concentration of heparin sodium and obstruction after percutaneous insertion of subclavian venous catheters.Flushing catheter with 125 U/ml heparin sodium can reduce thecatheter obstruction rate effectively.%目的 探讨不同浓度肝素钠溶液封管与锁骨下静脉留置管堵塞关系.方法 对进行锁骨下静脉穿刺置管术的肿瘤患者共889例,分A、B两组进行观察,A组在输液前后用肝素钠盐水(50μ/ml)5 ml冲管,B组肿瘤患者输液前后用肝素钠盐水(125μ/ml)5 ml冲管,两者均采用正压封管.统计学方法采用x2检验.结果 A组导管堵塞发生率为5.55%,B组导管堵塞发生率为1.13%,两者比较有显著性差异(P<0.01).结论 应用不同浓度肝素钠溶液冲管与导管堵塞有关系,研究结果表明,用肝素钠盐水(125μ/ml)5 ml冲管能有效降低导管堵塞发生率.

  9. Dedicated radial ventriculography pigtail catheter

    Energy Technology Data Exchange (ETDEWEB)

    Vidovich, Mladen I., E-mail: miv@uic.edu

    2013-05-15

    A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.

  10. The PML gene is linked to a megabase-scale insertion/deletion restriction fragment length polymorphism

    Energy Technology Data Exchange (ETDEWEB)

    Goy, A.; Xiao, Y.H.; Passalaris, T. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States)] [and others

    1995-03-20

    The PML gene located on chromosome band 15q22 is involved with the RAR{alpha} locus (17q21) in a balanced reciprocal translocation uniquely observed in acute promyelocytic leukemia. Physical mapping studies by pulsed-field gel electrophoresis revealed that the PML gene is flanked by two CpG islands that are separated by a variable distance in normal individuals. Several lines of evidence demonstrate that this is the consequence of a large insertion/deletion polymorphism linked to the PML locus: (1) overlapping fragments obtained with a variety of rare-cutting restriction enzymes demonstrated the same variability in distance between the flanking CpG islands; (2) mapping with restriction enzymes insensitive to CpG methylation confirmed that the findings were not a consequence of variable methylation of CpG dinucleotides; (3) the polymorphism followed a Mendelian inheritance pattern. This polymorphism is localized 3{prime} to the PML locus. There are five common alleles, described on the basis of BssHII fragments, ranging from 220 to 350 kb with increments of approximately 30 kb between alleles. Both heterozygous (61%) and homozygous (391%) patterns were observed in normal individuals. Mega-base-scale insertion/deletion restriction fragment length polymorphisms are very rare and have been described initially in the context of multigene families. Such structures have been also reported as likely regions of genetic instability. High-resolution restriction mapping of this particular structure linked to the PML locus is underway. 47 refs., 4 figs., 1 tab.

  11. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

    Directory of Open Access Journals (Sweden)

    Al-Hazmi H

    2015-03-01

    Full Text Available Hamdan Al-HazmiDivision of Urology, Department of Surgery, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi ArabiaObjective: Our aim is to prove that duration of catheterization and length of hospital stay (LOS are associated with the rate of hospital-acquired urinary tract infections (UTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis on admission, associated comorbidities, age, sex, precautions that should be taken to avoid UTI, and comparison with other studies.Methods: The study was done in a university teaching hospital with a 920-bed capacity; this hospital is a tertiary care center in Riyadh, Saudi Arabia. The study was done on 250 selected patients during the year 2010 as a retrospective descriptive study. Patients were selected as purposive sample, all of them having been exposed to urinary catheterization; hospital-acquired UTI were found in 100 patients. Data were abstracted from the archived patients' files in the medical record department using the annual infection control logbook prepared by the infection control department. The data collected were demographic information about the patients, clinical condition (diagnosis and the LOS, and possible risk factors for infection such as duration of catheterization, exposure to invasive devices or surgical procedures, and medical condition.Results: There was a statistically significant association between the rate of UTI and duration of catheterization: seven patients had UTI out of 46 catheterized patients (15% at 3 days of catheterization, while 30 patients had UTI out of 44 catheterized patients (68% at 8 days of catheterization (median 8 days in infected patients versus 3 days in noninfected patients; P-value <0.05, which means that the longer the duration of catheterization, the higher the UTI rate. There was a statistically significant association between the rate of UTI and LOS

  12. A statistical approach designed for finding mathematically defined repeats in shotgun data and determining the length distribution of clone-inserts

    DEFF Research Database (Denmark)

    Zhong, Lan; Zhang, Kunlin; Huang, Xiangang

    2003-01-01

    The large amount of repeats, especially high copy repeats, in the genomes of higher animals and plants makes whole genome assembly (WGA) quite difficult. In order to solve this problem, we tried to identify repeats and mask them prior to assembly even at the stage of genome survey. It is known...... that repeats of different copy number have different probabilities of appearance in shotgun data, so based on this principle, we constructed a statistical model and inferred criteria for mathematically defined repeats (MDRs) at different shotgun coverages. According to these criteria, we developed software......-inserts using our model. In our simulated genomes of human and rice, the length distribution of repeats is different, so their optimal length distributions of clone-inserts were not the same. Thus with optimal length distribution of clone-inserts, a given genome could be assembled better at lower coverage...

  13. Effects of peripherally inserted central catheter (PICC) on the internal jugular venous catheter in elderly patients%PICC导管在长期留置深静脉导管高龄老年患者中的应用效果

    Institute of Scientific and Technical Information of China (English)

    张沁芸; 夏文兰; 严炜红

    2011-01-01

    目的 观察peripherally inserted central catheter(PICC)导管在长期留置深静脉导管高龄老年患者中的应用效果及并发症.方法 收集80岁及以上需要长期留置深静脉导管的高龄患者132例.按穿刺途径不同分为两组:PICC导管组(n=72)和颈内静脉组(n=60 ).结果 PICC导管留置时间较颈内静咏组显著延长,分别为(146.84±100.46)d和(36.60±35.61)d,两组相比差异有统计学意义(P<0.01).PICC导管组导管相关性感染和滑脱分别为2例和1例.均较颈内静脉组(10例和9例)显著减少(均P<0.05).结论 高龄老人可应用PICC导管,留置时间长,安全性好,并发症少,值得临床上推广应用.%Objective To observe the intubation effects and complications of peripherally inserted central catheter (PICC) in elderly patients. Methods 132 patients with age ≥ 80-year-old underwent the long-term intravenous therapy. The patients were divided into two groups by different insertion methods: 72 patients in the PICC group and 60 patients in the internal jugular venous catheter group. Results Compared with internal jugular venous catheter group, PICC group had a longer time of intubation (146.84+100.46 days vs 36.60+35.61 days, .P<0.01), and a lower rate of catheter-related infection (2 vs 10, P<0.05) and a lower incidence of catheter slippage (1 vs 9, P<0.05). Conclusion PICC has longer time of intubation, higher safety and less complication, which is a recommendable technique in the elderly patients.

  14. A Statistical Approach Designed for Finding Mathematically Defined Repeats in Shotgun Data and Determining the Length Distribution of Clone—Inserts

    Institute of Scientific and Technical Information of China (English)

    LanZhong; KunlinZhang; XiangangHuang; PeixiangNi; YujunHan; KaiWang; JunWang; SonggangLi

    2003-01-01

    The large amount of repeats,especially high copy repeats,in the genomes of higher animals and plants makes whole genome assembly(WGA)quite difficult.In order to solve this problem,we tried to identify repeats and mask them prior to assembly even at the stage of genome survey.It is known that repeats of different copy number have different probabilities of appearance in shotgun data,so based on this principle,we constructed a statistical model and inferred criteria for mathematically defined repeats(MDRs)at different shotgun coverages.According to these criteria,we developed software MDRmasker to identify and mask MDRs in shotgun data.With repeats masked prior to assembly,the speed of as sembly was increased with lower error probability.In addition,clone-insert size affects the accuracy of repeat assembly and scaffold construction.We also designed length distribution of clone-inserts using our model.In our simulated genomes of human and rice,the length distribution of repeats in different,so their optimal length distributions of clone-inserts were not the same.Thus with optimal length distribution of clone-inserts,a given genome could be assembled better at lower coverage.

  15. A Statistical Approach Designed for Finding Mathematically De fined Repeats in Shotgun Data and Determining the Length Distri bution of Clone-Inserts

    Institute of Scientific and Technical Information of China (English)

    Lan Zhong; Kunlin Zhang; Xiangang Huang; Peixiang Ni; Yujun Han; Kai Wang; Jun Wang; Songgang Li

    2003-01-01

    The large amount of repeats, especially high copy repeats, in the genomes of higher animals and plants makes whole genome assembly (WGA) quite difficult. In order to solve this problem, we tried to identify repeats and mask them prior to assembly even at the stage of genome survey. It is known that repeats of different copy number have different probabilities of appearance in shotgun data, so based on this principle, we constructed a statistical model and inferred criteria for mathematically defined repeats (MDRs) at different shotgun coverages. According to these criteria, we developed software MDRmasker to identify and mask MDRs in shotgun data. With repeats masked prior to assembly, the speed of assembly was increased with lower error probability. In addition, clone-insert size affects the accuracy of repeat assembly and scaffold construction. We also designed length distribution of clone-inserts using our model. In our simulated genomes of human and rice, the length distribution of repeats is different, so their optimal length distributions of clone-inserts were not the same. Thus with optimal length distribution of clone-inserts, a given genome could be assembled better at lower coverage.

  16. Nursing research progress of eczema in intubation point after peripherally inserted central catheter%经外周置入中心静脉导管置管处湿疹的护理研究进展

    Institute of Scientific and Technical Information of China (English)

    茹晓坤

    2016-01-01

    Peripherally inserted central catheter increased the incidence of local eczema,preventing and treating eczema was important for the maintenance of venous access and ensuring the success of treatment.This paper summarized the nursing research progress of eczema in intubation point after peripherally inserted central catheter from four aspects including the clinical manifestations and incidence,pathogenesis,treatment measures and preventive measures.%目的:经外周置入中心静脉导管增加了局部湿疹的发生率,预防和治疗湿疹对维护静脉通路和保证治疗的顺利进行具有重要意义.本文从临床表现及发生率、发生原因、治疗措施、预防措施4个方面来总结经外周置入中心静脉导管置管处湿疹的护理研究进展.

  17. Relato de caso: implante transparietohepático de cateter de longa permanência para diálise Case report: transhepatic insertion of long-term dialysis catheter

    Directory of Open Access Journals (Sweden)

    Felipe Nasser

    2007-12-01

    Full Text Available O implante transhepático de cateteres de diálise de longa permanência é um procedimento de exceção, utilizado para obter um acesso em pacientes com oclusão de veias centrais de membros superiores e inferiores. O caso descrito relata um paciente jovem, com história de 15 anos de diálise, que foi submetido no passado a um transplante renal sem sucesso. Esse paciente encontrava-se em urgência dialítica e oclusão comprovada de veias centrais de membros superiores e de veias ilíacas. Foi realizado o implante do cateter de longa permanência pelo acesso transparietohepático sob anestesia geral. A ponta do cateter foi posicionada ao nível do átrio direito. A diálise foi realizada satisfatoriamente no mesmo dia.Transhepatic insertion of long-term dialysis catheter is an exception procedure used to obtain access in patients with central vein occlusion of lower and upper limbs. We report on a case of a young patient with history of dialysis for 15 years, who was submitted to an unsuccessful renal transplantation. This patient was in dialytic emergency and had confirmed occlusion of upper limb central veins and iliac veins. Transhepatic insertion of a long-term catheter was performed under general anesthesia. The catheter tip was placed at the level of the right atrium. Dialysis was satisfactorily performed on the same day.

  18. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

    Science.gov (United States)

    Al-Hazmi, Hamdan

    2015-01-01

    Objective Our aim is to prove that duration of catheterization and length of hospital stay (LOS) are associated with the rate of hospital-acquired urinary tract infections (UTI), while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis on admission, associated comorbidities, age, sex, precautions that should be taken to avoid UTI, and comparison with other studies. Methods The study was done in a university teaching hospital with a 920-bed capacity; this hospital is a tertiary care center in Riyadh, Saudi Arabia. The study was done on 250 selected patients during the year 2010 as a retrospective descriptive study. Patients were selected as purposive sample, all of them having been exposed to urinary catheterization; hospital-acquired UTI were found in 100 patients. Data were abstracted from the archived patients’ files in the medical record department using the annual infection control logbook prepared by the infection control department. The data collected were demographic information about the patients, clinical condition (diagnosis and the LOS), and possible risk factors for infection such as duration of catheterization, exposure to invasive devices or surgical procedures, and medical condition. Results There was a statistically significant association between the rate of UTI and duration of catheterization: seven patients had UTI out of 46 catheterized patients (15%) at 3 days of catheterization, while 30 patients had UTI out of 44 catheterized patients (68%) at 8 days of catheterization (median 8 days in infected patients versus 3 days in noninfected patients; P-value <0.05), which means that the longer the duration of catheterization, the higher the UTI rate. There was a statistically significant association between the rate of UTI and LOS: three patients had UTI out of 37 catheterized patients (8%) at 10 days LOS, while 42 patients had UTI out of 49 catheterized patients (85.7%) at 18 days LOS. The longer

  19. Evaluation of an intravenous catheter for use in the horse.

    Science.gov (United States)

    Gulick, B A; Meagher, D M

    1981-02-01

    A commercially available polyvinyl chloride intravenous catheter was studied in 9 horses for 3 to 10 days to evaluate the catheter's suitability for use in the horse, to develop a new insertion technique, and to establish a protocol for catheter care. Seven of the animals were clinically normal horses receiving parenteral nutrition; one was a horse with hypocalcemia receiving frequent intravenous injections of calcium gluconate, and one was a clinically normal horse receiving no infusions. The catheter dressings were changed every 48 hours, and an aspirate from the catheter and the catheter tip was cultured at the time of catheter removal. One catheter became infected following a break in the protocol. It was concluded that the polyvinyl catheter is suitable for use in the horse and that the proposed protocol for catheter insertion and maintenance may reduce the likelihood of complications such as catheter sepsis, thrombophlebitis, and embolism.

  20. Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2009-02-15

    Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils.

  1. 经外周中心静脉置管常见并发症及防治%Complications of peripherally inserted central venous catheter and its prevention

    Institute of Scientific and Technical Information of China (English)

    童莉; 邹碧荣

    2010-01-01

    @@ 经外周静脉穿刺置入中心静脉导管(peripherallyinserted central catheter),简称PICC[1],是指经外周静脉(肘正中静脉、贵要静脉、头静脉)穿刺置入的中心静脉导管.PICC能够安全地输注刺激性药物,保护血管,减轻痛苦,为患者提供一条无痛性输液通路[2].

  2. PICC置管后使用电热垫热疗预防静脉炎的观察%observation in prevention of phlebitis by thermotherapy with electric heating pad after peripher-ally inserted central catheter

    Institute of Scientific and Technical Information of China (English)

    张爱琴; 曹凤; 刘勤彩

    2009-01-01

    目的 探讨经外周静脉留置中心静脉导管(PICC)后使用电热垫热疗预防静脉炎发生的作用.方法 将100例PICC置管患者按随机数字表法进行分组,其中PICC置管后于输液过程中使用电热垫热疗的50例患者为实验组;PICC置管后未使用电热垫热疗,仅进行常规观察的50例患者为对照组,比较2组静脉炎的发生率,进行χ2检验.结果 实验组静脉炎的发生率显著低于对照组.结论 PICC置管后使用电热垫热疗可有效预防静脉炎的发生.%Objective To observe the effect of phlebitis prevention by thermotherapy with electric heating pad after peripherally inserted central catheter(PICC). Methods 100 patients underwent PICC were randomly divided into two groups, 50 patients receiving thermotherapy with electric heating pad were named the experimental group, other 50 patients only given routine observation was selected as the control group.The incidence rate of phlebitis was compared between the two groups and the results went through χ2 teat. Results The phlebitis rate of the experimental group was significantly lower than that of the control group. Conclusions Thermotherapy with electric heating pad can prevent phlebitis caused by peripheral-ly inserted central catheter (PICC) .

  3. Experience of peripherally inserted central catheter on the treatment of cancer patients with chemotherapy%外周中心静脉置管在肿瘤化疗患者中的应用体会

    Institute of Scientific and Technical Information of China (English)

    蔡丽华; 季健秋; 赵萍

    2013-01-01

    Objective To explore the application processes and effect of peripherally inserted central catheter (PICC) in the treatment of cancer patients with chemotherapy. Methods Standardized management was implemented for 86 cancer patients with PICC and chemotherapy in procedures such as manipulation, maintenance and health education in order to prevent or reduce the complications. Results All of 86 patients underwent chemotherapy successfully, and no one had complications such as catheter detachment, catheter fracture, catheter infection and septicemia. Quality of life of the patients was improved obviously, and the result was satisfactory. Conclusion With the advantages such as vascular prevention, long duration of catheterization and less complications, PICC can not only improve work efficiency of nursing staffs and quality of life of patients, but also relieve sufferings of patients. So it is worthy of clinical popularization and application.%目的 探讨外周中心静脉置管(PICC)在肿瘤患者化疗过程中的应用方法及效果.方法 对86例采用PICC置管的肿瘤化疗患者在操作、维护、健康教育等方面实施规范化管理,预防或减轻并发症.结果 86例患者均顺利度过化疗周期,未发生导管脱出、导管破裂、导管感染及败血症等并发症,患者生活质量得到不同程度提高,效果满意.结论 PICC置管既有保护血管、留置时间长、并发症少等优点,又可以提高护理人员工作效率,并可减轻患者的痛苦,提高患者的生活质量,值得临床推广使用.

  4. The Building and Implementation Effect of Maintenance Network about Peripherally Inserted Central Catheters%PICC维护网络的构建和护理实践

    Institute of Scientific and Technical Information of China (English)

    吴英; 胡庆新; 胡素容; 王艺桦; 李慧萍; 刘艳

    2015-01-01

    目的 探讨PICC维护网络构建及在肿瘤患者化疗间歇期延续护理服务中的作用. 方法 通过建立"PICC置管维护指导小组"和多学科参与"专家咨询组",与县(市)及乡镇(社区)医院建立PICC维护合作关系,对各级维护点护理人员进行相关知识和技能培训,对患者进行健康教育和PICC规范化维护管理. 对比PICC维护网络实施前后患者PICC并发症发生情况、患者对维护过程的满意度、PICC维护的便捷性和经济性、护理人员的维护能力的提升等. 结果实施前PICC置管维护379例,发生并发症133例,发生率为35. 13%;实施后PICC置管维护650例,发生并发症141例,发生率为21. 69%,两组并发症的发生率比较差异有统计学意义(P<0. 01). 实施前患者满意度为75%,实施后满意度为89. 5%. 到医院维护的就诊时间缩短、费用减少. 结论 建立 PICC维护网络,方便区域内患者就近接受规范统一的PICC维护,提高患者维护的依从性,降低PICC留置期间并发症发生率,使肿瘤患者化疗间歇期延续护理服务更加便捷和经济.%Objective Discussing on the building of maintenance network about PICC and its effectiveness to cancer pa-tients in continued nursing service during chemotherapy break. Methods Through the establishment of guidance group about PICC catheter maintenance and expert consultation group with multi-disciplinary participation,we had gone into partnership with the county( city) and village( community) hospitals in PICC maintenance to take knowledge and skill training for all levels of nur-ses at maintenance site,and take health education and standardize maintenance management with PICC for patients. Contrast the occurrence of complications of patients before and after the implementation of PICC,patient satisfaction,the convenience and econo-my of PICC maintenance and ability promotion of nursing staff etc. Results There were 379 cases of PICC catheter maintenance before the

  5. Nursing Care of Patients with Tracheotomy Treated by Central Venous Catheter Inserted in Different Sites%气管切开患者不同部位中心静脉导管置管护理观察

    Institute of Scientific and Technical Information of China (English)

    钱丽芳

    2014-01-01

    Objective To study the difference and clinical significance of patients with tracheotomy treated by central venous catheter inserted in different sites. Methods A total of 75 cases with tracheotomy from February 2012 to February 2014 were divided into three groups: subclavian vein group (group A), jugular vein group (group B) and femoral vein group (group C). 25 in each group. We compared the significance in success rates, complications, hematoma and exudate of puncture site, catheter tube jam, catheter emerge, central venous catheter-related infection (CVC-RI) and dressing change rates among all the groups. Results There was no significant difference of success rates and complications among all the groups (P>0.05), but group A was better than the other two groups in the targets (P<0.05). Central venous catheter was easier to emerge in group B compared with group A and group C (P<0.05). Conclusion Subclavian vein catheter way in the patients with tracheotomy has lower CVC-RI rate, and was easier for nursing care, so it was the first selection in the patient after tracheotomy.%目的:探讨气管切开患者不同部位中心静脉置管差异及临床意义。方法收集苏州大学附属第一医院2012年02月~2014年02月收治的75例气管切开患者临床资料,随机分为锁骨下静脉置管组(A组)、颈内静脉置管组(B组)、股静脉置管组(C组),每组25例。分别对穿刺成功率、并发症、穿刺部位血肿、渗液、导管堵管、脱出、导管相关感染、敷料更换频率等指标进行观察,比较各组之间差异。结果各组患者穿刺成功率及并发症差异无统计学意义(P>0.05),其余各指标A组显著低于B、C两组,具有统计学意义(P<0.05)。其中B组患者导管更易脱出,与A、C两组差异有统计学意义(P<0.05)。结论气管切开患者选择锁骨下静脉置管具有较低的导管相关感染发生率,且便于护理治疗,应作为首选置管途径。

  6. Complication Analysis of Further Modified Seldinger Technique for Peripherally Inserted Central Catheter Catheterization%再改良塞丁格技术降低 PICC 置管后的并发症分析

    Institute of Scientific and Technical Information of China (English)

    茅惠丽; 朱红

    2015-01-01

    Objective To discuss the complication of further modified seldinger technique for peripherally inserted cen‐tral catheter (PICC) catheterization .Methods 128 patients with malignant tumor performed regular PICC catheterization were randomly divided into the observation group and the control group ,with 64 cases in each group .Patients in the obser‐vation group were applied with further modified seldinger technique for PICC catheterization , and patients in the control group were applied with modified seldinger method . The successful rate of puncture once and the complication of further modified seldinger technique for peripherally inserted central catheter (PICC) catheterization between two groups were analyzed .Results The successful rate of puncture once of patients in the observation group was 93 .8% ,and it was significantly higher than that of the control group (P < 0 .05) .Catheter heterotopia rate was 3 .1% ,punctured hemorrhage rate was 14 .1% ,phlebitis rate was 4 .7% ,vein thrombosis rate was 6 .3% ,unplanned extubation rate was 6 .3% ,the plug‐ging pipe rate was 7 .8% ,and the incidence of catheter related infections was 1 .6% ,and they were all significantly lower than those of control group (P<0 .05) .Conclusion The complication of further modified seldinger technique for PICC cath‐eterization has been reduced significantly .It is high worthy of clinical application .%目的:探讨再改良塞丁格技术降低外周中心静脉置管(PICC )置管后的并发症发生率。方法选取128例行PICC置管的恶性肿瘤患者作为研究对象,随机分为对照组和观察组,各64例。对照组采用改良塞丁格技术穿刺置管。观察组采用再改良塞丁格技术穿刺置管。比较两组置管一次穿刺成功率及PICC置管后和带管期间并发症发生情况。结果观察组一次穿刺成功率93.8%,显著高于对照组(P<0.05),且观察组导管异位率3.1%,穿刺点出血14.1

  7. Clinical Experience of Color Doppler Ultrasound-Guided Improved Peripherally Inserted Central Catheter%超声引导改良外周静脉导入中心静脉置管术临床应用经验

    Institute of Scientific and Technical Information of China (English)

    李东海; 程芳; 朱超逸; 丁岩; 华克勤; 钱海林

    2015-01-01

    Objective:The aim of this study was to investigate the clinical value and the advantages of the improved peripherally inserted central catheter (PICC) guided by color Doppler ultrasound.Methods:Forty-two patients with malignant tumor history were included in this study.They all needed PICC and were not suitable for blind puncture because the superficial veins were not palpated.The improved PICC guided by color Doppler ultrasound were used.The improvements included the use of puncture frame on the probe and the substitution of one-off anesthesia needles for puncture needles in Seldinger package.The puncture success rate and the complication rate were analyzed and compared with 23 patients using standard PICC.Results:Both the improved PICC and the standard PICC had a 100 % puncture success rate.One-time success rate of the improved PICC and standard PICC were 97.6 % (41/42) and 91.3 % (21/23).And the difference was not statistically significant (P>0.05).Two patients with improved PICC had complications,including one case of local edema and one case of catheter heterotopia; six patients with standard PICC had complications,including two cases of local edema,one case of catheter heterotopia,one case of phlebitis and two cases of local infection.And the difference of the complication rate was statistically significant (P=0.019).Conclusions:The improved PICC guided by color Doppler ultrasound had higher success rate and lower complication rate compared with standard PICC and it was worthy of clinical promotion.%目的:探讨超声引导下改良的外周静脉导入中心静脉置管术(Peripherally Inserted Central Catheter,PICC)的临床应用.方法:对42例有恶性肿瘤病史需行PICC置管、浅静脉直视下不明显或触摸不到、不适合盲穿患者42例进行超声引导下改良的PICC术.改良方法包括穿刺支架超声引导以及用一次性使用麻醉用针替代Seldinger包内的穿刺针进行,并与23例标准PICC法对比分析穿

  8. 经外周静脉置入中心静脉导管运用中的伦理问题及对策%Ethical Reflection and Countermeasure for Peripheral Inserted Center Catheter Applications

    Institute of Scientific and Technical Information of China (English)

    祁静; 李惠玉; 伍庆; 杨国斌

    2014-01-01

    针对经外周静脉置入中心静脉导管在临床使用越来越广泛的现状,从置管前评估不规范、准入与考核制度不严、延续护理不到位、人文关怀缺失等方面探讨经外周静脉置入中心静脉导管运用中的伦理学问题,指出应科学评估,严格掌握适应症;加强规范,严格准入制度;主动随访,加强健康教育;强化职业道德,加强人文关怀等,从而保证患者安全,整体提升护理服务水平。%According to the widely use of peripheral inserted center catheters , this paper reflects ethical issues form the aspects such as the evaluation before catheter is lack of standards , the access and appraisal system is lax , the continuation of care does not reach and lack of humanistic care aspects .Furthermore , the article points out that the scientific assessment , grasping the indications strictly , strengthening the norms , stricting access system , taking the initiative to follow -up, strengthening health education , the professional ethics , the humanistic care and so on, can ensure the safety of patients and improve nursing service level as a whole .

  9. 授权式教育在行PICC化疗患儿家属健康教育中的应用%Application of empowerment education in health education of families of children receiving chemotherapy with percutaneously inserted central catheter

    Institute of Scientific and Technical Information of China (English)

    沈燕; 周玉峰; 王娟

    2014-01-01

    Objective To study the application effects of empowerment education in health education for families of children receiving chemotherapy with percutaneously inserted central catheter .Method Thirty five families of chil-dren diagnosed with malignancy and placed with percutaneously inserted central catheter (PICC) were enrolled in this study .Anxiety indexes of families of children before and after placed with PICC were assessed by Self-rating anxiety scale (SAS) established by Zung .Knowledge level of before and after PICC placement was evaluated by homemade health education evaluation .Result Compared with the parents of children before PICC treatment ,they known better of PICC after empowerment education (P< 0 .05) .Parents'anxiety was significantly reduced after PICC treatment ,There was significant differences between the two (P<0 .05) .Conclusion Empowerment education makes the families to participate in all aspects of health care ,changing their behavior and mental fitness and impro-ving their autonomy participation significantly .%目的:探讨授权式教育在行PICC化疗患儿家属健康教育中应用的效果。方法选取确诊为恶性肿瘤患儿行PICC置管的家属35例,分别在置管前和置管后采用Zung焦虑自评量表(SAS)测定家属焦虑指数,应用自制健康教育评价表观察比较置管前后家属对置管相关知识的掌握情况。结果置管后患儿家属对授权式教育获得的PICC知识掌握情况优于置管前(P<0.05),焦虑情绪明显减轻,与置管前相比差异有显著意义(P<0.05)。结论授权式教育让家庭参与健康照顾的各个方面,改变患儿家属行为方式和心理适应度,明显提升了患儿家属的自主性和参与性。

  10. Comparison of three different fixiation methods for peripherally inserted central catheter%三种经外周静脉置入中心静脉导管固定方法临床效果的比较

    Institute of Scientific and Technical Information of China (English)

    房芳; 张宏岩; 王峰杨武; 张景莲

    2011-01-01

    目的 比较3种不同的经外周静脉置人中心静脉导管(PICC)固定方法对导管固定的临床效果.方法 将120例留置PICC导管患者采用便利抽样的方法分为3组,每组各40例,分别采用缝合固定(A组)、免缝胶带交叉固定(B组)和思乐扣免缝导管固定装置固定(C组).观察并比较3组患者置管后留置期间导管固定的牢固性、并发症发生率、固定部位皮肤损伤情况及患者的满意度.结果 B组导管移位的发生率(57.5%)明显高于A组(12.5%,P=0.000)和C组(7.5%,P=0.000),导管脱出的发生率(15.0%)亦明显高于A组(0,P=0.034)和C组(0,P=0.034).导管留置期间静脉炎的发生率在B组(25.0%)明显高于A组(7.5%,P=0.034)和C组(5.0%,P=0.012);在A组中并发穿刺部位蜂窝织炎的发生率明显高于C组(20.0%比2.5%,P=0.034).A组患者出现固定翼下的皮肤压痕的发生率(37.5%)明显高于B组(5.0%,P=0.000)和C组(5.O%,P=0.000),且A组患者皮肤破损的发生率(22.5%)也高于B组(5.0%,P=0.023)和C组(0,P=0.005);各种原因所致的皮肤刺激痛在A组(52.5%)中明显增加,高于B组(0,P=0.000)和C组(2.5%,P=0.000).患者对3组不同导管固定法的满意度在A组(12.0%)显著低于B组(62.5%,P=0.000)和C组(90.0%,P=0.000),且C组满意度最高,明显高于B组(P=0.004).结论 思乐扣免缝导管固定装置固定法可以作为胶带和缝合固定的替代,具有等同于缝合法对导管的固定作用,预防了导管移位、脱出等导管相关并发症,同时也避免了缝合固定造成的皮肤损伤.%Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course

  11. Infections associated with the central venous catheters.

    Science.gov (United States)

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  12. An experimental comparative study of radiography, ultrasonography and CT imaging in the IV catheter fragment

    Energy Technology Data Exchange (ETDEWEB)

    Kweon, Dae Cheol [Dept. of Radiological Science, College of Health Science, Shinhan University, Uijeongbu (Korea, Republic of)

    2016-06-15

    The objective of this study was to detect the fragments generated during IV (intravenous) catheter injection of contrast medium and drug administration in a clinical setting and removal was performed by experimentally producing a phantom, and to compare the radiography, ultrasonography, and multi-detector computed tomography (MDCT) imaging and radiation dose. A 1 cm fragment of an 18 gage Teflon® IV catheter with saline was inserted into the IV control line. Radiography, CT, and ultrasonography were performed and radiography and CT dose were calculated. CT and ultrasonography showed an IV catheter fragment clinically and radiography showed no visible difference in the ability to provide a useful image of an IV catheter fragment modality (p >.05). Radiography of effective dose (0.2139 mSv·Gy-1·cm-2) form DAP DAP (0.93 μGy·m2 ), and dose length product (DLP) (201 mGy·cm) to effective dose was calculated as 0.483 mSv. IV catheter fragment were detected of radiography, ultrasonography and CT. These results can be obtained by menas of an excellent IV catheter fragment of detection capability CT. However, CT is followed by radiation exposure. IV catheter fragment confirming the position and information recommend an ultrasonography.

  13. 运用改良塞丁格技术行PICC穿刺的临床应用%Clinical application of modified Seldinger technique in peripherally inserted central catheters (PICC)

    Institute of Scientific and Technical Information of China (English)

    付小伟; 孙洪涛

    2012-01-01

    Objective To explore the clinical application of modified Seldinger technique in peripherally inserted central catheters ( PICC ). Methods Ten patients were included in the study with poor visible blood vessel. The modified Sledinger technique was employed to perform PICC. Results All of the 10 patients have been successfully catheterized by the modified Seldinger technique with a success rate of 100%. No complications occurred within seven days after catheterization. Conclusion The modified Seldinger technique overcomes the limitation of the routine PICC on the visibility of blood vessel.It greatly improves the success rale of catheterization and reduces the incidence of complications.%目的 探讨运用改良塞J格技术行PICC穿刺置管的临床应用.方法 10例患者,外观及触摸血管状况极差,使用改良塞丁格技术,行PICC穿刺.结果 10例患者一次性穿刺成功率为100%,术后7d内观察没有并发症发生.结论 此技术解决了传统置管方法受血管条件限制的局限性,大大提高了 PICC置管成功率,减少了并发症.

  14. Effect of Arm Positioning on Entrapment of Infraclavicular Nerve Block Catheter

    Science.gov (United States)

    Reddy, Rahul; Kendall, Mark C.; Nader, Antoun; Weeks, Jessica J.

    2017-01-01

    Continuous brachial plexus nerve block catheters are commonly inserted for postoperative analgesia after upper extremity surgery. Modifications of the insertion technique have been described to improve the safety of placing an infraclavicular brachial plexus catheter. Rarely, these catheters may become damaged or entrapped, complicating their removal. We describe a case of infraclavicular brachial plexus catheter entrapment related to differences in arm positioning during catheter placement and removal. Written authorization to obtain, use, and disclose information and images was obtained from the patient.

  15. Catheter Angiography

    Medline Plus

    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... iodine. If angiography is essential, a variety of methods is used to decrease risk of allergy: You ...

  16. Catheter Angiography

    Medline Plus

    Full Text Available ... injection of contrast material to examine blood vessels in key areas of the body for abnormalities such ... makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography produces very detailed, ...

  17. Catheter Angiography

    Medline Plus

    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... an hour away. top of page What does the equipment look like? The equipment typically used for ...

  18. Catheter Angiography

    Medline Plus

    Full Text Available ... atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a ... the aorta in the chest or abdomen or its major branches. show the extent and severity of ...

  19. Malposition of catheters during voiding cystourethrography

    Energy Technology Data Exchange (ETDEWEB)

    Rathaus, V.; Konen, O.; Shapiro, M. [Dept. of Diagnostic Imaging Sapir Medical Center, Kfar-Saba and Sackler Medical School, Tel Aviv University (Israel); Grunebaum, M. [Veteran Pediatric Radiologist, Kfar Saba (Israel)

    2001-04-01

    The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction. (orig.)

  20. Erroneous laboratory values obtained from central catheters.

    Science.gov (United States)

    Johnston, J B; Messina, M

    1991-01-01

    Serious analytic errors in potassium measurements have been identified in blood specimens obtained from newly inserted central catheters. Erroneous elevated readings have been related to interactions of chemistry analyzer electrodes and substances fixed to external and intraluminal walls of the central catheter. Anecdotal summaries of this phenomenon are presented to enable the nurse to recognize potential problems when sampling blood from central catheters. Studies were performed to determine the amount of flush necessary to clear the catheter of interfering residue. To eliminate this potentially hazardous occurrence, recommended flush volumes, nursing implications, and actions are described.

  1. Malfunctioning central venous catheters in children: a diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek; Hiorns, Melanie P. [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2008-04-15

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or 'linogram' technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. (orig.)

  2. Using urokinase to restore patency in double lumen catheters.

    Science.gov (United States)

    Northsea, C

    1994-08-01

    All hemodialysis patients with temporary or permanent double lumen catheters are at risk for catheter occlusion. Clinical outcomes and cost-effectiveness of using urokinase, a thrombolytic agent, to declot occluded double lumen dialysis catheters were evaluated for 2 years. Patency was restored in 95 of 102 catheters. These data support the use of urokinase to safely and effectively restore patency, thereby extending the length of time a catheter can be used for dialysis.

  3. Urinary catheters

    Science.gov (United States)

    ... incontinence. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a ... too small Bladder spasms Constipation The wrong balloon size Urinary tract infections POSSIBLE COMPLICATIONS Complications of catheter ...

  4. Catheter Angiography

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. ...

  5. Central venous catheter placement: where is the tip?

    Science.gov (United States)

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  6. Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1995-10-15

    To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy.

  7. The bowed catheter sign: a risk for pericardial tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Towbin, Richard [Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

    2008-03-15

    The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade. (orig.)

  8. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?

    Science.gov (United States)

    Nagashima, Goro; Kikuchi, Toshiki; Tsuyuzaki, Hitomi; Kawano, Rumiko; Tanaka, Hiroyuki; Nemoto, Hiroshi; Taguchi, Kazumi; Ugajin, Kazuhisa

    2006-12-01

    The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related, and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis wards. Collected data included the insertion method, purpose, length of catheter inserted, duration of catheterization, infection rate, and complication rate. Catheter-related infection was diagnosed based on bacteriological examinations from blood cultures. The total number of catheterizations was 806 a year, and average duration of catheterization was 9.8 days. The purpose of catheterization was nutritional support in 210 cases, hemodialysis in 96 cases, cardiac support in 174 cases, and other treatments in 260 cases. In 66 cases, the purpose of CV catheter was not specified. The rate of positive cultures was 7.1%, and complications other than infection occurred in 0.5%. The main causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) in 38.6%, coagulase-negative Staphylococcus epidermidis (CNS) in 33.3%, and S. aureus in 12.3% of infections. Infection rates were 3.8 per 1000 catheter-days in subclavian, 6.1 in jugular, and 15.7 in femoral vein catheterization. In high-risk departments (intensive care unit [ICU] and emergency departments) the infection rate was 5.4 for subclavian and 10.2 for jugular catheterization, whereas it was 3.6 for subclavian and 4.6 for jugular catheterization in noncritical-care departments. Considering complications such as pneumothorax, CV catheterization of the jugular vein is recommended in certain situations.

  9. Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

    Energy Technology Data Exchange (ETDEWEB)

    Burton, Kirsteen R. [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada); Guo, Lancia L. Q. [University of Calgary, Department of Radiology (Canada); Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K., E-mail: dheeraj.rajan@uhn.on.ca [University Health Network, University of Toronto, Department of Medical Imaging, Division of Vascular and Interventional Radiology (Canada)

    2012-12-15

    Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

  10. 肿瘤患者PICC导管相关静脉血栓形成影响因素Meta分析%Risk factors of venous thromboembolism associated with peripherally inserted central catheters among cancer patients:a

    Institute of Scientific and Technical Information of China (English)

    于瑞; 陈利芬

    2016-01-01

     目的:综合分析肿瘤患者PICC导管相关静脉血栓形成的危险因素,为预防PICC导管相关静脉血栓形成提供理论依据。方法:计算机检索Web of Science、PubMed、Cochrane Library、OVID EBM Reviews、 CNKI、万方数据、CBM及VIP,并辅以手工检索、文献追溯等方法收集符合标准的文献,采用Stata 12.1软件进行合并分析。结果:纳入符合标准的文献6篇,合计样本量1277例,其中血栓组253例,对照组1024例,血栓发生率为19.81%。Meta分析结果显示,化疗史、糖尿病、高血压、COPD、活动量减少与PICC导管相关静脉血栓形成有关。结论:化疗史、糖尿病、高血压、COPD、活动量减少是PICC导管相关静脉血栓形成的危险因素。%Objective: To analyze the risk factors of venous thromboembolism associated with peripherally inserted central catheters (PICC) among cancer patients, and to provide theoretical basis for prevention venous thromboembolism associated with PICC among cancer patients. Methods: We searched the related papers from the Web of Science, PubMed, Cochrane Library, OVID EBM Reviews, CNKI, Wan Fang Databases, CBM and VIP. The Stata 12.1 software was used to conduct the meta-analysis. Results: Six studies were included in the study. The sample size was 1277 with 253 cases in venous thromboembolism group and 1024 cases in control group. The incidence rate of venous thromboembolism associated with PICC was 19.81%. Meta-analysis showed that the risk factors were history of chemotherapy, diabetes, hypertension, COPD, and less activity. Conclusion: The risk factors of venous thromboembolism associated with PICC among cancer patients are history of chemotherapy, diabetes, hypertension, COPD, and less activity.

  11. 新生儿经不同部位置入PICC导管的应用比较%Effect comparison of peripherally inserted central catheter through different parts for neonates

    Institute of Scientific and Technical Information of China (English)

    韩雪婷

    2014-01-01

    目的:比较新生儿经2个不同部位置入 PICC导管的效果。方法选取2012年5月-2013年8月经肘部静脉及头部静脉置入 PICC导管患儿各26例,通过观察穿刺部位穿刺时、穿刺完毕出血情况、置管成功例数、发生静脉炎例数及皮肤过敏或破损情况,比较2个部位置管的效果。结果经头皮静脉置管术中及术后24 h更换敷料时出血例数均少于经肘部静脉置管。经头皮静脉置管更换敷料时造成皮肤过敏或破损的例数少于经肘部静脉置管。置管成功例数和发生静脉炎的例数2组比较,差异无统计学意义。结论肘部静脉条件差或凝血功能障碍的患儿,可选择头皮静脉穿刺置管。%Objective To compare the effects of peripherally inserted central catheter (PICC) through different parts for neonates .Methods From May 2012 to August 2013 ,52 neonates with PICC were randomly divided into elbow venous puncture group (n=26) and scalp venous puncture group (n=26) .The number of bleeding ,catheterization success ,phlebitis ,skin irritation or damage in 2 groups were compared .Results The number of bleeding at intraoperative and 24 hours after operation in the scalp venous puncture group were less than that in the elbow venous puncture group . The number of skin irritation or damage in the scalp venous puncture group were also less than that in the elbow venous puncture group . There were no statistical significance in number of catheterization success and phlebitis of 2 groups .Conclusions The neonates with poor elbow vein condition or dysfunction of blood coagulation should choose scalp venous puncture .

  12. A STUDY OF THE MOST APPROPRIATE PUNCTURE TIME IN THE PREMATURE BABIES WITH PE-RIPHERALLY INSERTED CENTRAL VENOUS CATHETERS%早产儿PICC最佳穿刺时间的探讨

    Institute of Scientific and Technical Information of China (English)

    刘树艳; 于燕; 刘海娟

    2014-01-01

    Objective To probe into the most appropriate puncture time of the premature babies with pe-ripherally inserted central venous catheters (PICC) .Methods A total of 109 premature infants admitted in the neonatal department of author's hospital were selected from March 2010 to May 2013 ,among which there were 59 premature babies (experimental group) given PICC puncture during 48 to 72 hours after birth and 50 premature babies (control group) given PICC puncture within 48 hours after birth .The puncture site is on the right side of the premature babies'basilic vein .χ2 was applied to test and analyze the relation-ship between PICC puncture time and one-time pass rate ,limb swelling of puncture side ,bleeding and oo-zing liquid rate of puncture site .Results the limb swelling of puncture side and the bleeding and oozing liq-uid rate of puncture site in the experimental group was lower than that in the control group ,which had sta-tistical significance .Conclusion 48 -72 hours after birth of premature babies is the best time for PICC puncture .%目的:探讨早产儿外周置入中心静脉导管的最佳穿刺时间。方法研究对象为唐山市妇幼保健院新生儿科2010年3月-2013年5月收治的119例早产儿,其中出生后48~72h行PICC穿刺组(观察组)59例,出生后48h内行PICC穿刺组(对照组)50例,穿刺部位为早产儿的右侧贵要静脉。应用χ2检验分析PICC穿刺时间与一次成功率、穿刺侧肢体肿胀及穿刺部位渗血渗液率的相关关系。结果观察组早产儿的穿刺侧肢体肿胀率、穿刺部位渗血渗液率低于对照组,且差异具有统计学意义。结论早产儿出生后48~72h是PICC的最佳穿刺时间。

  13. 水胶体敷料预防PICC患者机械性静脉炎效果的meta分析%A system review of the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis:meta-analysis

    Institute of Scientific and Technical Information of China (English)

    黎贵; 张淑香; 徐波

    2014-01-01

    目的:系统评价水胶体敷料对于PICC患者机械性静脉炎的预防效果。方法:计算机检索Cochrane Database of Systematic Reviews、JBI Database of Systematic Review、EMBase、PubMed、中国生物医学文献数据库、万方数据库和中国学术期刊全文数据库中关于水胶体敷料对于预防PICC患者机械性静脉炎效果的随机对照试验(RCT)和半随机对照试验(q-RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行meta分析。结果:共纳入9篇文献,meta分析的结果显示水胶体敷料能降低PICC患者机械性静脉炎的发生率。结论:水胶体敷料的使用对于预防PICC机械性静脉炎的发生具有显著效果,具有一定临床推广意义。%Objective:To systematically evaluate the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. Methods:The authors searched the Cochrane Database of Systematic Reviews, JBI Database of Systematic Review, EMBase, PubMed, CBMdisc, Wanfang Data and CNKI to collect randomized controlled trials (RCTs) and quasi-Randomized Controlled Trials (q-RCTs) which studied the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. The quality of RCTs and q-RCT were critically appraised and data were extracted by 2 reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results:9 RCTs were included. The meta-analysis had showed that hydrocolloid dressing could decrease the rate of Peripherally Inserted Central Catheter-related mechanical phlebitis significantly. Conclusion:Hydrocolloid dressing was effective to prevent Peripherally Inserted Central Catheter-related mechanical phlebitis.

  14. Causative analysis of obstruction of newborns undergoing central venous catheter insertion via peripheral vein and its strategies%新生儿经外周静脉置入中心静脉导管堵塞原因分析与对策

    Institute of Scientific and Technical Information of China (English)

    贾玉双; 占松莲; 谢微微; 时亚平; 王雅萍

    2007-01-01

    @@ 经外周静脉置人中心静脉导管(peripheral inserted central catheter,PICC)在新生儿重症监护室(neonatal intensive care unit,NICU)已广泛应用,其优点是操作简便、安全,并发症较其他的深静脉置管少,可减轻病人的痛苦,为需要中长期输液及输注刺激性药物的患儿提供静脉通道[1].

  15. Utilização de cateter central de inserção periférica e ocorrência da infecção da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal | Use of peripherally inserted central catheters and occurrence of bloodstream infections in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Márcia Yumi Yonekura

    2015-02-01

    Full Text Available Objetivo: Analisar a prevalência de infecção hospitalar primária da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal. Métodos: Estudo retrospectivo, com análise de prontuários de uma Unidade de Terapia Intensiva Neonatal, no período de janeiro a dezembro de 2010. Foi calculada a densidade de incidência de infecção de corrente sanguínea associada ao cateter por 1000 cateteres-dia. Resultados: Dos 192 recém-nascidos, 16 (8,3% apresentaram infecção da corrente sanguínea e todos estes utilizaram o cateter central de inserção periférica. A densidade de infecção confirmada por hemocultura foi de 5,9 e a baseada em critérios clínicos foi de 3,5 por 1000 pacientes com cateter vascular central-dia. A distribuição por faixa de peso foi de: 30,9 (750-999g; 11 (1000-1499g; 8,5 (1500-2499g e 6,8 (> 2500g por 1000 pacientes com cateter vascular dia. A média do tempo de uso do cateter foi de 11 dias. O sítio de inserção mais comum foi o acesso jugular (37,5% e a mortalidade associada à infecção da corrente sanguínea foi de 31%. Conclusões: A utilização do cateter central de inserção periférica é uma prática não isenta de riscos, considerando que este é um dispositivo invasivo e pode predispor à ocorrência de infecção. ------------------------------------------------------------------------------------------ Objective: To analyze the prevalence of hospital primary bloodstream infections in a neonatal intensive care unit (NICU. Methods: A retrospective study involving analyses of records of patients admitted to the NICU from January to December 2010 was conducted. The incidence density of catheter-associated bloodstream infections per 1000 catheter-days was calculated. Results: Among 192 newborns, 16 (8.3% who used peripherally inserted central catheters had bloodstream infections. The infection density confirmed by blood culture reached 5.9, while the density based on clinical criteria accounted for

  16. Unusual migration of pulmonary artery catheter

    Directory of Open Access Journals (Sweden)

    Sanjay Kuravinakop

    2007-01-01

    Full Text Available Pulmonary artery catheter is widely used in intensive care. Distal migration of the catheter is a know complication. Diagnosis of such a migration is made by both clinical criteria and radiographs. A 55 year old septic lady was admitted to the intensive care unit. Pulmonary artery catheter introduced for cardiac output monitoring migrated from right lung to left lung. Diagnosis was made following a chest radiograph the following day of insertion with the clinical criteria remaining unaltered. Migration of pulmonary artery catheter can occur not only distally but from one lung to another. Clinical criteria alone cannot rule out migration. Chest radiographs form an important part in monitoring the position of the pulmonary artery catheter.

  17. Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units

    Directory of Open Access Journals (Sweden)

    Daniela Bicudo

    2011-08-01

    Full Text Available INTRODUCTION: Central venous catheters (CVC are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI. In spite of its importance, few national studies have addressed this issue. OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication. METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex. RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001, with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates. CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001. The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001. There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.

  18. Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.

    Science.gov (United States)

    Nosari, Anna Maria; Nador, Guido; De Gasperi, Andrea; Ortisi, Giuseppe; Volonterio, Alberto; Cantoni, Silvia; Nichelatti, Michele; Marbello, Laura; Mazza, Ernestina; Mancini, Valentina; Ravelli, Erica; Ricci, Francesca; Ciapanna, Denis; Garrone, Federica; Gesu, Giovanni; Morra, Enrica

    2008-11-01

    Indwelling central venous catheters (CVCs) are used in the management of hematologic patients. However, insertion and maintenance of CVCs are susceptible to complications. Study design and methods data concerning 388 consecutive catheterisations, performed in oncohematologic patients between April 2003 and December 2004, were prospectively collected. At insertion thrombocytopenia was present in 109 cases (28.1%) and neutropenia in 67 (17.3%). Hemorrhage after CVC insertion occurred in five thrombocytopenic patients (1.3%). The median duration of catheterisation was 18.8 days (range 1-89), longer in the 7-French CVCs utilised in leukemic patients (24.3 days) and shorter in 12-French CVCs (11 days), used for PBSC harvesting. Deep venous thrombosis was diagnosed in 13 cases (3.3%). Ninety-two catheterisations (12.6/1000 days-catheter) were complicated by infections: 19 local infections (4.8%) and 73 (18.8%) bacteraemias of which 45 (11.6%) were catheter-related, mainly due to Gram positive germs (32/45, 71.1%). The frequency of catheter-related bacteraemia was 7.2 events/1000 days-catheter. Thirteen CVCs were removed due to thrombosis, 15 due to infections, 20 due to malfunction, the remaining 333 at patients discharge. At univariate analysis high-dose chemotherapy (p = 0.013), 7-Fr lumen (p = 0.023), acute myeloid leukemia (AML) (p = 0.001), duration of neutropenia >10 days and length of catheterisation were significantly correlated to infection. Multivariate analysis confirmed the duration of catheterisation, AML and high-dose chemotherapy as risk factors. Even though hematological in-patients are at increased risk for bleeding and infections, non-tunnelled CVCs offer a safe venous access also in patients affected by severe thrombocytopenia and prolonged neutropenia.

  19. Comparison of heparin-coated and conventional split-tip hemodialysis catheters.

    Science.gov (United States)

    Clark, Timothy W I; Jacobs, David; Charles, Hearns W; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph; Benstein, Judith A

    2009-07-01

    Catheter coatings have the potential to decrease infection and thrombosis in patients with chronic dialysis catheters. We report our midterm experience with a heparin-coated dialysis catheter. This retrospective, case-control study was approved by our Institutional Review Board. A total of 88 tunneled dialysis catheters were inserted over a 13-month period via the internal jugular vein. Thirty-eight uncoated split-tip catheters and 50 heparin-coated catheters were inserted. Primary catheter patency was compared between the two groups using the log rank test, with infection and/or thrombosis considered as catheter failures. Dialysis parameters during the first and last dialysis sessions, including pump speed, actual blood flow, and arterial port pressures, were compared using unpaired t-tests. Primary patency of the uncoated catheters was 86.0 +/- 6.5% at 30 days and 76.1 +/- 8.9% at 90 days. Primary patency of heparin-coated catheters was 92.0 +/- 6.2% at 30 days and 81.6 +/- 8.0% at 90 days (p = 0.87, log rank test). Infection requiring catheter removal occurred in four patients with uncoated catheters and two patients with heparin-coated catheters (p = 0.23). Catheter thrombosis requiring catheter replacement or thrombolysis occurred in one patient with an uncoated catheter and two patients with heparin-coated catheters (p = 0.9). No differences in catheter function during hemodialysis were seen between the two groups. In conclusion, the heparin-coated catheter did not show a significantly longer patency compared to the uncoated catheter. The flow characteristics of this device were comparable to those of the conventional uncoated catheter. A demonstrable benefit of the heparin-coated catheter in randomized trials is needed before a recommendation for routine implementation can be made.

  20. Comparison of ultrasound-guided peripherally inserted central catheter and ordinary puncture%B超引导下 PICC置管与常规肉眼穿刺的比较与分析

    Institute of Scientific and Technical Information of China (English)

    卫尹; 王蔚; 乐音; 施美丽; 龚怡

    2010-01-01

    Objective To compare the effect of ultrasound-guided peripherally inserted central catheter and ordinary puncture,and to explore an option of low risk,less pain for patients and higher nursing quality.Methods 167 patients who had undergone chemotherapy by PICC before or after breast cancer surgery in our hospital from Oct.2008 to Sep.2009 were retrospectively selected and divided into two groups:experimental group (ultrasound-guided PICC group,58 cases) and control group (routine puncture group,109 cases).Complications of the puncture site,armpit reversal,times of puncture,incidence of venous thrombosis,operation time of puncture and dressing change were compared between the two groups.Results Significant differences were found of complications of the puncture site,times of puncture,operation time of puncture and dressing change (P<0.01),as well as incidence of infection (P<0.05).There was no significant difference of armpit reversal between the two groups (P > 0.05).Neither mechanical phlebitis nor venous thrombosis was reported.Conclusions Ultrasound-guided PICC is superior to routine puncture.%目的 比较并分析B超引导下PICC置管与常规肉眼穿刺的效果,以选择更低风险的穿刺方法,减轻患者痛苦,提高护理质量.方法 采用回顾性调查进行资料收集,选取我科2008年10月至2009年9月乳腺癌术前及术后置PICC管进行化疗患者167例,按穿刺方法不同分为B超引导下置管组为实验组共58例,常规肉眼穿刺组为对照组共109例,观察并比较两组穿刺后并发症、腋下回折、穿刺次数、深静脉栓塞、穿刺操作用时、换药护理用时.结果 两组患者穿刺部位并发症、穿刺次数、穿刺操作用时、换药护理用时比较均有统计学意义(P<0.01),穿刺后感染的发生率比较有统计学意义(P<0.05),腋下回折比较无统计学意义(P>0.05),两组均无机械性静脉炎和深静脉栓塞发生.结论 应用B超引导进行PICC置管优于常规肉眼穿刺.

  1. Comparative Study of Ultrasound-guided Modified Seldinger Technique and Blind Insertion for Peripherally Inserted Central Catheters (PICC) in Cancer Patients%超声引导下改良Seldinger技术与盲穿法行PICC在肿瘤患者中的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈雅玫; 石新华; 张煜

    2013-01-01

    目的 探讨超声引导下改良Seldinger技术行外周静脉置入中心静脉导管(peripheral inserted central venous catheter,PICC)的价值.方法 2011年1月~2013年3月对213例肿瘤患者采用超声引导下改良Seldinger技术行PICC(超声引导组),与采用盲穿法的230例肿瘤患者(盲穿组)进行对比,比较2组PICC穿刺置管成功率及相关并发症.结果超声引导组一次性穿刺成功率95.3%(203/213),显著高于盲穿组78.3%(180/230)(χ2=27.436,P=0.000),一次性置管成功率98.1%(209/213),显著高于盲穿组78.3%(180/230)(χ2=40.755,P=0.000).超声引导组血栓性静脉炎发生率为0 5%(1/212),显著低于盲穿组4.5%(9/202)(χ2=5.377,P=0.020);机械性静脉炎发生率0.9%(2/212),显著低于盲穿组7.9%(16/202)(χ2=12.109,P=0.001).超声引导组无一例发生导管相关性感染,盲穿组1例,2组比较无统计学差异(Fisher's检验,P=0.488).结论超声引导下改良Seldinger技术对肿瘤患者行PICC比盲穿法可以显著提高穿刺置管成功率,并发症少,安全有效.

  2. Effects of proloading epidural space with epinephrine ( 1:200 000 ) on the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section%硬膜外腔预充1:200000肾上腺素对置管诱发剖宫产术患者硬膜外血管损伤的影响

    Institute of Scientific and Technical Information of China (English)

    韩传宝; 蒋秀红; 于力; 林聪; 丁正年; 钱燕宁

    2012-01-01

    目的 评价硬膜外腔应用肾上腺素(1∶200000)对置管诱发剖宫产术患者硬膜外血管损伤的影响.方法 选择2011年5至12月于南京医科大学第一附属医院,单胎足月妊娠急诊拟行子宫下段剖宫产术的产妇100例,美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,经本医院伦理委员会批准,按随机数字表法分为E组和N组(n=50).硬膜外穿刺成功后,E组经硬膜外穿刺针注入0.9%含肾上腺素( 1∶200000)的生理盐水5 ml;N组经硬膜外穿刺针注入0.9%生理盐水5 ml,两组注射完后均保持注射器压缩针栓20 s,使预充液充分扩散,然后置入硬膜外导管.于麻醉前(T1)、穿刺置管成功后改仰卧位2 min时(T2)、胎儿娩出时(T3)和手术结束时(T4)记录平均动脉压(MAP)和心率;记录置入硬膜外导管时硬膜外穿刺针针尾出现淡红色血水、硬膜外导管回抽见淡红色血水、硬膜外导管置入血管(从导管回抽出新鲜血液)和拔出硬膜外导管见尾端有暗红色血的例数.结果 两组血液动力学指标均波动在正常范围,组间比较差异无统计学意义(P>0.05);两组置入硬膜外导管时硬膜外穿刺针针尾出现淡红色血水(10%比12%)、硬膜外导管回抽见淡红色血水(4%比6%)、硬膜外导管置入血管(0%比0%)和拔出硬膜外导管见尾端有暗红色血(26%比30%)的发生率的差异均无统计学意义(均P>0.05).结论 硬膜外腔预充1∶200000肾上腺素并不能减少置管诱发的硬膜外血管损伤.%Objective To evaluate the effects of proloading epidural space with epinephrine (1∶200 000) on the incidence of vascular injuries through the insertion of an epidural catheter during cesarean section.Methods Between May 2011 and December 2011,upon obtaining institutional ethics approval and informed consent from the Human Ethics Committee of Nanjing Medical University, 100 laboring women with singleton cephalic presentation at term,ASA (American

  3. Central venous catheter-related infections: Risk factors and effects of glycopeptide antibiotics

    Directory of Open Access Journals (Sweden)

    Arsenijević Ljubica

    2007-01-01

    Full Text Available INTRODUCTION Central venous catheters (CVC are used in the treatment of critically ill patients. Indications for placement of CVCs include hemodynamic monitoring, administration of intravenous fluids, medications and total parenteral nutrition. MATERIAL AND METHODS We investigated risk factors and effects of glycopeptide antibiotics on the development of central venous catheter-related infections in 300 patients treated in intensive care units. A semiquntitative culture technique was used. The investigation included: age, diagnosis on admission, catheter insertion site, catheter duration, the first or next catheter and using of glycopeptide drugs. RESULTS 91 catheters (30.3% were colonised, catheter-related infection was found in 50 catheters (16.7%. Infections were more frequent in catheters inserted through the internal jugular vein than in subclavian venous catheters; they were also more frequent if duration of catheterization was longer than seven days, but less frequent in patients who received glycopeptide antibiotics. The isolated microorganism was Staphylococcus aureus. DISCUSSION According to the literature, a number of catheter-related risk factors for infections include: insertion site, type of catheter, the number of manipulations, inadequat asepsis, lumen number, type of antiseptic. The relative importance of one risk factor over another is difficult to assess, given that studies have no priority report. CONCLUSION The duration of catheterization and the insertion site were the most frequent risk factors for infection. The use of glycopeptide antibiotics during catheterization has protective effects.

  4. Hemodialysis Tunneled Catheter Noninfectious Complications

    Science.gov (United States)

    Miller, Lisa M.; MacRae, Jennifer M.; Kiaii, Mercedeh; Clark, Edward; Dipchand, Christine; Kappel, Joanne; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; Pike, Pamela; Hiremath, Swapnil

    2016-01-01

    Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.

  5. Central venous catheter (CVC) removal for patients of all ages with candidaemia

    DEFF Research Database (Denmark)

    Janum, Susanne; Afshari, Arash

    2016-01-01

    BACKGROUND: Candida bloodstream infections most often affect those already suffering serious, potentially life-threatening conditions and often cause significant morbidity and mortality. Most affected persons have a central venous catheter (CVC) in place. The best CVC management in these cases has...... conclusions. At this stage, RCTs have provided no evidence to support the benefit of early or late catheter removal for survival or other important outcomes among patients with candidaemia; no evidence with regards to assessment of harm or benefit with prompt central venous catheter removal and subsequent re......-insertion of new catheters to continue treatment; and no evidence on optimal timing of insertion of a new central venous catheter....

  6. Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath

    Science.gov (United States)

    Wallace, Daniel T.; Goldenberg, Alex S.; Peters, Nicholas S.; Davies, D. Wyn

    2008-01-01

    Background A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation. Objective To report our initial experience using this system for remotely performing catheter ablation in humans. Methods Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n = 1), atrial flutter (n = 2) and atrial fibrillation (n = 7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success. Results Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm2 for all ten ablation procedures. Conclusions Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator. Electronic supplementary material The online version of this article (doi:10.1007/s10840-007-9184-z) contains supplementary material, which is available to authorized users

  7. Effects comparison between ultrasound-guided peripherally inserted cen-tral catheter under modified Seldinger technique and traditional PICC%超声引导下改良Seldinger技术行PICC置管与传统穿刺置管应用效果比较

    Institute of Scientific and Technical Information of China (English)

    王璇

    2014-01-01

    目的:比较超声引导下改良Seldinger技术行PICC置管与传统穿刺置管的应用效果。方法选择沈阳医学院附属中心医院2010年6月~2013年12月门诊或住院需要进行PICC置管的患者280例,随机分为两组,各140例。研究组患者采用超声引导下改良Seldinger技术经上臂行PICC置管,对照组患者采用传统穿刺方法进行PICC置管。观察两组患者一次穿刺成功率、一次置管成功率、总置管成功率,观察贵要静脉使用情况、置管后导管末端位置及相关并发症情况。结果研究组一次穿刺成功率、一次置管成功率及总置管成功率明显高于对照组(99.3%、97.8%、99.3%比80.0%、77.8%、88.6%),组间比较差异均有统计学意义(字2=6.395、6.843、4.283,P0.05)。结论超声引导下改良Seldinger技术行PICC置管可有效提高穿刺及置管成功率,且导管异位及穿刺相关并发症发生率明显降低,安全性较高,值得推广应用。%Objective To compare the effect of ultrasound-guided peripherally inserted central catheter (PICC) under modified Seldinger technique and traditional PICC. Methods 280 cases of outpatients and inpatients required PICC in Central Hospital Affiliated to Shenyang Medical College from June 2010 to December 2013 were randomly divided into two groups, each of 140 cases. Patients of study group were given ultrasound-guided PICC on upper arm under modi-fied Seldinger technique, and patients in control group were given traditional PICC. One time puncture success rate, one time catheter success rate, total catheter success rate, the usage condition of basilic vein, tip position of catheter, and related complications of two groups were observed and compared. Results The one time puncture success rate, one time catheter success rate, total catheter success rate of study group were significantly higher than those of control group (99.3%, 97.8%, 99.3%vs 80.0%, 77.8%, 88.6%), the differences between the two

  8. A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit

    Directory of Open Access Journals (Sweden)

    Christiana Oluwatoyin Amira

    2016-01-01

    Full Text Available Hemodialysis (HD catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days. Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5% catheters were removed, 14 (20.3% due to catheter malfunction, eight (11.6% due to infection, five (7.2% elective removal, and three (4.3% due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

  9. Evaluation of the safety of latrogenic lntestinal perforation during placement of percutaneous drainage catheter in rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Choon Hyeong; Oh, Joo Hyung; Park, Ga Young; Shin, Hong Sub; Kim, In Sub; Yoon, Yup; Lee, Dong Ho; Ko, Young Tae; Choi, Woo Suk; Lim, Joo Won [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1996-10-01

    To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. Eight 8-F straight catheters were percutaneously inserted into the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed in all animals ten days after catheter placement, and gross and microscopic examination was carried out. Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. Although further study is warranted, our study with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.

  10. Accidental placement of central venous catheter in lung parenchyma causing hydrothorax

    Directory of Open Access Journals (Sweden)

    Vivek Badada

    2014-01-01

    Full Text Available Central venous catheterization is associated with its share of complications. Most of these complications can be avoided and treated by appropriate patient selection, careful insertion technique and vigilance following catheter insertion. We report a patient presenting with unilateral hydrothorax due malposition of central venous catheter in lung parenchyma. Prompt recognition of complication and its treatment remedied the situation.

  11. Chlorhexidine Gluconate Dressings Reduce Bacterial Colonization Rates in Epidural and Peripheral Regional Catheters

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    Klaus Kerwat

    2015-01-01

    Full Text Available Introduction. Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods. In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results. A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion. CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.

  12. The Use of the Peripherally Inserted Central Catheter (Picc in the Hospital Environment La utilización del catéter central de inserción periférica (CCIP en el ambiente hospitalario A utilização do cateter central de inserção periférica (CCIP no ambiente hospitalar

    Directory of Open Access Journals (Sweden)

    Graziella Gasparotto Baiocco

    2010-12-01

    Full Text Available The study aimed to analyze the history of the use of the peripherally inserted central catheters in adult patients admitted to hospital from 2000 to 2007. The historical cohort approach was used with retrospective data collection from medical records of the Catheter Group of the Moinhos de Vento Hospital Association in Porto Alegre, RS, totaling 229 catheters inserted. The growth curve in the use of the PICC was from 1 catheter inserted in 2000 to 57 in 2007. The most prevalent pathology was oncology (17.9%, n=41. In relation to the indications of use, antibiotic use prevailed (54.1%, n=124. In the radiological confirmation the vena cava was prevalent (68.1%, n=156. The use of the PICC in the hospital environment is expanding and nursing has a fundamental role in its insertion, maintenance and removal.El estudio objetivó analizar el histórico de la utilización del catéter central de inserción periférica en pacientes adultos e internados en ambiente hospitalario de 2000 a 2007. Tuvo abordaje de cohorte histórico con recolección de datos retrospectivo en fichas del Grupo de Catéteres de la Asociación Hospitalaria Molinos de Viento en Porto Alegre, RS, totalizando 229 catéteres inseridos. La curva de crecimiento en la utilización del CCIP fue de 1 catéter inserido en 2000 a 57 inseridos en 2007. La prevalencia inherente a la patología fue oncológica (17,9%, n=41. En relación a las indicaciones de uso prevaleció la terapia con antibióticos (54,1%, n=124. En la confirmación radiológica la vena cava fue prevalente (68,1%, n=156. La utilización del CCIP en el ambiente hospitalario está en expansión y la enfermería tiene un papel fundamental en la inserción, manutención y remoción.O estudo objetivou analisar o histórico da utilização do cateter central de inserção periférica em pacientes adultos e internados, em ambiente hospitalar, de 2000 a 2007. Teve abordagem de coorte histórica, com coleta de dados retrospectiva em

  13. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  14. Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition.

    Science.gov (United States)

    Sitges-Serra, A; Puig, P; Jaurrieta, E; Garau, J; Alastrue, A; Sitges-Creus, A

    1980-10-01

    Staphylococcus epidermidis is a pathogenic organism with increasing importance in total parenteral nutrition therapy. Strict asepsis during catheter insertion prolongs the interval free from Staphylococcus epidermidis infection. Staphylococcus epidermidis colonizes the catheter after migrating from the skin. For protection, we advise a long subcutaneous tunnel for all catheters that are to be indwelling for longer than three weeks. Prompt recatheterization of a patient with Staphylococcus epidermidis sepsis can result in hematogenous seeding of the new catheter and persistence of the infection. Catheter related Staphylococcus epidermidis sepsis has subsided after catheter withdrawal, and there is no need for antibiotic therapy provided that other prosthetic materials are not placed in the vascular tree. Immunologic status of the patients is not related to the frequency or severity of Staphylococcus epidermidis infections, or both.

  15. Advanced Imaging Catheter: Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Krulevitch, P; Colston, B; DaSilva, L; Hilken, D; Kluiwstra, J U; Lee, A P; London, R; Miles, R; Schumann, D; Seward, K; Wang, A

    2001-07-20

    Minimally invasive surgery (MIS) is an approach whereby procedures conventionally performed with large and potentially traumatic incisions are replaced by several tiny incisions through which specialized instruments are inserted. Early MIS, often called laparoscopic surgery, used video cameras and laparoscopes to visualize and control the medical devices, which were typically cutting or stapling tools. More recently, catheter-based procedures have become a fast growing sector of all surgeries. In these procedures, small incisions are made into one of the main arteries (e.g. femoral artery in the thigh), and a long thin hollow tube is inserted and positioned near the target area. The key advantage of this technique is that recovery time can be reduced from months to a matter of days. In the United States, over 700,000 catheter procedures are performed annually representing a market of over $350 million. Further growth in this area will require significant improvements in the current catheter technology. In order to effectively navigate a catheter through the tortuous vessels of the body, two capabilities must exist: imaging and positioning. In most cases, catheter procedures rely on radiography for visualization and manual manipulation for positioning of the device. Radiography provides two-dimensional, global images of the vasculature and cannot be used continuously due to radiation exposure to both the patient and physician. Intravascular ultrasound devices are available for continuous local imaging at the catheter tip, but these devices cannot be used simultaneously with therapeutic devices. Catheters are highly compliant devices, and manipulating the catheter is similar to pushing on a string. Often, a guide wire is used to help position the catheter, but this procedure has its own set of problems. Three characteristics are used to describe catheter maneuverability: (1) pushability -- the amount of linear displacement of the distal end (inside body) relative to

  16. 超声引导下改良塞丁格技术行经外周静脉置入中心静脉导管常见问题及对策%Common problems and countermeasure of ultrasound-guided modified Seldinger technique for peripherally inserted central catheter placement

    Institute of Scientific and Technical Information of China (English)

    何燕娴; 李平; 周利

    2011-01-01

    Objective To investigate the common problems and countermeasure of using ultrasound-guided modified Seldinger technique in peripherally inserted central catheter (PICC) placement Method The clinical data of 140 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were retrospectively analyzed. Results The success rate of catheterization was 98. 6% among these 140 patients,with 135 (96. 4% ) succeeded after a single attempt and 5 (3. 6% ) after 2 attempts. Besides, 7. 1% (n = 10) had difficulty in inserting the guide wire, 3. 6% (n =5) had difficult catheteration, 2. 1% (n =3) met resistance when inserting catheter into ipsilateral subclavian vein, 2. 1 % (n = 3 ) experienced dystopia of inserting catheter into internal jugulular vein, and 1.4% (n = 2) experienced the bending of PICC in the superior vena cava and axillary vein. All of these problems were handled successfully. Conclusions The common problems of PICC placement include puncture failure, difficulty in inserting guide wire, and difficult catheteration. A good knowledge of these problems will help increase the success rate.%目的 探讨超声引导下改良塞丁格技术行经外周静脉置入中心静脉导管(PICC)过程中遇到的常见问题及对策.方法 对140例超声引导下改良塞丁格技术行PICC置管,分析置管过程中出现的常见问题并提出相应的对策.结果 140例患者中置管成功率为98.6%,135例(96.4%)1次穿刺成功,5例(3.6%)2次穿刺成功.此外,10例(7.1%)送导丝不畅,5例(3.6%)PICC管送入不畅,3例(2.1%)在送管至同侧锁骨下静脉处受阻,3例(2.1%)PICC管异位至颈内静脉,2例(1.4%)PICC管分别在上腔静脉及腋静脉处折返,均经处理,置管成功.结论 超声引导下改良塞丁格技术行PICC置管过程中常见的问题有穿刺失败、送导丝不畅或失败、送管不畅或失败,要善于总结经验教训,才能提高置管成功率.

  17. Risk Factors Associated with Peripherally Inserted Central Venous Catheter-related Upper-extremity Deep Vein Thrombosis in Cancer Patients%肿瘤患者PICC置管并发上肢静脉血栓的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    范彬; 黄芬; 梅赣红; 张玉红

    2016-01-01

    Objective:To evaluate the incidence and risk factors of upper-extremity deep vein thrombosis (UEDVT) related to peripherally inserted central venous catheter in cancer patients.Method:From June 2014 to November 2014,177 cases of solid tumor patients who underwent implantation of a peripherally inserted central venous catheter were selected in our hospital.All patients were examined at prescribed intervals by ultrasonography (US) to estimate the incidence of catheter-related venous thrombosis.Result:During the study period,177 PICC were placed in 177 cases of patients followed up for a total of 15 115 catheter-days,the mean duration of catheter was 85.4 d.The incidence rate of cancer patients with PICC-UEDVT was 25.42%, of which the incidence of symptomatic usm - UEDVT was 5.08%.In adjusted by Logistic analysis,distant metastasis[OR=8.537,95%CI (2.447,29.781),P=0.001],Fibrinogen>2.0 g/L[OR=6.578,95%CI(2.076,20.845),P=0.001],D-Dimer>2.0 ng/L[OR=4.873,95%CI(1.482,16.025),P=0.009],infection[OR=6.069,95%CI(1.789,20.589),P=0.004] were factors influencing the risk of DVT,the differences were statistically significant(P2.0 g/L,D-Dimer>2.0 ng/L,infection increase the risk of PICC-UEDVT.%目的:研究PICC置管后合并PICC相关性上肢深静脉血栓形成(upper extremity deep vein thrombosis,PICC-UEDVT)的发生率及危险因素。方法:连续选取本院2014年6-11月PICC置管的177例实质性肿瘤患者,采用彩色多普勒超声诊断上肢深静脉血栓,观察PICC-UEDVT的发生率及影响因素。结果:177例患者共放置PICC177根,总置管时间为15115 d,平均置管时间为85.4 d。肿瘤患者PICC-UEDVT的发生率为25.42%,其中症状性PICC-UEDVT的发生率为5.08%。Logistic回归分析显示远处转移[OR=8.537,95%CI(2.447,29.781),P=0.001]、纤维蛋白原>4.0 g/L[OR=6.578,95%CI(2.076,20.845),P=0.001]、D-二聚体>2.0 ng/L[OR=4.873,95%CI(1.482,16.025),P=0.009]、置管期间感染[OR=6

  18. 改良法置入深静脉双腔半永久性导管建立血液透析通路应用体会%Insertion of the semipermanent cuffed catheter as vascular access for hemodialysis by a modified method

    Institute of Scientific and Technical Information of China (English)

    袁亮; 郝丽; 王德光; 何衡杰; 刘桂凌

    2011-01-01

    目的 观察改良法经颈内静脉留置半永久性导管的可行性和安全性.方法选择2009年11月至2011年3月接受血液净化治疗患者19例,均为血管条件差或多次内瘘手术失败无法建立动静脉内瘘.术前均接受颈部血管彩色多普勒检查,明确右颈内静脉位置、有无血栓形成.如右颈内静脉血栓形成或狭窄,则采用左侧颈内静脉.所有患者均使用改良法置入双腔半永久性导管.结果19例置管均一次性手术成功,术中出血少,无空气栓塞等严重并发症.术后恢复良好.术后次日患者即经半永久性导管进行血液透析,最高血流量可达280 ml/min以上,流速稳定,无导管吸壁现象发生,完全可满足血液透析需要.平均留置时间(7.5±4.4)个月,最长留置14个月.结论改良法置入深静脉双腔半永久性透析管实用、简便、安全,值得临床推广.%Objective To assess feasibility and safety of the modified method to insert a semipermanent ruffed catheter as vascular access for hemodialysis. Methods 19 patients was enrolled for this study who received hemodialysis in our department during Nov 2009 to Mar 2011. All of the patients could not establish arteriovenous fistula because of their poor vessel condition or more than one failure in their fistula. Every patient performed Ultrasonography examination ,in order to make sure the position of the right jugular vein and clear wheather there is thrombosis or not. If there was embolism in the right jugular vein, we would use the left jugular vein instead. All of the patients received modified method to insert the semipermanent cuffed catheter. Results 19 procedures were performed in 19 patients (68. 5 ± 13. 6 years). The success rate was 100%. Only a little blood was lost during the procedure. No air embolism occurred in all of the procedure. All of patients recovered well after the procedure. Hemodialysis was performed next day of the procedure. The maximum blood flow was

  19. Using an indwelling catheter for the domiciliary management of malignant effusions

    Directory of Open Access Journals (Sweden)

    Ramkumar P

    2003-01-01

    Full Text Available Background: Many patients with malignant pleural effusions and ascites require repeated hospital visits for paracentesis. Materials and Methods: Patients and caregivers were taught to drain malignant effusions at home, using an indwelling catheter inserted into the pleural/ peritoneal cavity. The catheter, (ARROW 14 wire gauge with three additional side holes made to prevent blockage was inserted using the Seldenger technique for central venous cannulation and secured with a stitch. A three way stopcock was used to regulate fluid drainage. The caregiver was taught to do biweekly dressings with antiseptic ointment. Results: The catheter has been used in 200 patients over a period of five years. Two patients developed infections in the pleural cavity, which were managed with antibiotics. Two patients needed catheter change because of blockage. Other patients retained the catheter till last follow up or death. The procedure can be carried out as a day case. This article describes practical guidelines for inserting and maintaining the catheter.

  20. Long-axis ultrasound imaging of the nerves and advancement of perineural catheters under direct vision: a preliminary report of four cases

    DEFF Research Database (Denmark)

    Koscielniak-Nielsen, Z.J.; Rasmussen, H.; Hesselbjerg, L.

    2008-01-01

    nerve scans for controlling perineural catheter placement. METHODS: Four orthopedic patients scheduled for continuous peripheral nerve blocks (interscalene, femoral, midfemoral sciatic, and popliteal sciatic), had perineural catheters inserted under ultrasound guidance. After obtaining adequate short...

  1. 降低骨肿瘤患者外周中心静脉导管感染的管理%Reducing infection caused by peripherally inserted central catheter for bone tumor patients

    Institute of Scientific and Technical Information of China (English)

    杨明玉; 于丽; 徐静; 范维; 赵丹; 王林; 王景佳

    2014-01-01

    OBJECTIVE To analyze the relevant risk factors of infection after PICC for bone tumor patients ,and discuss the effective interventions ,so as to reduce the infection incidence after PICC .METHODS A total of 218 patients with bone tumors who received chemotherapy with PICC catheter in department of orthopaedics from Nov 2012 to Jul 2013 were collected and divided into infection group including 14 patients with infection and control group including 204 patients without infection .Multivariate regression analysis method was adopted to analyze the cause of PICC infection ,to develop preventive measures and take appropriate measures and nursing methods .All the data were statistically analyzed by SPSS 19 .0 software .RESULTS Among the 218 patients suffered PICC ,14 patients got catheter-related infection with incidence rate of 6 .4% .The multiple regression analysis results indica-ted that the age ,cathetering time ,frequency of changing filter ,residence and compliance of patients and the seni-ority of nurses were all risk factors causing infection after PICC .CONCLUSION To strengthen the propaganda and education of PICC maintenance and operation training for nurses ,intensify environment management ,and improve the health education compliance of patients obviously reduce the postoperative infections of PICC and improve the nursing quality as well as alleviating the suffering of patients .%目的:分析骨肿瘤患者外周中心静脉导管(PICC )置管术后感染的相关危险因素,探讨有效的预防对策,降低PICC置管术后感染发生率。方法选择2012年11月-2013年7月骨科骨肿瘤化疗使用PICC导管的患者218例,根据感染与否将其分为感染组与对照组,其中感染组14例,对照组204例;采用多元回归分析的方法,分析引起PICC感染的原因,制定预防对策并采取相应的措施及护理方法,所有数据采用SPSS 19.0软件进行统计分析。结果218例患者有14例发生PICC导

  2. Effects of heparin sodium on the prethrombotic state in lung cancer patients with peripherally inserted central catheter%肝素钠封管对经外周静脉置入中心静脉导管肺癌患者血栓前状态的影响

    Institute of Scientific and Technical Information of China (English)

    洪跃玲; 杨相梅

    2013-01-01

    Objective:To study the effect of heparin sodium (125 U/ml) for locking on the prethrombotic state in lung cancer patients with peripherally inserted central catheter(PICC).Methods:Clinical data of 20 lung cancer patients with PICC were randomly selected in our department.Heparin sodium(125 U/ml) was used for locking after PICC being inserted.All parameters in our study including prothromhin time (PT),activated partial thromboplsatin time (APTT),thrombin time (TF),fibrinoge (Fbg),platelet (PLT) and D-dimer were dynamically monitored 2 times:0~1 d before(T0) and 2~3 d after(T1)PICC insertion.Results:Differences in PLT and D-dimer between T0 and T1 were significant (t=2.387,P=0.028 ;t=2.487,P=0.022).There was no significant difference in PT,APTT,TT,Fbg,FDP between T1 and T0.Conclusions:①Using heparin sodium (125 U/ml) for locking is safe for patients with lung cancer after PICC insertion.②Heparin sodium(125 U/ml) for locking can reduce PLT and D-dimer levels of patients with lung cancer after PICC insertion and can prevent venous thrombosis.%目的:探讨在经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)的肺癌患者中,用肝素钠(125U/ml)稀释液进行封管对其血栓前状态的影响.方法:随机抽取我科20例PICC肺癌患者,在置管后采用肝素钠稀释液进行封管,通过对PICC置管前0~1 d(T0期)、置管后2~3 d(T1期)与血栓形成相关量化指标凝血酶原时间(prothromhin time,PT)、部分活化凝血酶原时间(activated partial thromboplsatin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原量(fibrinoge,Fbg)、血小板(platelet,PLT)、纤维蛋白降解产物(Fibrinogen degradation products,FDP)以及D-二聚体的动态检测,对比T0期与T1期各项指标的变化.结果:T0与T1比较,置管前后PLT、D-二聚体值有统计学差异(t=2.387,P=0.028;t=2.487,P=0.022),而PT、APTT、TT、Fbg、FDP统计学差异不明显.结论:①对PICC

  3. Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

    Directory of Open Access Journals (Sweden)

    Eraksoy Haluk

    2003-02-01

    Full Text Available Abstract Backround We undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheter – related infections. Methods During the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage. Results Ninety-one (30.3% of the catheters were colonized and infection was found with 50 (16.7% catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005. The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03. The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005. The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01. The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%. Conclusion Duration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

  4. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    Science.gov (United States)

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  5. Study on application of failure mode and effect analysis in reducing the risk of peripherally inserted central catheter%应用失效模式和效果分析降低经外周静脉中心静脉导管置管风险的研究

    Institute of Scientific and Technical Information of China (English)

    叶丽萍; 夏海英; 孙佩红

    2013-01-01

    Objective To apply failure mode and effect analysis (FMEA) to reduce nursing risk of peripherally inserted central catheter (PICC).Methods 100 patients with PICC in central hospital of Minxing District of Shanghai were named as the experimental group,failure mode and effect analysis were performed in this group to obtain the value of risk priority number (PRN) and array them according to the RPN value to work out improved plan systematically and put it into practice to guide the clinical operation and nursing care.98 PICC patients in Xinzhuang health service center and Tumor Hospital of Minhang district were set as the control group,which were subjected to traditional nursing.All statistical analysis were done by SPSS 11.0 software package,the differences of the incidence of PICC-related nursing risk between the two groups due to the implementation of FMEA was analyzed by X2 test.Results Application of FMEA could reduce the nursing risk of PICC,After the application of FMEA,the incidence of PICC-related complications such as focal or systemic infection,puncture site oozing and bleeding,skin allergies,mechanical phlebitis,too deeply placed catheter,catheterization into cervical veins and reflexed into axillary vein,catheter occlusion,catheter migration,difficult removal of catheter,puncture failure in the experimental group decreased obviously,the differences had statistical meaning.Conclusions The application of failure mode and effects analysis can reduce the nursing risk of PICC,decrease medical disputes,alleviate the suffering of patients,reduce medical costs caused by PICC-related complications,and improve the satisfaction degree of patients and the quality of nursing care.%目的 应用失效模式和效果分析降低经外周置入中心静脉导管(PICC)置管护理风险.方法 以上海市闵行区中心医院100例PICC患者为实验组,应用失效模式和效果分析,计算风险顺序数(RPN)值风险排列,根据RPN值的大小判断确定计划,

  6. Peripherally Inserted Central Catheters: A Randomized,Controlled, Prospective Trial in Pediatric Surgical Patients%经外周置入中心静脉导管用于小儿外科患者的随机、对照、前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    Deborah A. Schwengel; John McGready; Sean M. Berenholtz; Lori J. Kozlowski; David G. Nichols; Myron Yaster; 王永

    2006-01-01

    经外周置入的中心静脉导管(peripherally-inserted central catheters,PICCs)均为长期静脉留置管,用于给药、输液、采集血样或静脉高营养.PICCs短期用于术后患者尚无报道.在这次随机、对照研究中,患儿被分成两组,一组接受PICCs,另一组接受外周静脉导管(peripheral Ⅳ catheter,P Ⅳ).结果以患者和家属对治疗的满意度、静脉穿刺所造成的并发症、术后静脉穿刺的次数以及两种方法的效价比来衡量.与PⅣ组相比,PICCs组的满意度明显增高(P<0.05),而且术后静脉穿刺的次数明显减少(P<0.05).PⅣ组常有较轻的并发症,但两组都很少发生严重并发症.PICCs组费用较昂贵,但满意度较高,使之效价比可以接受.此外,在手术室内术前准备时置管,并不会由于增加麻醉医师和手术室内时间而使费用增加.对于术后留院治疗时间超过4天,特别是需要经常采血或经常使用静脉通路的患者,麻醉医师应该考虑放置PICCs.

  7. Effect of steel and teflon infusion catheters on subcutaneous adipose tissue blood flow and infusion counter pressure in humans

    DEFF Research Database (Denmark)

    Højbjerre, Lise; Skov-Jensen, Camilla; Kaastrup, Peter;

    2009-01-01

    microcirculation and infusion counter pressure. METHODS: One steel catheter and one Teflon (Dupont, Wilmington, DE) catheter were inserted in subcutaneous, abdominal adipose tissue (SCAAT) in 10 healthy, lean men. The catheters were infused with isotonic saline at a rate of 10 microL/h for 48 h. Another steel...... catheter and a Teflon catheter were inserted contralateral to the previous catheters after 48 h. The infusion counter pressure was measured during a basal infusion rate followed by a bolus infusion. The measurements during a basal rate infusion were repeated after the bolus infusion. Adipose tissue blood...... flow (ATBF) was measured in SCAAT continuously. RESULTS: A significant increase in ATBF was observed with wear time for Teflon but not for steel catheters. Mean infusion pressure during the bolus phase increased significantly from 0 to 48 h for Teflon but not for steel catheters. ATBF and infusion...

  8. Influence Factors of Insertion Site Errhysis of Central Venous Catheter in Pediatric Intensive Care Unit%重症监护室患儿中心静脉导管穿刺口渗血的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    申叶林; 李亚洁; 昌艳军; 刘冬丽

    2014-01-01

    Objective To explore the incidence and influence factors of insertion site errhysis of central venous catheter in pediatric intensive care unit. Methods A prospective study was undertaken from November 2012 to November 2013 of 413 central venous catheterizations in 364 children in a pediatric intensive care unit on a third-level first-class hospital in Guangzhou. Results Insertion site errhysis occurred in 176 cases (42.6%) with 164 cases of mild to moderate bleeding and 12 cases of severe bleeding and 29 (7.2%) began to bleeding within 24 hours after the puncture and the average time of errhysis occurrence was (4.19 ±2.95) days. CVC fixed-stitches-off, displacement, the duration of catheterization ( longer than 4 days) were risk factors of errhysis but age(3 years above) was a protective factor. Conclusion Patients’ age, the duration of catheterization and CVC-fixing are important influence factors of insertion site errhysis of central venous catheter during catheter maintenance.%目的:探讨儿童重症监护室患儿中心静脉导管穿刺口渗血发生情况及其影响因素。方法对广州某三级甲等医院儿童重症监护室2012年11月-2013年11月留置中心静脉导管364例患儿413例次导管穿刺点情况,进行观察和记录并收集相关临床资料,进行统计分析。结果穿刺口渗血的176(42.6%)例次,其中轻中度出血164例次,重度出血12例次;穿刺后24 h内渗血29(7.2%)例次;开始出现渗血时间为(4.19±2.95)d;中心静脉导管固定缝线的脱落、导管移位、管道留置时间>4 d是穿刺口渗血的危险因素,患儿年龄>3岁是保护因素。结论患儿的年龄、管道留置时间、中心静脉导管固定是中心静脉导管留置过程中穿刺口渗血重要影响因素。

  9. 外周中心静脉导管与中心静脉导管在肠外营养应用中的比较%Comparison on application of peripherally inserted central venous catheter and central venous catheter for patients undergoing parenteral nutrition

    Institute of Scientific and Technical Information of China (English)

    柴惠红; 朱明丽; 范永琴

    2007-01-01

    @@ 肠外营养(parenteral nutrition,PN)是危重症病人重要的营养支持手段之一,由于肠外营养往往输液量大、液体渗透压高、对外周静脉刺激大,所以需要经中心静脉导管(central venous catheters,CVC)输注.常规的中心静脉导管一般有颈内静脉、锁骨下静脉和股静脉导管,但在穿刺置管和输液过程中都有可能发生不同程度的并发症.

  10. Knotting of a Cervical Epidural Catheter in the Patient with Post-Herpetic Neuralgia: A Rare Complication

    Science.gov (United States)

    Park, Jong Taek; Cho, Dong Woo; Lee, Young Bok

    2017-01-01

    Epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter. Complications associated with epidural catheters include breakage, entrapment, and knotting. Knotting of epidural catheters is very rare, but knotting in lumbar epidural catheters has been reported in a number of studies, and most of these cases involved removal difficulty. We report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post-herpetic neuralgia and then removed the knotted catheter without complications. PMID:28261560

  11. Nonholonomic catheter path reconstruction using electromagnetic tracking

    Science.gov (United States)

    Lugez, Elodie; Sadjadi, Hossein; Akl, Selim G.; Fichtinger, Gabor

    2015-03-01

    Catheter path reconstruction is a necessary step in many clinical procedures, such as cardiovascular interventions and high-dose-rate brachytherapy. To overcome limitations of standard imaging modalities, electromagnetic tracking has been employed to reconstruct catheter paths. However, tracking errors pose a challenge in accurate path reconstructions. We address this challenge by means of a filtering technique incorporating the electromagnetic measurements with the nonholonomic motion constraints of the sensor inside a catheter. The nonholonomic motion model of the sensor within the catheter and the electromagnetic measurement data were integrated using an extended Kalman filter. The performance of our proposed approach was experimentally evaluated using the Ascension's 3D Guidance trakStar electromagnetic tracker. Sensor measurements were recorded during insertions of an electromagnetic sensor (model 55) along ten predefined ground truth paths. Our method was implemented in MATLAB and applied to the measurement data. Our reconstruction results were compared to raw measurements as well as filtered measurements provided by the manufacturer. The mean of the root-mean-square (RMS) errors along the ten paths was 3.7 mm for the raw measurements, and 3.3 mm with manufacturer's filters. Our approach effectively reduced the mean RMS error to 2.7 mm. Compared to other filtering methods, our approach successfully improved the path reconstruction accuracy by exploiting the sensor's nonholonomic motion constraints in its formulation. Our approach seems promising for a variety of clinical procedures involving reconstruction of a catheter path.

  12. A prototype catheter designed for ultraviolet C disinfection

    DEFF Research Database (Denmark)

    Bak, Jimmy; Begovic, Tanja

    2013-01-01

    Background Disinfection of the intraluminal space of single-lumen polymer tubes can be obtained by ultraviolet C (UVC) light exposure from an external light source. In existing catheters UVC disinfection is hampered by the design of the catheter hub and tube connector. Aim To demonstrate...... that it is possible to design a single-lumen catheter with a hub, tube connector and tube parts that can be UVC-disinfected throughout its entire lumen. Methods Two single-lumen catheters were designed: one control and one for UVC exposure. They were contaminated with Pseudomonas aeruginosa (104–105 cfu/mL) before...... UVC light exposure, sampling and plate counting. Findings Two minutes of UVC exposure was sufficient to obtain 4 log10 disinfection for the full-length prototype catheter. This exposure corresponds to ∼40 mJ/cm2 at the catheter tip and indicates that even shorter exposure times can be achieved...

  13. Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

    Directory of Open Access Journals (Sweden)

    Mohamed Sharaf-Eldin

    2016-01-01

    Full Text Available Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80% patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20% patients, blockage of the catheter in only 2 (3.3% patients, and rapid reaccumulation of fluid in 12 (20% patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169.

  14. Calorimeter insertion

    CERN Multimedia

    2006-01-01

    Calorimeter insertion between toroids in the ATLAS experiment detector Calorimeters are surrounding the inner detector. Calorimeters will absorb and measure the energies of the most charged and neutral particles after the collisions. The saved energy in the calorimeter is detected and converted to signals that are taken out with data taking electronics.

  15. Insertion devices

    CERN Document Server

    Bahrdt, J

    2006-01-01

    The interaction of an insertion device with the electron beam in a storage ring is discussed. The radiation property including brightness, ux and polarization of an ideal and real planar and helical / elliptical device is described. The magnet design of planar, helical, quasiperiodic devices and of devices with a reduced on axis power density are resumed.

  16. [The bladder catheter].

    Science.gov (United States)

    Pestalozzi, D M

    1996-09-01

    The benefit of the transurethral catheter to protect or measure renal function is well accepted. Urethral stricture and infection of the lower urinary tract as the complications should lead to a cautious use of catheters. A careful placement, the choice of the best material and a correct management help to avoid complications. Alternatives are discussed.

  17. 改良塞丁格技术行上臂PICC在乳腺癌化疗期间的临床应用%Clinical Application of Modified Seldinger Technique on Peripherally Inserted Central Catheter (PICC) in Upper Arm During Chemotherapy for Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    谭海梅; 高铭云; 黄小珍; 莫乙瑜

    2013-01-01

    Objective To investigate effect of modified Seldinger technique on peripherally inserted central catheter (PICC) in upper arm under real-time ultrasonographic guidance during chemotherapy for patients with unilateral breast cancer.Methods A total of 64 patients with unilateral breast cancer underwent postoperative chemotherapy,and modified Seldinger technique on peripherally inserted central catheter (PICC) in upper arm under real-time ultrasonographic guidance.The success rate,complications and questionnaires of comfort levels were observed.Results Success rate of 64 patients was 100%,and 3 patients (4.69%) with mechanical phlebitis were without vein thrombosis; catheter tips of 57 patients (89.06%) were at the best position,7 patients (10.94%) were not at the best position with normal chemotherapy after normotopia rectification.Questinnnaire of comfort level for all patients showed 54 patients (84.38%) were comfortable,9 patients (14.06%) were nomal and 1 patient was uncomfortable (1.56%).Conclusion Intravenous infusion channel by modified Seldinger technique on P1CC in upper arm under real-time ultrasonographic guidance during chemotherapy may improve patients'comfort level and success rate as a safe approach.%目的 探讨乳腺癌患者化疗期间在超声引导下应用改良塞丁格技术行上臂经外周中心静脉置管(PICC)的效果.方法 对64例单侧乳腺癌术后化疗患者,在超声引导下应用改良塞丁格技术行上臂PICC置管,观察置管成功率、并发症,并进行舒适度问卷调查.结果 64例上臂置管成功率为100%,发生机械性静脉炎3例(4.69%),无静脉血栓形成;57例(89.06%)导管头端处于最佳位置,7例(10.94%)处于非最佳位置,经正位后可正常化疗.患者舒适度问卷调查显示,舒服54例(84.38%),一般舒服9例(14.06%),不舒服I例(1.56%).结论 乳腺癌化疗患者在超声引导下应用改良塞丁格技术行上臂PICC置入,使用安全,置管

  18. Diagnosis of intra vascular catheter-related infection.

    Science.gov (United States)

    Cicalini, S; Palmieri, F; Noto, P; Boumis, E; Petrosillo, N

    2002-01-01

    The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.

  19. Modified Seldinger technique for the insertion of standard chest tubes.

    Science.gov (United States)

    Altman, E; Ben-Nun, A; Curtis, W; Best, L A

    2001-04-01

    Closed tube thoracostomy is a standard procedure for the evacuation of air, blood, or other materials from the pleural space. This paper describes a modification of the Seldinger technique that facilitates chest tube insertion. Either a Nelaton or Thieman catheter is threaded into the side drainage hole and out the tip of a standard Argyle-type chest tube. After using the clamp to insert the catheter into the pleural space through a previously dissected tract, the catheter serves as a guide over which the chest tube is inserted. The technique is simple to use, effective, and safe. It employs standard, inexpensive materials to insert chest tubes in such a way as to minimize the potential traumatic complications inherent in other techniques.

  20. A new model for suprapubic catheterization: the MediPlus Seldinger suprapubic catheter.

    Science.gov (United States)

    Mohammed, Aza; Khan, Azhar; Shergill, Iqbal S; Gujral, Sandy S

    2008-11-01

    Insertion of a suprapubic catheter is one of the essential skills that all surgeons should master. It provides an alternative way to drain the bladder in cases where urethral catheterization is contraindicated or deemed difficult. It also has a role in elective cases where long-term drainage of the bladder is required. In this article, we discuss the MediPlus suprapubic catheter kit, which offers a new and potentially promising technique for safe introduction of the catheter into the bladder.

  1. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

    Energy Technology Data Exchange (ETDEWEB)

    Qanadli, S.D.; Mesurolle, B.; Sissakian, J.F.; Chagnon, S.; Lacombe, P. [Service de Radiologie, Hopital Ambroise Pare, 92 - Boulogne (France)

    2000-08-01

    We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. (orig.)

  2. Facility target insert shielding assessment

    Energy Technology Data Exchange (ETDEWEB)

    Mocko, Michal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-10-06

    Main objective of this report is to assess the basic shielding requirements for the vertical target insert and retrieval port. We used the baseline design for the vertical target insert in our calculations. The insert sits in the 12”-diameter cylindrical shaft extending from the service alley in the top floor of the facility all the way down to the target location. The target retrieval mechanism is a long rod with the target assembly attached and running the entire length of the vertical shaft. The insert also houses the helium cooling supply and return lines each with 2” diameter. In the present study we focused on calculating the neutron and photon dose rate fields on top of the target insert/retrieval mechanism in the service alley. Additionally, we studied a few prototypical configurations of the shielding layers in the vertical insert as well as on the top.

  3. Single-centre experience with tunnelled central venous catheters in 150 cancer patients.

    NARCIS (Netherlands)

    Koolen, D.A.; Laarhoven, H.W.M. van; Wobbes, Th.; Punt, C.J.A.

    2002-01-01

    BACKGROUND: Tunnelled venous catheters improve venous access in cancer patients, but are associated with complications. We retrospectively analysed the outcome of Hickman catheter and Port-A-Cath (PAC) insertion in cancer patients from a department of medical oncology and compared these results with

  4. Thrombosis caused by polyurethane double-lumen subclavian superior vena cava catheter and hemodialysis

    DEFF Research Database (Denmark)

    Wanscher, Maria Rørbæk; Frifelt, J J; Smith-Sivertsen, C

    1988-01-01

    During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were...

  5. Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?

    Directory of Open Access Journals (Sweden)

    Amir Poya Zanjani

    2015-01-01

    Full Text Available Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team′s experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.

  6. Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?

    Science.gov (United States)

    Zanjani, Amir Poya; Mirzashahi, Babak; Emami, Ali; Hassani, Motahareh

    2015-01-01

    Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.

  7. Nurses’ Knowledge about the Insertion Procedure for Peripherally Inserted Central Catheters in Newborns Conocimiento de los enfermeros sobre la técnica de inserción del catéter central de inserción periférica en recién nacidos Conhecimento dos enfermeiros sobre a técnica de inserção do cateter central de inserção periférica em recém-nascidos

    Directory of Open Access Journals (Sweden)

    Solange Antonia Lourenço

    2010-04-01

    Full Text Available The right to practice the Peripherally Inserted Central Catheter (PICC technique, mainly in neonatal intensive care units, was achieved by nursing and consists of efforts that lead to a new challenge: the improvement of the practice of this procedure. This study determined and evaluated the theoretical and practical knowledge acquired by nurses in qualification courses concerning aspects of PICC line insertion in the case of newborns. This descriptive and quantitative study used a questionnaire with nine questions to collect data. The study population was composed of 40 nurses qualified to insert a PICC line in newborns. According to the conceptual knowledge scale established for this study, the results reveal that the nurses have inadequate knowledge concerning the studied aspects, indicating the need for nurses to constantly update and improve their knowledge about this practice so as to better the quality of care delivered to newborns.La utilización del catéter central de inserción periférica (PICC, principalmente en unidades de terapia intensiva neonatal, es una conquista de la enfermería constituida por una trayectoria de esfuerzos que condujeron a un nuevo desafío - el perfeccionamiento del ejercicio de esa práctica. Este artículo tuvo como objetivo verificar el conocimiento teórico y práctico adquirido por los enfermeros, en los cursos de calificación, sobre algunos aspectos de la técnica de inserción del PICC en recién nacidos. Se trata de un estudio descriptivo, de naturaleza cuantitativa, que utilizó como instrumento de investigación un cuestionario con nueve preguntas. La población se constituyó de 40 enfermeros calificados para inserción del PICC en neonatos. Los resultados mostraron que, según la atribución conceptual establecida para el estudio, los enfermeros presentaron un nivel de conocimiento malo sobre esos aspectos, denotando la necesidad de actualización y perfeccionamiento constante de los enfermeros

  8. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies.

    NARCIS (Netherlands)

    Boersma, R.S.; Jie, K.S.; Verbon, A.; Pampus, EC van; Schouten, H.C.

    2008-01-01

    Central venous catheters (CVCs) have considerably improved the management of patients with hematological malignancies, by facilitating chemotherapy, supportive therapy and blood sampling. Complications of insertion of CVCs include mechanical (arterial puncture, pneumothorax), thrombotic and infectio

  9. Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion

    Directory of Open Access Journals (Sweden)

    Fernando Conrado Abrão

    Full Text Available ABSTRACT Objective: To evaluate the safety and feasibility of the use of indwelling pleural catheters (IPCs in patients with malignant pleural effusion (MPE. Methods: We prospectively collected data from patients with MPE undergoing IPC placement between January of 2014 and July of 2015. All patients submitted to IPC placement had a life expectancy > 30 days, in accordance with the MPE treatment guidelines established by the British Thoracic Society. The data collected included gender, age, body mass index, primary cancer site, duration of IPC drainage, IPC-related complications, length of hospital stay, pleural effusion recurrence, and occurrence of spontaneous pleurodesis. Results: A total of 19 patients underwent IPC placement during the study period. Median overall survival after IPC insertion was 145 days. The median follow-up among the surviving patients was 125 days (range, 53-485 days, and the median time between catheter insertion and removal was 31 days (range, 2-126 days. There were IPC-related complications in 5 patients (26.2%, and spontaneous pleurodesis was achieved in 8 (42.0%. Among those 8 patients, the IPC was removed between days 30 and 126 in 4, and spontaneous pleurodesis occurred within the first 30 days in 4. Conclusions: The use of IPCs seems to be feasible and safe in patients with MPE.

  10. Risk factors for development of complication following peripherally inserted central

    OpenAIRE

    Hakan Aydın; Gülsen Korfalı; Suna Gören; Esra Mercanoğlu Efe; Bachri Ramadan Moustafa; Tolga Yazıcı

    2014-01-01

    Objectives: Peripherally inserted central venous catheters (PICCs) are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia Methods: ‘Central Venous Catheterization Forms’ filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009 and March 2013 in t...

  11. 植入式静脉输液港与经外周静脉穿刺中心静脉置管在肿瘤化疗中的应用效果评价%A comparative research of venous port access and peripherally inserted central catheter in cancer chemotherapy

    Institute of Scientific and Technical Information of China (English)

    罗祎; 石磊; 江智霞; 王万玲; 李昌秀; 潘红平

    2015-01-01

    Objective To analyze the difference of the venous port access (VPA) and peripherally inserted central catheter (PICC) in cancer chemotherapy.Methods All eligible studies on VPA and PICC were searched in the databases of PubMed,China National Knowledge Internet (CNKI),Chinese Biomedical Database (CBM),WANFANG Database and VIP Database.Literatures screening,quality evaluation and data extraction were conducted according to Cochrane Handbook;Meta-analysis was calculated by using RevMan 5.2.Results Twenty-nine studies with a total of 4 449 cases of patients were included in this Meta-analysis,with 1 912 cases in experimental group which adopted VPA and 2 537 cases in controlled group which adopted PICC.Experimental group had advantages in the average catheter retention time (SMD=3.36,95%CI 2.51-4.21) and quality of life (RR=1.61,95%CI 1.15-2.24) compared with controlled group.The overall complication rate (RR=0.26,95%CI 0.20-0.34,P<0.01),phlebitis incidence (RR=0.08,95%CI 0.04-0.16,P<0.01),catheter infection incidence (RR=0.32,95%CI 0.23-0.44,P<0.01),catheter obstruction incidence (RR=0.32,95%CI 0.22-0.48,P<0.01),catheter dystopy incidence (RR=0.18,95%CI 0.09-0.37,P<0.01) in experimental group were remarkably lower than that in controlled group.However,no significant difference was found between the two groups in the incidence of the puncture success rate for the first time,errhysis or hematoncus,thrombus and catheter leakage (P >0.05).Conclusions Compared with PICC,VPA had advantages in a long retention time,fewer complications and few influence on quality of life.Therefore,VPA should be widely used in cancer chemotherapy.%目的 系统评价植入式静脉输液港(VPA)与经外周静脉穿刺中心静脉置管(PICC)在恶性肿瘤患者化疗中应用的相关研究,分析2种置管方式在临床应用中的差异.方法 计算机检索PubMed、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、

  12. 静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告%Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate: A Case Report

    Institute of Scientific and Technical Information of China (English)

    万兴丽; 曾力楠

    2012-01-01

    Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates' PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate's physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient's family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed throm-bopenia and aggravated coagulation disorders resulted from heparin. Conclusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.%目的 借助循证医学方法为1例经外周静脉穿刺中心静脉导管(PICC)输注全合一静脉

  13. PICC在早产儿静脉营养中的应用及护理%Application of peripherally inserted central catheter in parenteral nutrition for preterm children and nursing

    Institute of Scientific and Technical Information of China (English)

    刘晓霞; 李怀营

    2016-01-01

    目的:探讨PICC在早产儿临床应用中的疗效,并分析常见的护理问题。方法:给予36例患儿PICC术,对患儿的体重增长、住院天数及导管护理进行疗效观察及分析。结果:成功32例,总有效率为88.8%。结论:PICC能够快速满足早产儿生长发育及减少并发症的发生,值得在危重新生儿中推广应用。%Objective: To investigate effcacy of PICC and nursing following surgery on parenteral nutrition in preterm children, and analyze common nursing problems. Methods: 36 patients were given PICC; weight gain, length of stay of preterm children and nursing effcacy were observed and analyzed. Results: 32 cases were successful; and the total effcacy was 88.8%. Conclusion: PICC could promote growth of preterm children, with less adverse reactions, and was worthy of promotion.

  14. Intraurethral Catheter: Alternative Management for Urinary Retention in Patients With Benign Prostatic Hypertrophy

    OpenAIRE

    Sulabha Punekar; Ramkrishnan, Prem A.; Anand R. Kelkar; Date, Jaydeep A.; Vasudeo R. Ridhorkar

    1995-01-01

    A polyurethane intraurethral catheter (IUC) was used in 27 patients with benign prostatic hypertrophy who were unfit for surgery, or were awaiting surgery. All of them had previously had a periurethral catheter inserted. The IUC was inserted with a cystoscope under fluoroscopic control. Spontaneous voiding through the IUC resumed in 25 patients (93%) in the immediate postprocedure period. At the end of 6 months follow-up, the peak flow rates and the residual volumes estimated in 22 patients w...

  15. Central venous catheters in hemodialysis: To accept recommendations or to stick to own experience

    Directory of Open Access Journals (Sweden)

    Stolić Radojica

    2008-01-01

    Full Text Available Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 centralvein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein − 403 (86.8%, significantly less into the jugular vein − 42 (9.2%, while into the subclavian vein there were placed only 19 catheters (4%. The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03. By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51. Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p

  16. Laparoscopic Placement of Peritoneal Dialysis Catheters in CAPD Patients: Complications and Survival

    Directory of Open Access Journals (Sweden)

    A Roueentan

    2008-06-01

    Full Text Available Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD patients.Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women with a mean age of 50 years (range: 19-83 years in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation; however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%. The most frequent late-onset medical and mechanical complications were peritonitis (6.3% and hernia (3.7%. During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

  17. Cuidados com cateter central de inserção periférica no neonato: revisão integrativa da literatura Cuidados con catéter central de inserción periférica en el neonato: revisión integrativa de la literatura Peripherally inserted central catheter care in neonates: an integrative literature review

    Directory of Open Access Journals (Sweden)

    Derdried Athanasio Johann

    2012-12-01

    Full Text Available O cateter central de inserção periférica é tecnologia comum empregada na terapia intravenosa de neonatos. Trata-se de revisão integrativa, cujo objetivo foi investigar e analisar as evidências disponíveis na literatura acerca da temática. As bases de dados pesquisadas foram Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS e Biblioteca Nacional de Medicina dos Estados Unidos (PubMed. Resultados apontam lacunas no que tange à população neonatal; conhecimento insuficiente dos profissionais quanto indicações (n=1; e variados temas sobre uso de anticoagulantes (n=6, comparação com outros cateteres (n=4, diagnóstico por imagem (n=2, dor (n=2, infecção relacionada a cateter e sua prevenção (n=7, entre outros fatores. Conclui-se que há necessidade de atualização profissional, evidências científicas de fácil acesso e publicações nacionais.El catéter central de inserción periférica es una tecnología común empleada en terapia endovenosa de neonatos. Se trata de una revisión integrativa, cuyo objetivo fue investigar y analizar las evidencias disponibles en la literatura acerca de la temática. Se investigaron las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS y la Biblioteca Nacional de Medicina de los Estados Unidos (PubMed. Los resultados expresan omisiones en lo referente a la población neonatal; conocimiento insuficiente de los profesionales al respecto de las indicaciones (n=1, diagnóstico por imagen (n=2, dolor (n=2, infección relacionada al catéter y su prevención (n=7, entre otras. Se necesita de actualización profesional; evidencias científicas de fácil acceso y publicaciones nacionales.The peripherally inserted central catheter is a common technology employed in the intravenous therapy of neonates. This integrative review was performed with the objective to investigate and analyze the evidence available in the literature regarding this

  18. 低出生体质量儿经外周静脉置入中心静脉导管不同穿刺部位留置导管并发症的护理%Related factors analysis on complications caused by peripherally inserted central catheter puncture on low birth weight infant with different puncture sites

    Institute of Scientific and Technical Information of China (English)

    姜红; 贺琳晰; 范玲

    2015-01-01

    目的 对低出生体质量儿经外周静脉置入中心静脉导管(PICC)不同穿刺部位留置导管主要并发症的相关因素进行分析,以降低并发症发生,达到安全留置目的.方法 收集2008年1月至2013年1月留置PICC的低出生体质量儿431例,其中肘部静脉261例,肘部下行静脉147例,颞浅静脉5例,腋静脉12例,股静脉6例.对不同穿刺部位留置导管过程中的并发症进行分析,并采取相应的治疗或预防护理干预措施.结果 431例PICC均穿刺成功.穿刺部位主要在上臂静脉,并发症主要以静脉炎、肢端肿胀、堵管、感染为主.肘部下行静脉留置导管静脉炎、肿胀发生率高于肘部静脉[10.89%(16/147)比3.83%(10/261)、17.69%(26/147)比4.98%(13/261)],差异有统计学意义,x2=7.840、17.561,P<0.05.结论 PICC穿刺部位主要选择肘部和肘部下行静脉.对不同穿刺部位可能发生的并发症要及时评估并采取有效措施.良好的导管维护意识对减少并发症发生有重要意义.%Objective To analyze the correlative factors that affect the main complications caused by peripherally inserted central catheter puncture (PICC) on low birth weight infant with different puncture sites,in order to reduce the incidence of complications and achieve the purpose of indwelling safely.Methods A total of 431 infants with different PICC puncture sites were recruited in this study from January 2008 to January 2013,261 cases of them were punctured in the elbow upper extremity veins, 147 cases were in the elbows downward veins,5 cases were in the superficial temporal veins, 12 cases were in the axillary veins,and 6 cases were in the femoral veins.The complications occurring in the period of indwelling catheter were analyzed, and the effective treatments or preventive nursing measures were taken.Results 431 cases were punctured successfully.The sites of puncture were mainly in the veins of the upper arm,and the main complications were

  19. Site Rite 5型超声导引下结合改良塞丁格技术置入PICC的应用效果评价%Evaluation on application effect of modified Seldinger technique guided by Site Rite Ⅴ ultrasonic in peripherally inserted central catheter

    Institute of Scientific and Technical Information of China (English)

    杜华

    2014-01-01

    Obj ective:To evaluate the clinical application effect of modified Seldinger technique guided by Site Rite Ⅴ ultrasonic in peripherally in-serted central catheter (PICC).Methods:A total of 140 cases of tumor patients with good elbow vascular conditions were selected as control group (85 cases),patients with bad elbow vascular conditions were as the observation group (5 5 cases).The patients in control group received rou-tine PICC method or blind biopsy method,while the patients in observa-tion group adopted modified Seldinger technique guided by Site Rite V ultrasonic for PICC.The success rate of disposable puncture,disposable catheter success rate and incidence of postoperative tissue inj ury,mechan-ical phlebitis,thrombosis,arterial strayed were compared between the two groups.Results:The disposable catheter success rate in observation group was higher than that of control group (P<0.05),the incidence of tissue inj ury and mechanical phlebitis was lower than that in control group(P<0.05),the incidence of straying artery was higher in observa-tion group(P<0.05).Conclusion:Modified Seldinger technique guided by Site Rite V ultrasonic in PICC has higher success rate,the overall postoperative complications were significantly lower than the routine PICC method or blind biopsy method,But there are risk of Mistakenly perforating arteries.%[目的]评价 Site Rite 5型超声导引下结合改良塞丁格技术经外周置入中心静脉导管(PICC)的临床应用效果。[方法]将140例肿瘤病人肘部血管条件良好者作为对照组(85例),差者为观察组(5 5例),对照组采用常规盲穿式PICC置管法,观察组采用 Site Rite 5型超声导引下结合改良塞丁格技术行 PICC 置管。比较两组一次性穿刺成功率、一次性置管成功率以及术后组织损伤、机械性静脉炎、血栓、误入动脉发生率。[结果]观察组一次性置管成功率高于对照组(P<0.05),组织损伤、机械性静脉炎发

  20. 改良塞丁格技术和PICC置管在晚期鼻咽癌患者诱导加同期放化疗中的应用比较%Comparison of modified Seldinger technique and peripherally inserted central catheter technique applied in advanced NPC patients treated with induction chemotherapy and concurrent chemoradiotherapy

    Institute of Scientific and Technical Information of China (English)

    张杏兰; 张甫银; 张杏红

    2012-01-01

    目的 比较改良塞丁格技术和传统经外周静脉穿刺置入中心静脉导管(peripherally inserted central catheter,PICC)技术在鼻咽癌患者诱导加同期放化疗中应用的利弊.方法 按随机分配原则,单号置管的患者行传统PICC置管设为A组(35例),双号置管的患者行改良塞丁格技术设为B组(30例).比较两组患者置管后在舒适度、相关并发症、价格方面情况.结果 两组患者置管舒适度、并发症总发生率比较,均P<0.05,差异具有统计学意义,改良塞丁格技术优于PICC技术,但改良塞丁格技术的费用高于PICC技术费用.结论 改良塞丁格技术提高了诱导加同期放化疗鼻咽癌患者化疗时的舒适度,减少了相关并发症.但传统PICC技术有价格优势,对于血管条件好、经济条件差的患者仍不失为一种可选择的置管方法.%Objective To investigate the effects of modified Seldinger technique (MST) and peripherally inserted central catheters (PICC) applied in patients with advanced nasopharyngeal carcinoma (NPC) treated with induction chemotherapy and concurrent chemoradiotherapy. Methods 65 advanced NPC patients treated with induction chemotherapy and concurrent chemoradiotherapy were divided into two groups: 35 of them with odd numbers underwent PICC as group A and 30 of them with even numbers underwent MST as group B. The differences in comfort, complications and expenses were compared between the two groups. Results As for the comfort and the incidence of complications, group B with modified Seldinger technique was superior to group A with PICC statistically significant (both P < 0.05). The cost of group B was higher than that of group A. Conclusions The modified Seldinger technique can improve the comfort and reduce the complications in advanced NPC patients undergoing induction chemotherapy and concurrent chemoradiotherapy. PICC is advantageous at price, so it is still an alternative for the patients if only their

  1. The application of elastic pasting bandage for puncture point errhysis after peripherally inserted central catheter using seldinger technique with beside ultrasound%弹力粘贴绷带在超声引导下塞丁格技术PICC置管后穿刺点渗血中的应用

    Institute of Scientific and Technical Information of China (English)

    胡华琼; 刘爱华

    2016-01-01

    Objective:To discuss the effective hemostasis method for puncture point errhysis after peripherally inserted central catheter using Seldinger tech-nique with beside ultrasound to avoid the dismantled side limb swelling and improve patients′comfort. Methods:Sity successful cases of patients under PICC with seldinger technique the beside ultrasound were randomly divided into observation group and control group. On the basis of conventional fixation,for ob-servation group the catheter-inserting nurses used elastic pasting bandage to compress on the puncture fixed point for hemostasis for 2 hours,while for the comparison group the nurse put one bag of 500 ml liquid at the puncture point for 30 minutes with traditional approach. Then compare two groups of patients for their hemostatic effect and blood vascular complications. Results:The puncture point hemostatic effect of observation group was better than that of control group (P<0. 05),the vascular complication subcutaneous ecchymosis occurrence rate of the observation group was lower than that of the control group (P<0. 05). Conclusion:Elastic pasting bandages can effectively prevent puncture point errhysis after PICC using Seldinger technique with beside ultra-sound so as to reduce the complications and improve patients′comfort.%目的::探讨超声引导下塞丁格技术PICC置管后穿刺点渗血的有效止血方法,避免拆除侧肢体肿胀,并提高患者舒适度。方法:将60例超声引导下塞丁格技术PICC置管成功患者随机等分为观察组和对照组。在常规固定的基础上,观察组由置管护士采用弹力粘贴绷带加压固定穿刺点止血2 h,而对照组则用传统方法将1袋500 ml液体置于穿刺点处30 min。比较两组患者止血效果及血管并发症发生情况。结果:观察组穿刺点止血效果优于对照组(P<0.05),观察组患者血管并发症中皮下瘀斑发生率低于对照组(P<0.05)。结论:弹力粘贴绷带可有效防止超

  2. Knowledge of nursing students about central venous catheters

    Directory of Open Access Journals (Sweden)

    Mlinar Suzana

    2012-01-01

    Full Text Available Background/Aim. Central venous catheters (CVC are at the crucial importance, particulary in the intensive therapy units. In order to handle a CVC safely, nursing students need to acquire theoretical and practical knowledge during the course of their studies. The aim of the study was to establish theoretical knowledge of nursing students about the procedures of nurses in placing and removing a central venous catheter (CVC, dressing the catheter entry point, the reasons for measuring central venous pressure (CVP, possible complications and risk factors for developing infections related to CVC. Methods. The questionnaire developed specifically for this cross-sectionl study was handed out to 87 full-time students and 57 part-time students. Results. The results show that all the surveyed nursing students know why chest radiography is carried out when inserting a catheter, have relatively good knowledge of CVC insertion points, procedures carried out in case of a suspected catheter sepsis and complications and risk factors for the development of infections related to CVC. However, the study show that the majority of students have insufficient knowledge of the procedures accompanying insertion of a catheter, signs that indicate correct functioning of CVC, frequency of flushing a catheter when it is not in use and the reasons for introducing an implanted CVC. Conclusion. Based on the results of the study it can be concluded that the second-year nursing students have insufficient knowledge of CVC. In order to correctly and safely handle a CVC, good theoretical knowledge and relevant practical experience are needed. The authors therefore believe that, in future, the classes should be organized in smaller groups with step-by-step demonstrations of individual procedures in handling a CVC, and the students encouraged to learn as actively as possible.

  3. Levantamento sobre a infecção na inserção do cateter de duplo lúmen Inventario sobre la infección en la inserción del cateter de doble lúmen Survey about infection at the site of a double-lumen catheter insertion

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    Rita de Cássia Helú Mendonça Ribeiro

    2008-01-01

    ás encontrado el Staphylococcus aureus, el tiempo promedio de permanencia del catéter fue de 43 días en los dos períodos evaluados. CONCLUSIÓN: En este estudio se demostró que hubo mejora significativa en cuanto a los índices de infección en esa población.OBJECTIVE: The purpose of this study was to identify the infection rate, etiologic agent, infectious complications and the double-lumen catheter permanence in one same period in alternating years. METHODS: This retrospective study was carried out in the Center of Hemodiálysis of the Hospital de Base de São José do Rio Preto-SP. All patients who presented infection in the double-lumen catheter insertion site within the period of the survey were included. RESULTS: It was reported that of the 80 patients undergoing hemodialysis treatment in the first period, from January to June 2002, 21% of the patients were using catheter. Three years later, 186 patients were in the same conditions, and of these, 10.7% was being treated with catheter therapy. The bloodstream infections were reduced by 9.4% in the last period. Bacteremia was the main prevailing infectiou complication. The Staphylococcus aureus was the most prevalent etiologic agent and the average double-lumen catheter permanence time was of 43 days in both periods of the study. CONCLUSION: This study revealed that there was a significant improvement as for the infection indexes in that population.

  4. Unusual cause for ventriculoperitoneal shunt failure: Carcinoma breast compressing distal catheter

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    Roka Yam

    2010-01-01

    Full Text Available Insertion of a ventriculoperitoneal (VP shunt is one of the most common surgical procedures in any neurosurgery unit worldwide. Distal catheter obstruction outside the peritoneum is a rare cause of shunt failure. We report the first case of distal obstruction in a 70-year old female by carcinoma breast engulfing the catheter and causing kinking. Intraoperatively, the catheter was intratumoral with no flow of cerebrospinal fluid distally. She underwent relocation of a new catheter to the opposite side of the abdomen and modified mastectomy with resolution of the hydrocephalus. The postoperative course has been uneventful.

  5. Localização inicial da ponta de cateter central de inserção periférica (PICC em recém-nascidos Localización inicial de la punta del catéter central de inserción periférica (PICC en recién nacidos Initial placement of the peripherally inserted central catheter's tip in neonates

    Directory of Open Access Journals (Sweden)

    Patrícia Ponce de Camargo

    2008-12-01

    Full Text Available Estudo transversal com coleta prospectiva de dados, que objetivouidentificar o posicionamento inicial da ponta do cateter central de inserção periférica (PICC e verificar a prevalência de sucesso de sua inserção em neonatos. Os dados foram coletados no berçário anexo à maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre março e setembro de 2006. Dos 37 neonatos submetidos à inserção do cateter PICC, a taxa de sucesso no procedimento foi de 72,3% (27 neonatos; destes, quatro (14,8% estavam com as pontas dos cateteres alojadas nas veias axilar ou inominada; outros três (11,1%, alojadas em veia jugular. Estes cateteres foram removidos por desvio de trajeto. 13 (48,2% estavam com as pontas alojadas em átrio direito, cujos cateteres foram tracionados para reposicionamento da ponta para a veia cava superior.Estudio transversal con recolección prospectiva de datos. La finalidad fue identificar la posición inicial de la punta del catéter central de inserción periférica (PICC y verificar la prevalencia de éxitos durante su introducción en neonatos. Los datos fueron recolectados en un servicio de neonatología anexo a la maternidad del Hospital de las Clínicas de la Facultad de Medicina de la Universidad de São Paulo, entre marzo y setiembre del 2006. De los 37 neonatos sometidos a introducción del catéter PICC, la tasa de éxito fue de 72.3% (27 neonatos, de ellos, cuatro (14.8% estaban con las puntas de los catéteres alojadas en las venas axilar o no determinada, tres (11.1% localizadas en la vena yugular. Siendo estos últimos retirados por desviación en su trayecto. El 48.2% (13 se encontraba con las puntas en el atrio derecho, siendo estos catéteres nuevamente posicionados en la vena cava superior.This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC and to verify the prevalence of success in inserting

  6. Bacterial infection of central venous catheters in short-term total parenteral nutrition.

    Science.gov (United States)

    Chan, L; Ngeow, Y F; Parasakthi, N

    1998-03-01

    Fourteen severely ill ventilated patients in an intensive care unit, requiring short-term total parenteral nutrition, were examined for catheter-related infection. Microbiological analysis using Maki's SQ technique was carried out on catheter exit site, catheter hub, proximal subcutaneous segment of catheter and catheter up. Qualitative cultures were carried out on total parenteral nutrition and peripheral blood samples. Twenty six of 29 catheters removed (90%) were culture positive but only 7 catheters were related to positive blood cultures, giving a catheter-related bacteremia (CRB) rate of 24%. Haematogenous seeding was strongly implicated in 7/29 (24%) of catheters. Patients' skin flora appeared to be the main source of catheter-related infection. The organisms isolated for patients with CRB included coagulase-negative staphylococci, Acinetobacter and Klebsiella. It is suggested that to control infective complications of central venous catheters, emphasis should be focused on specialised intravenous therapy teams and the use of strict protocols for insertion and care of central lines.

  7. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    Science.gov (United States)

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  8. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

    Directory of Open Access Journals (Sweden)

    Carlos J. Roldan

    2015-10-01

    Full Text Available Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  9. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    Science.gov (United States)

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  10. Usefulness of multifunctional gastrointestinal coil catheter for colorectal stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Jin Hyoung; Lim, Jin-Oh; Kim, Kyung Rae [Asan Medical Center, Radiology and Research Institute of Radiology, Seoul (Korea); Song, Ho-Young [Asan Medical Center - Radiology, Songpa-gu, Seoul (Korea); Park, In Kook [Dongguk University, Life Science, Seoul (Korea); Choi, Eugene K. [Weill Medical College of Cornell University, New York, NY (United States)

    2008-11-15

    The purpose of this study was to evaluate the usefulness of a multifunctional gastrointestinal coil catheter for stent placement in 98 patients with colorectal strictures. The catheter was used in 98 consecutive patients for stent placement in the rectum (n = 24), recto-sigmoid (n = 13), sigmoid (n = 38), descending (n = 6), transverse (n = 11), splenic flexure (n = 3), hepatic flexure (n = 2), and ascending (n = 1) colon. The catheter was made of a stainless steel coil (1.3 mm in inner diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the catheter was evaluated depending on whether the catheter could pass a stricture over a guide wire and whether measurement of the stricture length was possible. The passage of the catheter over a guide wire beyond the stricture was technically successful and well tolerated in 93 (94.9%) of 98 patients. In the failed five patients, it was not possible to negotiate the guide wire due to presence of nearly complete small bowel obstruction. The average length of stricture was 6.15 cm (range, 3 cm to 20 cm) in patients with the colorectal stricture. There were no procedure-related complications. In conclusion, the multifunctional coil catheter seems to be useful in colorectal stent placement. (orig.)

  11. Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

    Directory of Open Access Journals (Sweden)

    Rolf Bambauer

    2012-01-01

    Full Text Available Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007 evaluated silver-coated (54 patients and noncoated (105 patients implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.

  12. Dosimetric equivalence of non-standard high dose rate (HDR) brachytherapy catheter patterns

    CERN Document Server

    Cunha, J Adam M; Pouliot, Jean

    2009-01-01

    Purpose: To determine whether alternative HDR prostate brachytherapy catheter patterns can result in improved dose distributions while providing better access and reducing trauma. Methods: Prostate HDR brachytherapy uses a grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. On CT data from ten previously-treated patients new catheters were digitized following three catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a p...

  13. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    Energy Technology Data Exchange (ETDEWEB)

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J. [University of California, San Francisco, California 94115 (United States)

    2009-01-15

    Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V{sub 100}{sup Prostate}>90%) and organ-at-risk dose sparing (V{sub 75}{sup Bladder}<1 cc, V{sub 75}{sup Rectum}<1 cc, V{sub 125}{sup Urethra}<<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of

  14. Epidural catheter fragment entrapment: a case report

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    Mohammadi M

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous. "n"nCase presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic."n"nConclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.

  15. Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies.

    Science.gov (United States)

    Whitehead, William E; Riva-Cambrin, Jay; Kulkarni, Abhaya V; Wellons, John C; Rozzelle, Curtis J; Tamber, Mandeep S; Limbrick, David D; Browd, Samuel R; Naftel, Robert P; Shannon, Chevis N; Simon, Tamara D; Holubkov, Richard; Illner, Anna; Cochrane, D Douglas; Drake, James M; Luerssen, Thomas G; Oakes, W Jerry; Kestle, John R W

    2017-02-01

    OBJECTIVE Accurate placement of ventricular catheters may result in prolonged shunt survival, but the best target for the hole-bearing segment of the catheter has not been rigorously defined. The goal of the study was to define a target within the ventricle with the lowest risk of shunt failure. METHODS Five catheter placement variables (ventricular catheter tip location, ventricular catheter tip environment, relationship to choroid plexus, catheter tip holes within ventricle, and crosses midline) were defined, assessed for interobserver agreement, and evaluated for their effect on shunt survival in univariate and multivariate analyses. De-identified subjects from the Shunt Design Trial, the Endoscopic Shunt Insertion Trial, and a Hydrocephalus Clinical Research Network study on ultrasound-guided catheter placement were combined (n = 858 subjects, all first-time shunt insertions, all patients 0.60). In the univariate survival analysis, however, only ventricular catheter tip location was useful in distinguishing a target within the ventricle with a survival advantage (frontal horn; log-rank, p = 0.0015). None of the other catheter placement variables yielded a significant survival advantage unless they were compared with catheter tips completely not in the ventricle. Cox regression analysis was performed, examining ventricular catheter tip location with age, etiology, surgeon, decade of surgery, and catheter entry site (anterior vs posterior). Only age (p < 0.001) and entry site (p = 0.005) were associated with shunt survival; ventricular catheter tip location was not (p = 0.37). Anterior entry site lowered the risk of shunt failure compared with posterior entry site by approximately one-third (HR 0.65, 95% CI 0.51-0.83). CONCLUSIONS This analysis failed to identify an ideal target within the ventricle for the ventricular catheter tip. Unexpectedly, the choice of an anterior versus posterior catheter entry site was more important in determining shunt survival than

  16. The impact of sodium citrate on dialysis catheter function and frequency of catheter-related bacteriemia and haemorrhage

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    Maciej Szymczak

    2009-10-01

    Full Text Available Vascular access is one of the most important problems of hemodialysis therapy. It is known that an arteriovenous fi sutla provides the best vascular access, but its creation is not always possible. Other solutions, such as the insertion of a central venous catheter, are then required. Adequate protection of such catheters by interdialytic fi ll with locking solution affects the frequency of hemodialysis-related complications. The most widespread catheter locking solution is heparin. Sodium citrate is being used more frequent recently. Available data indicate that hemorrhage is 11.9 times more frequent if the catheter locking solution is 5000 IU/ml heparin than if 4�0sodium citrate or 1000 IU/ml heparin is used. Other data indicate that the frequency of infection is statistically decreased when 30�0sodium citrate is used to fi ll the catheter instead of 5000 IU/ml heparin. Analogous data on 46.7�0sodium citrate are not consistent. It seems that the use of 4�0sodium citrate instead of 5000 IU/ml heparin does not decrease the frequency of infections. Numerous studies indicate that sodium citrate at various concentrations exerts a positive infl lence on catheter function. However, not all data are in accord. The spill of sodium citrate from the catheter to the systemic circulation is connected with a risk of adverse events. It may be dangerous if the citrate concentration is 46.7�20However, adequate fi lling of the catheter should prezent such events. Available data indicate that fi lling of the catheter with a solution of citrate of a concentration of no more than 30�0should be safe. Data on 46.7�0citrate are not conclusive, so precautions should be taken.

  17. Port- a- Cath Catheter placement by general surgery residents

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    F. Schlottmann

    2015-04-01

    Full Text Available In recent years an increasing incidence and prevalence of oncological diseases is observed, with a consequent increase in chemotherapies. In order to avoid repeated venipuncture of patients and toxicity in small veins during different cycles of treatment, devices that provide a permanent central venous access are used. The aim of this study was to evaluate the success and safety of port a cath devices inserted by surgery residents. A consecutive case series of patients in whom Port-a-CathTM catheter was placed by residents of surgery in the period from March 2009 to January 2014 were included. A total of 358 Port-a-CathTM catheters were inserted. Average age 58.7 years (16-88. Females 53.1%. Chemotherapy treatment for solid neoplasias (74.8% and for hematological diseases (25.2%. SThe different venous accesses were: Subclavian (67.6%, Cephalic (27.4%, external jugular (3.3%, internal jugular (1.7%. The morbidity rate was 5.3%, twelve patients with catheter-associated infection requiring the removal of it, 3 venous thrombosis with subsequent replacement of the catheter and 4 patients required pleural drainage. Port-a-CathTM catheter placement by residents is a safe and effective procedure for the administration of chemotherapy

  18. A Taurolidine-Citrate-Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients.

    Science.gov (United States)

    Zwiech, Rafał; Adelt, Maria; Chrul, Sławomir

    2016-01-01

    Catheter-related bacteremia (CRB) is a typical complication of hemodialysis catheter use. Catheter lumen colonization by pathogens is regarded as a direct cause of CRB. Once settled, the catheter biofilm increases the risk of developing infection, thus necessitating insertion replacement and antibiotic treatment. The study assessed the self-sufficient efficacy of taurolidine-citrate-heparin lock solution in eradicating catheter biofilm bacteria and keeping it sterile in patients on hemodialysis. Twenty-nine chronic patients on hemodialysis with tunneled and nontunneled catheters locked with a heparin filling (the mean time of heparin lock use -30.1 ± 2.0 days) and subsequently converted to a taurolidine-citrate-heparin filling were included. Peripheral vein and catheter lumen blood cultures were obtained before the filling change and after taurolidine-citrate-heparin lock use (mean time 33.8 ± 7.6 days). Twenty-four participants with tunneled and nontunneled catheters locked with taurolidine-citrate-heparin filling served as the control group. During the heparin-locking period, CRB was diagnosed in 3 cases (only nontunneled catheters). The catheter blood cultures findings were positive in 23 patients (10 temporary and 13 permanent catheters), whereas both the catheter and peripheral vein blood cultures were sterile in 3 of 29 subjects (only permanent catheters). Irrespective of catheter type (tunneled or nontunneled), repeated culture revealed no pathogens in any of the 23 patients with initial positive catheter blood culture, after the use of taurolidine-citrate-heparin filling. No positive blood culture was noted in the control group. The taurolidine-citrate-heparin lock solution effectively eradicated pathogens from nontunneled and tunneled catheter biofilms and helped to maintain catheter lumen sterility.

  19. 集束化干预管理预防肝移植患者外周中心静脉导管相关性血流感染的效果研究%Effect of bundle care on prevention of peripherally inserted central venous catheter-related bloodstream infections in liver transplantation patients

    Institute of Scientific and Technical Information of China (English)

    王丽芹; 陈东方; 李丽

    2014-01-01

    OBJECTIVE To explore the effect of bundle care on prevention of peripherally inserted central venous catheter (PICC)‐related bloodstream infections in the liver transplantation patients so as to provide guidance for clinical prevention of the PICC‐related bloodstream infections and the standardized nursing .METHODS Totally 32 liver transplantation patients who underwent PICC from Nov 2011 to Oct 2012 and did not receive the bundle care were assigned as the control group ,and 29 liver transplantation patients who underwent PICC from Nov 2012 to Oct 2013 and received the bundle care were set as the experimental group ;the incidence of catheter‐related blood‐stream infections was observed and compared between the two groups .RESULTS The catheter indwelling time of the control group was 3 840 days ,the experimental group 4 524 days;the catheter‐related bloodstream infections occurred in 7 cases of the control group with the infection rate of 1 .82‰ and occurred in 3 cases of the experimen‐tal group with the infection rate of 0 .66‰ ,there was statistically significant difference in the incidence of catheter‐related bloodstream infections between the two groups (P<0 .05) .CONCLUSION The bundle care can effectively prevent the catheter‐related bloodstream infections in the liver transplantation patients .%目的:探讨集束化干预管理预防肝移植患者外周中心静脉导管(PICC)相关性血流感染(CRBSI)的效果,为临床预防PICC导管相关性血流感染及规范化护理提供参考依据。方法将2011年11月-2012年10月32例肝移植患者行PICC术未采取集束化干预管理的患者作为对照组,将2012年11月-2013年10月29例肝移植患者行PICC术采取集束化干预管理的患者作为试验组,比较两组CRBSI的发生率。结果对照组患者导管留置时间3840 d ,发生CRBSI 7例,CRBSI发生率1.82‰;试验组29例,导管留置时间4524 d ,发生CRBSI 3例,C RBS I

  20. [Medial venous catheter or midline (MVC)].

    Science.gov (United States)

    Carrero Caballero, Ma Carmen; Montealegre Sanz, María; Cubero Pérez, Ma Antonia

    2014-01-01

    Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings

  1. Soft robotic concepts in catheter design: an on-demand fouling-release urinary catheter.

    Science.gov (United States)

    Levering, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; López, Gabriel P

    2014-10-01

    Infectious biofilms are problematic in many healthcare-related devices and are especially challenging and ubiquitous in urinary catheters. This report presents an on-demand fouling-release methodology to mechanically disrupt and remove biofilms, and proposes this method for the active removal of infectious biofilms from the previously inaccessible main drainage lumen of urinary catheters. Mature Proteus mirabilis crystalline biofilms detach from silicone elastomer substrates upon application of strain to the substrate, and increasing the strain rate increases biofilm detachment. The study presents a quantitative relationship between applied strain rate and biofilm debonding through an analysis of biofilm segment length and the driving force for debonding. Based on this mechanism, hydraulic and pneumatic elastomer actuation is used to achieve surface strain selectively within the lumen of prototypes of sections of a fouling-release urinary catheter. Proof-of-concept prototypes of sections of active, fouling-release catheters are constructed using techniques typical to soft robotics including 3D printing and replica molding, and those prototypes demonstrate release of mature P. mirabilis crystalline biofilms (e.g., ≈90%) from strained surfaces. These results provide a basis for the development of a new urinary catheter technology in which infectious biofilms are effectively managed through new methods that are entirely complementary to existing approaches.

  2. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

    Science.gov (United States)

    Urbanetto, Janete de Souza; Peixoto, Cibelle Grassmann; May, Tássia Amanda

    2016-01-01

    ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC) and following their removal - (post-infusion phlebitis) in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective. PMID:27508916

  3. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

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    Janete de Souza Urbanetto

    Full Text Available ABSTRACT Objective: to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC and following their removal - (post-infusion phlebitis in hospitalized adults. Method: a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed. Results: average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis. Conclusions: this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective.

  4. Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns.

    Science.gov (United States)

    Martín-Rabadán, P; Pérez-García, F; Zamora Flores, E; Nisa, E S; Guembe, M; Bouza, E

    2017-04-01

    Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

  5. Explore the effects of the two injection liquids to seal trochars in patients with ieukemia by peripherally inserted central catheter%两种封管液对白血病患者外周导入中心静脉置管留置效果的影响

    Institute of Scientific and Technical Information of China (English)

    吴道仙; 邓春晓

    2010-01-01

    Objective To explore the effects of the two injection liquids to seal trochars in patients with ieukemia by peripherally inserted central catheter. Methods Sixty cases of ieukemia were randomly divided into the observation group (30 cases) and the control group (30 cases). For the observation group, 0.9% sodium chloride injection was adopted to seal the trochars, while for the control group, sodium chloride injection containing heparin sodium (heparin sodium 50 U/ml) was adopted. The sealing effects of these two kinds of injections were compared. Results There was statistical difference between the two groups in the rate of the puncture ( P < 0.05 ). While there was no statistical difference between the two groups in the rate of phlebitis or the rate of blockage ( P > 0.05 ). Conclusions 0.9% sodium chloride injection may presrve extracellular fluid volume and osmotic pressure. Therefore, 0.9% sodium chloride injection can replace sodium chloride injection containing heparin sodium ( heparin sodium 50 U/ml) in order to seal venous trochars for neonates and to minimize the hemorrhaging at the puncture.%目的 比较两种封管液对白血病患者外周导入中心静脉置管(PICC)留置效果的影响.方法 将60例应用PICC置管化疗的白血病患者随机分为观察组和对照组各30例.观察组用0.9%生理盐水作封管液,对照组用肝素钠盐水(含肝素钠50 U/L)作封管液.结果 观察组与对照组PICC穿刺点出血率比较差异有统计学意义(P<0.05),而观察组与对照组静脉炎发生率、PICC管的堵管率比较,差异无统计学意义(P均>0.05).结论 生理盐水能维持细胞外液容量及渗透压,符合生理要求,可代替肝素盐水封管,以减少PICC穿刺点出血的发生率.

  6. Influence of intralumenal and antibiotic-lock of vancomycin on the rate of catheter removal in the patients with permanent hemodialysis catheters

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    Beigi Ali

    2010-01-01

    Full Text Available Infection of permanent catheters (Permcath in hemodialysis (HD patients can lead to catheter removal. The successful use of an antibiotic-lock to treat infection has reported good results in the treatment of catheters′ infections. This study was designed to evaluate the impact of the intraluminal vancomycin in comparison with intravenous antibiotic administration. We included 67 (37 males and 30 females chronic HD patients requiring Permcath insertion at our tertiary care hospital from July 2004 to June 2007. We studied two subgroups: an intervention group, which received 500 mg vancomycin infusion via both lumens of the Permcath and antibiotic lock of 1.5 mL each 48 hours with 1 g i.v. ceftriaxone every 12 hours for 7 days, followed by oral antibiotics according to the culture for three weeks; and a control group, which received 500 mg intravenous vancomycin with daily 100-150 mg amikacin intravenously. Our endpoint was the rate of catheter removal. The patients characteristics including age, sex, time of insertion of the catheter and number of dialysis sessions per week did not differ between both subgroups. Of 28 patients in the intervention group, there was one catheter removal, and of 39 patients in the control group, there were 22 catheter removals, (P< 0.001. We conclude that administration of vancomycin as an antibiotic-lock in permcaths is more effective than its mere intravenous injection, and can increase the life span of catheters.

  7. Comparison of microbial adherence to antiseptic and antibiotic central venous catheters using a novel agar subcutaneous infection model.

    Science.gov (United States)

    Gaonkar, Trupti A; Modak, Shanta M

    2003-09-01

    An agar subcutaneous infection model (agar model), which simulates the rat subcutaneous infection model (rat model), was developed to assess the ability of antimicrobial catheters to resist microbial colonization. The catheters were implanted in the agar and rat models and the insertion sites were infected immediately or on day 7, 14 or 21 post-implantation. The catheters implanted in the agar model were transferred to fresh media one day before infection on day 7, 14 or 21. The efficacy of chlorhexidine and silver sulfadiazine impregnated (CS) catheters, CS catheters with higher levels of chlorhexidine (CS+ catheters), minocycline-rifampicin (MR) catheters and silver catheters against Staphylococcus aureus and rifampicin-resistant Staphylococcus epidermidis RIF-r2 was compared in the agar and rat models. No significant difference in the adherence or the drug release was found between the in vitro and in vivo models. In both models, CS+ and MR catheters were effective against S. aureus even when infected on day 14, whereas CS catheters were colonized when challenged on day 7. CS+ catheters were effective against S. epidermidis RIF-r2, whereas MR catheters showed adherence when infected on day 7. CS+ catheters prevented colonization of all the organisms including, Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Candida albicans in the agar model, whereas MR catheters were effective only against S. aureus and S. epidermidis strains. Silver catheters were ineffective against all the organisms. The agar model may be used to predict the in vivo efficacy of antimicrobial catheters against various pathogens.

  8. Temporary hemodialysis catheter placement by nephrology fellows: implications for nephrology training.

    Science.gov (United States)

    Clark, Edward G; Schachter, Michael E; Palumbo, Andrea; Knoll, Greg; Edwards, Cedric

    2013-09-01

    The insertion of temporary hemodialysis catheters is considered to be a core competency of nephrology fellowship training. Little is known about the adequacy of training for this procedure and the extent to which evidence-based techniques to reduce complications have been adopted. We conducted a web-based survey of Canadian nephrology trainees regarding the insertion of temporary hemodialysis catheters. Responses were received from 45 of 68 (66%) eligible trainees. The median number of temporary hemodialysis catheters inserted during the prior 6 months of training was 5 (IQR, 2-11), with 9 (20%) trainees reporting they had inserted none. More than one-third of respondents indicated that they were not adequately trained to competently insert temporary hemodialysis catheters at both the femoral and internal jugular sites. These findings are relevant to a discussion of the current adequacy of procedural skills training during nephrology fellowship. With respect to temporary hemodialysis catheter placement, there is an opportunity for increased use of simulation-based teaching by training programs. Certain infection control techniques and use of real-time ultrasound should be more widely adopted. Consideration should be given to the establishment of minimum procedural training requirements at the level of both individual training programs and nationwide certification authorities.

  9. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    Science.gov (United States)

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  10. Nursing care in the central venous cateterism of pheripheral access with two- lumen or multilumen catheter through the Seldinger technique

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    Alicia Oliva Cesar

    2007-07-01

    Full Text Available Central venous catheters are essential above all in intensive care units, to such an extent that all the patients have one or several catheters.Recently there are other alternatives for the insertion of central lines and one is the two-lumen or multilumen central line peripherally inserted through Seldinger technique which allows:- Administration of hypertonic solutions and drugs- Haemodynamic monitoring- Sample’ s extractionBut the price is the risk of nosocomial infection and for this reason nurses play a fundamental role for their direct implication in the catheter’s care since its insertion until it is removed.The aim of this work is to report in a general way which the procedures and the nursing cares are for the insertion and the maintenance of the polyurethane multilumen catheter inserted through Seldinger technique based on a wide bibliographic review and the consultation with experts on the subject.

  11. Dimensionamento da dor durante a instalação do cateter central de inserção periférica em neonatos Medida de la intensidad del dolor durante la instalación del catéter central de inserción periférica en neonatos Measuring pain in neonates during placement of central line catheter via peripheral insertion

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    Priscila Costa

    2010-01-01

    necesario adoptar medidas analgésicas, ya que los neonatos internados en la unidad de terapia intensiva neonatal son frecuentemente sometidos a procedimientos invasores y dolorosos.OBJECTIVE: To measure pain in neonates during placement of central line catheter via peripheral insertion by comparing pain at the moment of the introduction of the catheter and pain at the progression of the catheter. METHODS: This was a descriptive exploratory study with 28 neonates from a large teaching hospital in Sao Paulo city. Data were collected with the Premature Infant Pain Profile (PIPP 15 seconds prior the initial introduction of the catheter, during the initial introduction of the catheter (30 seconds, and during the progression of the catheter (30 seconds. RESULTS: The majority of neonates (59.1% had a score e" 7 on the PIPP, moderate to high pain intensity, during the initial introduction of the catheter. A greater number of neonates (45.5% who did not receive analgesic or sedative medication had score e" 7 on the PIPP, moderate to high pain intensity, during the progression of the catheter. CONCLUSION: There is a need for adoption of use of analgesic medication in the neonatal unit, since neonates often undergo invasive and painful procedures.

  12. Effect of One versus Two Drain Insertion on Postoperative Seroma Formation after Modified Radical Mastectomy

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    farzaneh ebrahimifard

    2016-04-01

    Full Text Available Background: Modified radical mastectomy (MRM is still one of globally accepted surgical techniques for breast cancer and in some selected patient is the gold standard type of surgery. The most frequent complication of this procedure is seroma under skin flaps or in the axilla as reported as much as 30% in some studies. The use of closed suction drainage system to reduce the incidence of this complication has been routinely accepted by surgeons; however, length of catheter stay and the number of catheters inserted in the wound are still controversial. The present study compares the results of single versus double drain insertion in patients undergoing MRM for breast cancer.Materials and Methods: The study was conducted on 100 women with breast cancer who were candidate for MRM surgery during 2007-2010 referred to Modarres hospital, Tehran, Iran as a randomized group matched controlled trial.Results: There was no significant difference between the two groups in terms of age, BMI, and tumor weight (P=0.406 (Table 1. Similarly, the difference between the two groups was insignificant in tumor size (T and number of lymph nodes involved (P=0.145. There was no significant difference between the two groups in timing of axillary drain removal (P=0.064. No significant differences were observed between the two groups in mean aspirated fluid (P=0.071 and mean aspirated sera (P=0.484 after removal of drains.Conclusion: This study revealed one drain insertion in MRM surgery is as effective as two drain and probably less morbidity and cost.

  13. HEPARIN OR 0.9% SODIUM CHLORIDE TO MAINTAIN CENTRAL VENOUS CATHETER PATENCY: A RANDOMISED TRIAL

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    Mahesh Babu

    2014-01-01

    Full Text Available BACKGROUND: Maintaining the lumen patency of Central venous catheters (CVCsusing low dose Heparin is recommended in many guidelines of CVC maintenance. This study is to compare the efficacy of low - dose Heparin 3ml (10U/ml and 0.9% Sodium chloride (10ml flush solutions to maintain Centra l venous catheter (CVC lumen patency. METHODS: We s tudied 100 adult patients between March 2012 and August 2012 who required short - term CVC insertion to compare two flush solutions , Heparin and0.9% Sodium Chloride on catheter lumen patency . RESULTS : The crude catheter non patency was 4% ( two lumensin Heparin group and 8% (four lumens in the Sodium Chloride group . There was no incidence of thrombocytopenia in both the study groups. CONCLUSION : This study has demonstrated no significant difference bet ween Heparin and 0.9% Sodium Chloride flushes with regards to catheter patency in adult patients with short - term use of CVCs .

  14. Influence of the hole geometry on the flow distribution in ventricular catheters for hydrocephalus

    OpenAIRE

    Giménez, Ángel; Galarza, Marcelo; Pellicer, Olga; Valero, José; Amigó, José M.

    2016-01-01

    Background Hydrocephalus is a medical condition consisting of an abnormal accumulation of cerebrospinal fluid within the brain. A catheter is inserted in one of the brain ventricles and then connected to an external valve to drain the excess of cerebrospinal fluid. The main drawback of this technique is that, over time, the ventricular catheter ends up getting blocked by the cells and macromolecules present in the cerebrospinal fluid. A crucial factor influencing this obstruction is a non-uni...

  15. Pentaxial access platform for ultra-distal intracranial delivery of a large-bore hyperflexible DIC (distal intracranial catheter: A technical note

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    Li-Mei Lin

    2016-12-01

    Conclusion: Distal intracranial catheters can achieve ultra-distal intracranial positions safely with the pentaxial access platform. This technique is a near no step-off, atraumatic method of navigating a DIC in a stepwise fashion over de-escalating smaller diameter catheters via a microwire. Familiarity with catheter specifications including diameters and length is essential for the success of this system.

  16. Use of a balloon catheter in management of the pelvic space following laparoscopic abdominoperineal excision

    DEFF Research Database (Denmark)

    Bulut, Orhan; Rasmussen, Helle B; Jess, Per

    2012-01-01

    patients (26.6%) had a deep pelvic abscess, which required surgical drainage. The median time of perineal wound healing was 3 months (range 2-8). The median follow-up time was 36 months (range18-60). None of the patients developed perineal hernia and intestinal obstruction in the follow-up period. One...... procedure and a Foley catheter Ch. 24 was inserted through the right lower port under direct vision. The balloon of the catheter, placed in the presacral space, was filled with 50 ml sterile saline and connected to passive drainage. The catheter was removed 10 days postoperatively. Results: This technique...

  17. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis.

    Science.gov (United States)

    Chen, Kai; Agarwal, Arnav; Tassone, Maria Cristina; Shahjahan, Nadia; Walton, Mark; Chan, Anthony; Mondal, Tapas

    2016-06-01

    Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children.

  18. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

    Directory of Open Access Journals (Sweden)

    Geraldo Sadoyma

    2006-04-01

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  19. Application of Nasal obstruction catheter insertion in the treatment of early postoperative inflammatory ileus%经鼻插入型肠梗阻导管在治疗术后早期炎性肠梗阻中的应用

    Institute of Scientific and Technical Information of China (English)

    苏冀

    2013-01-01

    Objective To explore the application of ileus tube in early postoperative inflammatory small bowel obstruction. Methods From January 2006 to March 2013, According to the Sequence of hospitalization, 50 patients with early postoperative inflammatory small bowel obstruction were divided into two groups respectively:the group with ilues tube (25 cases) and the Group with nasogastrictube (25 cases). Abdominal distension symp-tom, borborygmus,abdominal circumference,gastrointestinal Decompression amounts, plain abdominal radiogra-phy,time of bowel movements and fart,abdominal plain film and the disappearing time of liquid and gas were ob-served and compared. Results Compared with the nasogastric tube group, nasal obstruction catheter insertion in patients abdominal pain, bloating and other abdominal symptoms relief time, recovery time of bowel sounds, ex-haust and defecation was significantly shorter recovery time, decompression increased significantly. Conclusion The ilues tube can more effectively drain digestive juice,relieve intestional dilatation and promotein testional peristalsis.The ilues tube has a notably treatment effect to the patients with early postoperative inflammatory Small bowel obstruction.%目的:探讨经鼻插入型肠梗阻导管治疗术后早期炎性肠梗阻的临床疗效。方法:对我院2006年1月~2013年3月期间50例腹部术后早期炎性肠梗阻患者分为经鼻插入型肠梗阻导管组和普通鼻胃管组进行治疗,观察患者腹痛、腹胀等腹部症状缓解情况、肠鸣音变化、腹围、胃肠减压量、排气排便恢复时间、X线立卧位腹平片、气液平面消失时间等指标。对结果进行分析比较。结果:与鼻胃管组相比较,经鼻插入型肠梗阻导管组患者腹痛、腹胀等腹部症状缓解时间、肠鸣音恢复时间、排气与排便恢复时间明显缩短,胃肠减压量显著增加。结论:经鼻插入型肠梗阻导管能更有效胃肠减压,减轻

  20. 持续改进护理在预防恶性肿瘤患者化疗期间外周置入中心静脉导管感染的效果观察%Effect of continuous improvement nursing for peripherally inserted central catheter in the prevention of chemotherapy patients with malignant tumor infection

    Institute of Scientific and Technical Information of China (English)

    刘远玲; 张秋蓉

    2014-01-01

    Objective To investigate the effect of the continuous improvement nursing care in the prevention during chemotherapy in patients with malignant tumor of peripherally inserted central catheter (PICC) infection. Methods Total of 123 patients with cancer chemotherapy with PICC in January 2012 to December 2012 in our hospital were collected as the control group. While 129 cases with cancer chemotherapy with PICC in January 2013 to December 2013 in our hospital were collected as the observation group. Control study were taked, the PICC related knowledge and the processing ability before and after the continuous improvement nursing of the two groups were compared, at the same time, the infection incidence during PICC tube in the two group were compared, respectively. Results After the implementation of continuous improvement of nursing care, oncology nurses in our hospital, the PICC theoretical knowledge and infection ability were improved signiifcantly, with signiifcant difference (P all <0.05). The infection rate of the control group was 13.82%, the infection rate of the observation group was 3.83%, with signiifcant difference (χ2=4.100, P<0.05). Conclusions The nursing of circulation management mode of continuous improvement, is conducive to reduce and eliminate PICC infection related to improper care, has good control effect, for the smooth completion of chemotherapy in patients with malignant tumor and create necessary conditions.%目的:观察持续改进护理在预防恶性肿瘤患者化疗期间外周置入中心静脉导管(PICC)感染的疗效。方法采用回顾性对照研究,选择2012年1月至2012年12月123例PICC置管化疗的恶性肿瘤患者作为对照组,选取2013年1月至2013年12月129例PICC置管化疗的恶性肿瘤患者为观察组,比较持续改进护理前后护理人员PICC相关知识及处理能力改进情况,同时比较两组患者PICC置管期间感染发生率。结果持续改进护理实施后,本院肿瘤

  1. Effect of comprehensive nursing intervention on the negative emotion and pain of patients with gastrointestinal tumors and undergoingperipherally inserted central catheter%综合护理干预对消化道肿瘤 PICC 置管患者负性情绪及疼痛的影响

    Institute of Scientific and Technical Information of China (English)

    张珍珍; 吴贤翠

    2015-01-01

    目的:探讨综合护理干预对消化道肿瘤经外周置入中心静脉导管(PICC)置管患者负性情绪及疼痛的影响。方法选取2012年1月—2014年1月消化道肿瘤 PICC 置管患者35例设为观察组,2010年1月—2011年12月同类患者30例设为对照组,对照组给予常规护理,观察组在此基础上给予综合护理干预,包括健康宣教、环境护理、心理护理、放松训练等。结果观察组置管并发症总发生率为14.29%(5/35),对照组总发生率为16.67%(5/30),差异无统计学意义(P >0.05)。2组置管后7 d 焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较置管前1 d 降低,视觉模拟评分(VAS)较置管完毕即刻降低,且观察组低于对照组,差异有统计学意义(P <0.01)。结论综合护理干预可有效改善消化道肿瘤 PICC 置管患者的负性情绪,缓解疼痛,从而改善其生活质量,促进病情康复。%Objective To explore the effect of comprehensive nursing intervention on the negative emotion and pain of patients with gastrointestinal tumors and undergoing peripherally in-serted central catheter (PICC).Methods Thirty-five PICC patients with gastrointestinal tumors were as observation group from January 2012 to January 2014,and the same type of 30 patients as control group from January 2010 to January 2011.Both groups were given routine nursing,and the observation group was added comprehensive nursing intervention,including healthy education,envi-ronmental and psychological nursing as well as relaxation training.Results The total incidences of complications were 14.29% (5 /35)in observation group and 16.67% (5 /30)in control group (P>0.05).Compared with 1 d before intubation,both self-rating anxiety scale (SAS)and self-rating depression scale (SDS)scores decreased in two groups 7 d after intubation.Visual analogue scale (VAS)scores also went down compared with immediately after

  2. 知-信-行健康教育模式对PICC置管肿瘤患者自我护理能力的影响%Effect of knowledge attitudes, and practices health education model on self-care skill among cancer patients with peripherally inserted central catheter

    Institute of Scientific and Technical Information of China (English)

    梅思娟; 段培蓓

    2012-01-01

    Objective To explore the effect of knowledge,attitudes,and practices (KAP) health education model on the self-care skill among cancer patients with peripherally inserted central catheter (PICC),and to implement the effective health education methods.Methods Totals of 66 cases of cancer patients with PICC were randomly divided into control group(n =35 ) and the experimental group (n =31 ).The control group received routine health education whlie the experimental group received KAP health education regarding strengthened self-care knowledge of PICC,establishment in self care attitude or belief,promotion in self care practice.Before and after intervention,we apply the Exercise of Self-care Agency Scale (ESCA) to asses the extent to which individuals take action toward their health care.Results After intervention,experimental group was higher than the control group significantly in ESCA total score [ ( 117.07 ± 13.75 ) vs ( 101.14 ± 11.56) ],self care skills [ (31.52 ± 3.67 ) vs (26.74 ± 3.46) ],self care responsibility [ (22.39 ± 3.89 ) vs ( 16.03 ±2.80) ],self-concept [ ( 23.39 ± 3.36 ) vs ( 18.83 ± 3.43 ) ],and the difference was statistically significant (t=-3.717,-5.242,-7.685,-5.434,respectively;P<0.05).Conclusions KAP health education model appears effective in improving the self-care agency among cancer patients with PICC.%目的 探讨知-信-行健康教育模式对PICC置管肿瘤患者自我护理能力的干预效果,实施有效的健康教育方法.方法 采用方便抽样的方法将66例PICC置管肿瘤患者分为对照组35例和实验组31例,对照组采用常规的健康教育方式,实验组应用知-信-行模式实施健康教育:强化PICC自我护理知识、建立自我护理信念、促进自我护理行为改变.干预前后运用自我护理能力测定量表( ESCA)进行测试,比较两组自我护理能力.结果 干预前两组ESCA总分及各维度得分比较差异无统计学意义(P>0.05)

  3. Analysis of risk factors for venous thrombosis associated with the placement of peripherally inserted central catheters in patients with malignant tumors during the course of chemotherapy%肿瘤化疗患者PICC置管后静脉血栓形成的危险因素分析及护理干预

    Institute of Scientific and Technical Information of China (English)

    魏素臻; 王爱红; 李贵新; 路中; 周学伟

    2009-01-01

    目的 调查恶性肿瘤患者PICC置管后静脉血栓形成的相关因子水平,建立针对致栓原因的干预模式.方法 将恶性肿瘤化疗实施PICC置管后并发静脉血栓的40例患者作为血栓组;选择同期PICC置管后无静脉血栓形成的患者40例作为无血栓组;选择同期门诊健康体检者30例作为健康对照组.对3组分别采血检测凝血系统分子标志物水平、血小板参数及纤溶系统分子标志物水平,并进行比较.结果 血栓组患者的vWF、GMPl40、TAT数值均高于健康对照组及无血栓组,而ATⅢ值显著低于健康对照组;血栓组患者MPV和PCT显著高于健康对照组和无血栓组;血栓组患者的PLG、PAI水平均显著高于健康对照组及无血栓组,而PLM值显著低于健康对照组.结论 恶性肿瘤化疔患者PICC置管致静脉血栓形成的原因主要由于患者存在明显的高凝状态、血小板活性增强及PICC易导致血栓形成前状态有关.在恶性肿瘤患者PICC置管治疗过程中,应把检测相应凝血系统分子标志物水平、血小板参数、纤溶系统分子标志物水平列为临床工作常规,作为选择早期干预和评价置管效果的一项指标.%Objective To investigate the induced-factors levels of venous thrombosis associated with the placement of peripherally inserted central catheters (PICC) in patients with malignant tumor,and establish intervention model accordingly. Methods 40 patients complicated with venous thrombosis after PICC were set as the thrombosis group, 40 patients without venous thrombosis were selected as the no-thrombosis group, 30 healthy cases were selected as the control group. All cases' serum samples were ob-tained to measure the levels of molecular biomarkers of the coagulation system, platelet parameters and molecular biomarkers of the fibrinolysis system. The results of the three groups were assessed. Results Patients in the thrombosis group were reported significantly higher

  4. 临床药师参与1例肿瘤患者中心静脉置管感染合并深静脉血栓治疗的实践与体会%Practice and Experience of Clinical Pharmacists Participating in One Case of Cancer Patients with Infection Induced by Peripherally Inserted Central Catheter Complicated with Deep Venous Thrombosis

    Institute of Scientific and Technical Information of China (English)

    闫秀娟; 李进峰; 张媛

    2016-01-01

    Objective:To explore the methods for drug therapy regimen formulation and pharmaceutical service of clinical pharma-cists for the infection induced by peripherally inserted central catheter ( PICC) complicated with deep venous thrombosis in cancer pa-tients. Methods:Referring to the related guide, clinical pharmacists put forward concrete opinions on how to choose anti-infective drugs and anti-thrombotic drugs for a cancer patient with PICC infection complicated with deep venous thrombosis. Clinical pharmacists sug-gested that vancomycin be used for the infection and low molecular weight heparin sodium for prophylactic anticoagulation. Meanwhile, pharmaceutical care for blood clotting function should be strengthened. Results:The proposals of clinical pharmacist were partly adopt-ed by clinicians. After the therapy, the temperature of the patient returned to normal, and the deep venous thrombosis was well con-trolled. The patient was out of hospital smoothly. Conclusion:Through the participation in clinical practice, clinical pharmacists can assist physicians in optimizing treatment plan and summarize the pharmaceutical care mode for the PICC infection and deep venous thrombosis in cancer patients, which can provide instructions for pharmaceutical care in the future.%目的::探讨临床药师参与肿瘤患者中心静脉置管( PICC)感染合并血栓的药物治疗方案的制定以及提供药学服务的方法。方法:对1例出现PICC感染合并血栓的肿瘤患者,临床药师结合相关指南对抗感染药物及抗血栓药物治疗方案的选择提出了具体意见,建议选用万古霉素治疗导管相关性感染,选用低分子肝素钠预防性抗凝治疗,治疗同时加强凝血功能的药学监护。结果:临床药师的建议被临床医生部分采纳,经治疗后患者的体温恢复正常,深静脉血栓得到良好控制,顺利出院。结论:临床药师通过参与临床实践,可协助医师优化治疗方

  5. Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Power, Sarah, E-mail: sarahpower28@yahoo.co.uk; Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Department of Radiology (Ireland)

    2013-04-15

    Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

  6. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis.

    Science.gov (United States)

    Ballard, David H; Samra, Navdeep S; Gifford, Karen Mathiesen; Roller, Robert; Wolfe, Bruce M; Owings, John T

    2016-06-01

    Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p venous thrombosis (p catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible.

  7. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

    Directory of Open Access Journals (Sweden)

    Amy Leung

    2016-01-01

    Full Text Available Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%. The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

  8. Percutaneous versus laparoscopic placement of peritoneal dialysis catheters: Simplicity and favorable outcome

    Directory of Open Access Journals (Sweden)

    Abdulla K Al-Hwiesh

    2014-01-01

    Full Text Available Implantation of peritoneal dialysis (PD catheters via the laparoscopic technique is expanding, but none of the studies concerning this technique have compared its outcome with the percutaneous insertion done by the nephrologist. We compared the technical survival and outcome of 52 PD catheters placed in 43 patients with end-stage renal disease (ESRD in our center from March 2006 to October 2007. Of these, 27 PD catheters were inserted percutaneously by a nephrologist (group 1 and 25 were placed by a surgeon using the conventional laparoscopic technique (group 2. Very obese patients, those with previous abdominal surgery, and those who refused local anesthesia were excluded from the study. All catheters were evaluated for mechanical and infectious complications and the overall technique survival was analyzed. The incidence of complications in PD catheters did not largely differ between the two groups. Early catheter-related infection episodes (within two weeks of catheter placement occurred in three of 22 (13.6% patients in group 1, versus three of 21 (14.3% patients in group 2 (P >0.05. The incidence of exit site leak was higher in group 2 (19.0% compared to (4.5% group 1 (P 0.05. We conclude that in our study, the percutaneous bedside placements of PD catheters done by nephrologists were comparable with the laparoscopic insertions performed by surgeons where the high-risk patients were avoided, and the former provided a safer and more reliable access that allowed a rapid initiation of PD.

  9. US-guided placement of central vein catheters in patients with disorders of hemostasis

    Energy Technology Data Exchange (ETDEWEB)

    Tercan, Fahri [Baskent University, Faculty of Medicine, Department of Radiology, Ankara (Turkey)], E-mail: ftercan@yahoo.com; Ozkan, Ugur; Oguzkurt, Levent [Baskent University, Faculty of Medicine, Department of Radiology, Ankara (Turkey)

    2008-02-15

    Objective: To prospectively evaluate the technical success and immediate complication rates of temporary central catheter placement in a homogenous patient population with disorders of hemostasis. Materials and methods: One hundred and thirty three temporary central vein catheters inserted under ultrasound guidance in 119 patients with bleeding disorders were analyzed over a 4-year period. Patients were males (n = 51; 43%) and females (n = 68; 57%) with a mean age of 56.6 years (age range 18-95 years). A catheter was inserted in IJV in 129 (97%) procedures, subclavian vein in 2 (1.5%) procedures and femoral vein in 2 (1,5%) procedures. Thirty-three (24.8%) procedures were performed on bedside. Of 119 patients, 106 (89%) had only one catheter placement and the rest had had more than one catheter placement (range 1-3). Results: Technical success was achieved in all patients (100%). Average number of puncture was 1.01 (range 1-2). One hundred and nineteen insertions (89.5%) were single-wall punctures, whereas 14 insertions were double-wall punctures. Eight (6%) minor complications occurred including oozing of blood around the catheter in five (3.8%) procedures, small hematoma in two (1.5%) procedure and both in one patient. There was no inadvertent arterial puncture or major complications like hemothorax or pneumothorax in any patients. Conclusion: US-guided placement of central vein catheters in patients with disorder of hemostasis is safe with high technical success and low complication rates. US guidance for central venous catheterization should be the preferred method in this group of patients, if available in the hospital setting.

  10. Cateter central de inserção periférica: descrição da utilização em UTI Neonatal e Pediátrica Catéter central de inserción periférica: descripción da utilización en UTI Neonatal y Pediátrica Peripherally inserted central catheter: description of its utilization in Neonatal and Pediatric ICU

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Baggio

    2010-03-01

    ,9%, ruptura (11,2%, retirada accidental (8,3%, flebitis (4,2%, cianosis (1,4% y migración (1,4%, con media de permanencia de 14,5 días. Para el mantenimiento del catéter es requerida la capacitación y educación permanente de los profesionales, estrategias que cualifican la asistencia.The purpose of this descriptive, retrospective, documental study is to describe the use of peripherally inserted central catheters (PICC in a neonatal and pediatric intensive care unit regarding their insertion, maintenance, and removal. This study also characterized the population which received the catheter through descriptive and statistical analysis of 176 instruments filled out by nurses, in a two year period. The population attended consisted of 125 patients, mainly premature (43.2% and male (60%. The basilic and cephalic (43.2% veins were primarily used for the insertion of a 1.9Fr (85.8% catheter. The success rate was 98.9% in the punctures, but anticipated removal occurred due to obstruction (25%, infiltration (18%, suspected contamination (16,6%, traction (13,9%, rupture (11,2%, accidental removal (8,3%, phlebitis (4,2%, cyanosis (1,4%, and migration (1,4%, with an average period of permanence of 14.5 days. In order to maintain the catheter, professional education and preparation are required to qualify care.

  11. Feeding tube insertion - gastrostomy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002937.htm Feeding tube insertion - gastrostomy To use the sharing features on this page, please enable JavaScript. A gastrostomy feeding tube insertion is the placement of a feeding ...

  12. Central venous catheter insertion drainage and intrapleural administration staphylococcal enterotoxin C injection plus low dose cisplatin for treatment of malignant pleural effusion compared with bleomycin:a clinical control study%中心静脉导管置入引流并胸腔内灌注金葡素注射液联合小剂量顺铂治疗恶性胸腔积液与博莱霉素临床对照研究

    Institute of Scientific and Technical Information of China (English)

    闫培清; 于晓红; 张华; 卜宪聪; 葛长胜

    2008-01-01

    目的 评价中心静脉导管置入引流并胸腔内灌注金葡素注射液联合小剂量顺铂治疗恶性胸腔积液的疗效及不良反应.方法 64例恶性胸腔积液随机分成两组:治疗组32例,胸腔内灌注金葡素注射液20 ml+顺铂20 mg;对照组32例,胸腔内灌注博莱霉素60 mg.结果 治疗组和对照组胸水控制、生活质量Karnofsky评分有效率差异无统计学意义(P>0.05);治疗组不良反应程度明显低于对照组(P<0.05).结论 中心静脉导管置入引流并胸腔内灌注金葡素注射液联合小剂量顺铂治疗恶性胸腔积液是有效的,且不良反应少.%Objective To evaluate the efficacy and side effects of the treatment using central venous catheter insertion drainage and the intrapleural administration of staphyloccal enterotoxin C injection plus low dose cisplatin for malignant pleural effusion.Methods Sixty-four patients were randomly divided into two groups.Test group 32 cases:staphyloccal enterotoxin C injection 20 ml combined with cisplatin 20 mg were infused into the thoracic cavity;control group (32 cases):bleomycin 60 mg were infused into the thoracic cavity.Results There was not statistical difference in the total response rate of pleural control and Karnofsky score between two groups(P>0.05).The side effects in test group were less than that in control group(P<0.05).Conclusion Placement of central venous catheter for drainage and intrapleural administration of staphyloccal enterotoxin C injection plus low dose cisplatin is effective for malignant pleural effusion,and the side effects less.

  13. Titanium-Nickel Shape Memory Alloy Spring Actuator for Forward-Looking Active Catheter

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    Takahiro Namazu

    2011-01-01

    Full Text Available The fabrication and characterization of forward-looking active catheter actuated by titanium-nickel (Ti-Ni shape memory alloy (SMA springs are described. The catheter has been designed for wide-range observation of an affected area inside a blood vessel when the blood vessel is occluded. The developed active catheter consists of eight Ti-Ni SMA spring actuators for actuation of catheter tip, an ultrasonic transducer for forward-looking, a guide wire, a polyurethane tube for coating, and spiral wirings for realization of various flexure motions of catheter tip using Ti-Ni SMA actuators. The size of the catheter is 3.5 mm in diameter and 60 mm in length of the sum of transducer and actuator sections. Ti-Ni SMA springs were fabricated from a Ti-50.9at.%Ni sheet by electrochemical etching with a mixed solution of ethanol and lithium chloride. The catheter was assembled by hand under a stereomicroscope. The tip of the produced catheter was able to move in parallel toward at least eight directions by controlling an applied current to Ti-Ni SMA springs. We have confirmed that the active catheter was able to observe an object settled in the front.

  14. The Hunter pulmonary angiography catheter for a brachiocephalic vein approach.

    Science.gov (United States)

    Rosen, Galia; Kowalik, Karen J; Ganguli, Suverano; Hunter, David W

    2006-01-01

    The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a "C-shaped" curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk.

  15. An evaluation of the relationships between catheter design and tissue mechanics in achieving high-flow convection-enhanced delivery.

    Science.gov (United States)

    White, Edward; Bienemann, Alison; Malone, John; Megraw, Lisa; Bunnun, Chotirote; Wyatt, Marcella; Gill, Steven

    2011-07-15

    Convection-enhanced delivery (CED) is a rational technique for the direct intracranial administration of a range of therapeutic agents. CED critically depends on the use of a catheter with a narrow outer diameter and low infusion rate. Failure to adhere to these requirements can lead to reflux of infusate along the catheter-brain interface and damage at the catheter-tip. In this study we have tested the hypothesis that the relationship between infusion parameters and infusate distribution, including reflux, is critically dependent on the occurrence of tissue damage. The relationship between catheter outer diameter and the extent of blood-brain barrier disruption and subsequent tissue oedema was evaluated following catheter insertion into the striatum of rats. Three patterns of infusate distribution were observed: (1) Reflux restricted to the traumatised tissue around the catheter site. (2) Distribution in the white matter beyond the area of tissue trauma. (3) Widespread distribution in the striatum, which occurred only with catheters of an outer diameter of 0.35 mm or less. Extensive tissue damage occurred with a 0.2mm outer diameter catheter. This damage was completely prevented by rounding the catheter-tip. Infusions into pig brain demonstrated that high-flow CED could be performed in a large brain in both grey and white matter using a 0.2mm outer diameter catheter, with minimal reflux or MRI-evidence of tissue damage. This study demonstrates that by minimising tissue damage from catheter design and insertion, high flow-rate CED can be utilised to distribute therapeutic agents over large volumes of brain within clinically practical timescales.

  16. Ventriculoperitoneal shunt malfunction caused by proximal catheter fat obstruction.

    Science.gov (United States)

    Mizrahi, Cezar José; Spektor, Sergey; Margolin, Emil; Shoshan, Yigal; Ben-David, Eliel; Cohen, José E; Moscovici, Samuel

    2016-08-01

    Ventriculoperitoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus, yet shunts remain vulnerable to a variety of complications. Although fat droplet migration into the subarachnoid space and cerebrospinal fluid pathways following craniotomy has been observed, a VP shunt obstruction with fat droplets has never been reported to our knowledge. We present the first reported case of VP shunt catheter obstruction by migratory fat droplets in a 55-year-old woman who underwent suboccipital craniotomy for removal of a metastatic tumor of the left medullocerebellar region, without fat harvesting. A VP shunt was inserted 1month later due to communicating hydrocephalus. The patient presented with gait disturbance, intermittent confusion, and pseudomeningocele 21days after shunt insertion. MRI revealed retrograde fat deposition in the ventricular system and VP shunt catheter, apparently following migration of fat droplets from the fatty soft tissue of the craniotomy site. Spinal tap revealed signs of aseptic meningitis. Steroid treatment for aseptic "lipoid" meningitis provided symptom relief. MRI 2months later revealed partial fat resorption and resolution of the pseudomeningocele. VP shunt malfunction caused by fat obstruction of the ventricular catheter should be acknowledged as a possible complication in VP shunts after craniotomy, even in the absence of fat harvesting.

  17. Assessment of central venous catheter-associated infections using semi-quantitative or quantitative culture methods

    Directory of Open Access Journals (Sweden)

    E. L. Pizzolitto

    2009-01-01

    Full Text Available

    Semiquantitative (Maki and quantitative (Brun- Buisson culture techniques were employed in the diagnosis of catheter-related bloodstream infections (CRBSI in patients who have a short-term central venous catheter (inserted for 30 days. The diagnosis of CRBSI was based on the results of semiquantitative and quantitative culture of material from the removed catheters. Catheter tips (118 from 100 patients were evaluated by both methods. Semiquantitative analysis revealed 34 catheters (28.8% colonized by ≥15 colonyforming units (cfu, while quantitative cultures (34 catheters, 28.8% showed the growth of ≥103 cfu/mL. Bacteremia was confirmed in four patients by isolating microorganisms of identical species from both catheters and blood samples. Using the semiquantitative culture technique on short-term central venous catheter tips, we have shown that with a cut-off level of ≥15 cfu, the technique had 100.0% sensitivity, specificity of 68.4%, 25.0% positive predictive value (PPV and 100.0% negative predictive value (NPV, efficiency of 71.4% and a prevalence of 9.5%. The quantitative method, with a cut-off limit of ≥103 cfu/mL, gave identical values: the sensitivity was 100.0%, specificity 68.4%, positive predictive value (PPV 25.0%, negative predictive value (NPV 100.0%, efficiency 71.4% and prevalence 9.5%. We concluded that the semiquantitative and quantitative culture methods, evaluated in parallel, for the first time in Brazil, have similar sensitivity and specificity. Keywords: central venous catheter; semi-quantitative culture; quantitative culture; catheter-related bacteremia.

  18. Hydrodynamics of catheter biofilm formation

    CERN Document Server

    Sotolongo-Costa, Oscar; Rodriguez-Perez, Daniel; Martinez-Escobar, Sergio; Fernandez-Barbero, Antonio

    2009-01-01

    A hydrodynamic model is proposed to describe one of the most critical problems in intensive medical care units: the formation of biofilms inside central venous catheters. The incorporation of approximate solutions for the flow-limited diffusion equation leads to the conclusion that biofilms grow on the internal catheter wall due to the counter-stream diffusion of blood through a very thin layer close to the wall. This biological deposition is the first necessary step for the subsequent bacteria colonization.

  19. SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

    Directory of Open Access Journals (Sweden)

    A. Keshvari

    2006-06-01

    Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

  20. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients.

    Science.gov (United States)

    Moini, Majid; Rasouli, Mohammad R; Kenari, Mohammad Mahmoodzadeh; Mahmoodi, Hamid Reza

    2009-01-01

    To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD), we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (pvein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

  1. Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?

    NARCIS (Netherlands)

    Hanson, J.; Lam, S.W.K.; Mohanty, S.; Alam, S.; Hasan, M.M.U.; Lee, S.J.; Schultz, M.J.; Charunwatthana, P.; Cohen, S.; Kabir, A.; Mishra, S.; Day, N.P.J.; White, N.J.; Dondorp, A.M.

    2011-01-01

    ABSTRACT: BACKGROUND: To optimize the fluid status of adult patients with severe malaria, World Health Organization (WHO) guidelines recommend the insertion of a central venous catheter (CVC) and a target central venous pressure (CVP) of 0-5 cmH2O. However there are few data from clinical trials to

  2. Shunt implantations and peritoneal catheters: Do not cut beyond 20 cm

    Directory of Open Access Journals (Sweden)

    Angelo Luiz Maset

    2014-01-01

    Full Text Available Background: Ventriculoperitoneal shunts are supplied with long peritoneal catheters, most commonly between 80 and 120 cm long. ISO/DIS 7197/2006 [15] shunt manufacturing procedures include peritoneal catheter as an integrate of the total resistance. Cutting pieces of peritoneal catheters upon shunt implantation or revision is a common procedure. Methods: We evaluated five shunts assembled with different total pressure resistances and variable peritoneal catheter lengths in order to clarify the changes that occurred in the hydrodynamic profile when peritoneal catheters were cut upon shunt implantation or shunt revision. Results: Originally, all shunts performed within the operational range. Shunt 1 performed in a lower pressure range at 200 mm cut off peritoneal catheter and as a low-pressure shunt with -300 mm cut off. Shunt 2 was manufactured to run at the higher border pressure range, and it went out of specification with a 300 mm cut off. Shunt 3 was manufactured to run close to the lower border pressure range, and at 100 mm cutoff, it was already borderline in a lower resistive category. Other shunts also responded similarly. Conclusion: The limit to maintain a shunt in its original pressure settings was 20 cm peritoneal catheter cutting length. By cutting longer pieces of peritoneal catheter, one would submit patients to a less-resistive regimen than intended and his reasoning will be compromised. The pediatric population is more prone to suffer from the consequences of cutting catheters. Shunt manufacturers should consider adopting peritoneal catheters according to the age (height of the patient.

  3. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    Science.gov (United States)

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.

  4. A catheter malpositioned patient with pain and paresthesia

    Directory of Open Access Journals (Sweden)

    Akbar Fadaei Haghi

    2017-01-01

    Full Text Available We report a 54-year-old woman with the history of end-stage renal disease (ESRD who was admitted to our hospital because of volume overload. Due to long-term use of peripheral veins and arteriovenous fistula (AVF failure, central venous catheterization was the only choice for hemodialysis. She developed right upper extremiti’s pain and paresis during hemodialysis. A posteroanterior chest x-ray showed the catheter tip was accidently pushed from right internal jugular vein into right subclavian vein during hemodialysis by the dialysis center nurse. Therefore, we believe that the physician should be aware of any changes in the catheter size after insertion. And a chest x-ray should ensure the catheter’s correct position in any patient who develops complications.

  5. Isolated Calyx Mistaken for a Cyst: Inappropriately Performed Catheter-Directed Sclerotherapy and Safe Removal of the Catheter After Selective Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Gwak, Jng Won, E-mail: jjungwonie@hanmail.net; Lee, Seung Hwa, E-mail: gareureung@daum.net; Chung, Hwan Hoon, E-mail: chungmic@korea.ac.kr; Je, Bo Kyung, E-mail: purity21@hanmail.net; Yeom, Suk kyu, E-mail: pagoda20@hanmail.net [Korea University College of Medicine, Department of Radiology, Ansan Hospital (Korea, Republic of); Sung, Deuk Jae, E-mail: urora@korea.ac.kr [Korea University College of Medicine, Department of Radiology, Anam Hospital (Korea, Republic of)

    2015-02-15

    We present a case of isolated calyx that was mistaken for a large cyst. A 47-year-old woman was referred for sclerotherapy of a large cystic lesion on her left kidney. Computed tomography (CT) and ultrasound showed that the cystic lesion was a large cyst. We noticed that the cystic lesion was not a typical simple cyst, even after two sessions of catheter-mediated sclerotherapy. Isolated calyx was presumed by medical history review and was confirmed by aspirated fluid analysis and far delayed-phase CT after intravenous contrast injection. We performed meticulous selective arterial embolization for an isolated calyx and inserted a catheter that could be removed without complication.

  6. Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation.

    Science.gov (United States)

    Martinho, Gláucia Helena; Romanelli, Roberta M C; Teixeira, Gustavo Machado; Macedo, Antonio V; Chaia, Juliana M C; Nobre, Vandack

    2013-07-01

    In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

  7. A Novel Technique for Split-Thickness Skin Donor Site Pain Control: Subcutaneous Catheters for Continuous Local Anesthetic Infusion

    Science.gov (United States)

    2012-01-01

    has been described after laparotomy, tho- racotomy, inguinal hernia repair, and rib fractures.2–4 We describe our experience at the U.S. Army Insti... complications (one catheter insertion site infection and one early catheter discontinuation due to poor skin fixation). This report is limited by its...Sanchez B, Waxman K, Tatevossian R, Gamberdella M, Read B. Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a

  8. Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Faisal A. Khasawneh

    2011-01-01

    Full Text Available Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.

  9. Compensation for Unconstrained Catheter Shaft Motion in Cardiac Catheters

    Science.gov (United States)

    Degirmenci, Alperen; Loschak, Paul M.; Tschabrunn, Cory M.; Anter, Elad; Howe, Robert D.

    2016-01-01

    Cardiac catheterization with ultrasound (US) imaging catheters provides real time US imaging from within the heart, but manually navigating a four degree of freedom (DOF) imaging catheter is difficult and requires extensive training. Existing work has demonstrated robotic catheter steering in constrained bench top environments. Closed-loop control in an unconstrained setting, such as patient vasculature, remains a significant challenge due to friction, backlash, and physiological disturbances. In this paper we present a new method for closed-loop control of the catheter tip that can accurately and robustly steer 4-DOF cardiac catheters and other flexible manipulators despite these effects. The performance of the system is demonstrated in a vasculature phantom and an in vivo porcine animal model. During bench top studies the robotic system converged to the desired US imager pose with sub-millimeter and sub-degree-level accuracy. During animal trials the system achieved 2.0 mm and 0.65° accuracy. Accurate and robust robotic navigation of flexible manipulators will enable enhanced visualization and treatment during procedures. PMID:27525170

  10. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses

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    Sevgisun Kapucu

    2017-01-01

    Full Text Available Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%, control of catheter before the administration (93.9%, influence of chemotherapeutic agent on length of catheter (40.6%, and management of extravasation (75.7%. Nurses also had correct information about the first use of port catheter (67.3% and checking the catheter whether it is working properly or not (75.8%. Conclusions: In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.

  11. 抗感染中心静脉导管预防导管相关性血流感染的效果%Effect in prevention of catheter-related bloodstream infection using antiseptic impregnated central venous catheter

    Institute of Scientific and Technical Information of China (English)

    罗蕾; 秦英; 向亚娟

    2011-01-01

    Objective To evaluate the clinical effect in prevention of catheter-related bloodstream infection(CRBSI) using antiseptic impregnated central venous catheter. Methods The incidence of catheterrelated bloodstream infection was compared between 420 cases performed with antiseptic impregnated central venous catheter ( experimental group ) and 430 cases performed with general central venous catheter (control).Besides, the categories and characteristics of pathogenic bacteria which resulted in catheter-related bloodstream infection were analyzed. Results There were 66 cases of CRBSI in 850 cases, 25 cases were inserted antiseptic impregnated central venous catheter and 41 cases inserted general central venous catheter. No significant difference in the incidence between the two groups was found during 7 days(χ2 = 0. 06 ,P > 0. 05), however, the incidence of CRBSI was lower in the experimental group than of the control group after 7 days( χ2 = 3.91,4.30 ;P 0.05),7 d后实验组CRBSI感染率较对照组低,差异有统计学意义(χ2分别为3.91,4.30,P<0.05).实验组减少导管相关性血流感染的病原体主要为革兰阳性菌.结论 抗感染中心静脉导管可明显减少导管相关性血流感染的发生,有很大的临床价值.

  12. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

  13. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed. PMID:28168186

  14. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  15. Hemodialysis catheter implantation in the axillary vein by ultrasound guidance versus palpation or anatomical reference

    Directory of Open Access Journals (Sweden)

    Restrepo Valencia CA

    2013-10-01

    Full Text Available Cesar A Restrepo Valencia,1 Carlos A Buitrago Villa,1 Jose A Chacon Cardona21Internal Medicine, Nephrology, 2Epidemiology, Caldas University, Manizales, ColombiaBackground: We compared the results of four different methods of hemodialysis catheter insertion in the medial segment of the axillary vein: ultrasound guidance, palpation, anatomical reference, and prior transient catheter.Methods: All patients that required acute or chronic hemodialysis and for whom it was determined impossible or not recommended either to place a catheter in the internal jugular vein (for instance, those patients with a tracheostomy, or to practice arteriovenous fistula or graft; it was then essential to obtain an alternative vascular access. When the procedure of axillary vein catheter insertion was performed in the Renal Care Facility (RCF, ultrasound guidance was used, but in the intensive care unit (ICU, this resource was unavailable, so the palpation or anatomical reference technique was used.Results: Two nephrologists with experience in the technique performed 83 procedures during a period lasting 15 years and 8 months (from January 1997–August 2012: 41 by ultrasound guidance; 19 by anatomical references; 15 by palpation of the contiguous axillary artery; and 8 through a temporary axillary catheter previously placed. The ultrasound-guided patients had fewer punctures than other groups, but the value was not statistically significant. Arterial punctures were infrequent in all techniques. Analyzing all the procedure-related complications, such as hematoma, pneumothorax, brachial-plexus injury, as well as the reasons for catheter removal, no differences were observed among the groups. The functioning time was longer in the ultrasound-guided and previous catheter groups. In 15 years and 8 months of surveillance, no clinical or image evidence for axillary vein stenosis was found.Conclusion: The ultrasound guide makes the procedure of inserting catheters in the

  16. Bacteriological Profile of Epidural Catheters

    Directory of Open Access Journals (Sweden)

    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  17. Tie rod insertion test

    CERN Multimedia

    B. LEVESY

    2002-01-01

    The superconducting coil is inserted in the outer vaccum tank and supported by a set of tie rods. These tie rods are made of titanium alloy. This test reproduce the final insertion of the tie rods inside the outer vacuum tank.

  18. Poor value of surveillance cultures for prediction of septicaemia caused by coagulase-negative staphylococci in patients undergoing haemodialysis with central venous catheters

    DEFF Research Database (Denmark)

    Nielsen, J; Kolmos, H J; Rosdahl, V T

    1998-01-01

    Surveillance cultures for the demonstration of coagulase-negative staphylococci in patients on catheter haemodialysis were performed in an attempt to predict dialysis catheter-related septicaemia. In all, 43 patients with 67 haemodialysis catheters were followed for a 1-y period. Once a week, swab...... specimens were obtained from the skin at the insertion site and the hub, and blood cultures were obtained from the catheter. Among coagulase-negative staphylococci, S. epidermidis was the most frequently (80%) isolated species, and two biotypes accounted for 55.7% of the 41 biotypes isolated. 11 septicaemia...... cases due to coagulase-negative staphylococci occurred, all caused by S. epidermidis, and the incidence of S. epidermidis septicaemia was 21% among patients and 16% among catheter periods. S. epidermidis septicaemia occurred in 17%, 31% and 33% of all catheter periods in which S. epidermidis...

  19. Transient neurological deficit due to a misplacement of central venous catheter despite ultrasound guidance and ultrasound assistance.

    Science.gov (United States)

    Idialisoa, Rado; Jouffroy, Romain; Saint Martin, Laure Castres; Lamhaut, Lionel; Baud, Frédéric; Philippe, Pascal; Carli, Pierre; Vivien, Benoît

    2015-10-01

    Central venous catheters (CVC) are frequently used in intensive care units (ICU), with a low incidence of complications, most of them being of mechanical origin and occurring during the insertion of the catheter. To avoid such complications, "ultrasound guidance" and "ultrasound assistance" are recommended. Nevertheless, even with trained and experienced physicians, mechanical complications of IJV access such as carotid punctures are still reported. We report the case of a 75-year-old woman, admitted into the ICU for CVC insertion due to impossibility of peripheral venous access. About 12 hours after the procedure, the patient presented a neurological deficit. The cervical and thoracic CT scan showed a transfixing path of the catheter from the left IJV into the left common carotid artery, with distal extremity of the catheter localized in the ascending aorta. The catheter was removed, and thereafter the neurological deficit immediately and definitely disappeared. Onset of a neurological deficit after CVC insertion into the IJV, regardless the time of occurrence after the procedure, should suggest complication due to the CVC insertion, even if procedure was uneventful and chest radiography confirmed the apparent accurate position of CVC.

  20. Catheter-based photoacoustic endoscope

    Science.gov (United States)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  1. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications).

    Science.gov (United States)

    Pittiruti, Mauro; Hamilton, Helen; Biffi, Roberto; MacFie, John; Pertkiewicz, Marek

    2009-08-01

    When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion

  2. Atuação do enfermeiro no cuidado com o cateter central de inserção periférica no recém-nascido Actuación del enfermero en el cuidado con el cateter central de inserción periferica en el recién nacido Action of the nurse with peripherally inserted central catheter in the infant newborn

    Directory of Open Access Journals (Sweden)

    Zaira Simas Rodrigues

    2006-10-01

    Full Text Available Os avanços tecnológicos em Neonatologia vêm beneficiando os recém-nascidos que necessitam de um acesso venoso seguro. Objetivou-se investigar a atuação do enfermeiro no cuidado com o Cateter Central de Inserção Periférica (PICC na Unidade de Terapia Intensiva Neonatal em Fortaleza, CE. A amostra foi composta por 17 enfermeiros e os dados foram coletados de julho a agosto/2004 através de questionário estruturado. Nos resultados verificou-se que 09 citaram a veia basílica como a mais indicada para a punção; 17 mencionaram a lavagem das mãos antes e após o manuseio e a lavagem do cateter antes e após as medicações como os cuidados mais importantes. Conclui-se que o manuseio deste dispositivo requer conhecimento e habilidade por parte dos profissionais.Los avances tecnológicos en la Neonatología han beneficiando los recién nacidos de alto riesgo, que necesitan de un acceso venoso seguro. Este trabajo tuvo por objetivo investigar la actuación del enfermero en el cuidado con el Cateter Central de Inserción Periférica (PICC en la Unidad de Terapia Intensiva Neonatal en Fortaleza, CE. Los datos fueron recolectados de julio a agosto de 2004 a través de un cuestionario. En los resultados se verificó que 09 citaron la vena basílica como de más indicada para la punción; 17 mencionaron de entre los cuidados, el lavado de las manos antes y después de lo manoseo y el lavado del cateter antes y después de las medicaciones como los más importantes. Se concluye que lo manoseo de este dispositivo requiere conocimiento y habilidad por parte de los profesionales.Technological advances in Neonatology have benefited the infant newborn who need a safe venous access. This study aimed at investigating the actions of the nurse regarding Peripherally Inserted Central Catheter (PICC in the Neonatal Intensive Care Unit in Fortaleza, CE. The sample was composed by 17 nurses; the data were collected from July to August 2004 through a structured

  3. Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

    Energy Technology Data Exchange (ETDEWEB)

    Paek, Auh Whan [Dept. of Radiology, Virginia University Heath Center, Charlottesville (United States); Won, Je Hwan; Lee, Jei Hee; Sun, Joo Sung; Kwak, Kyu Sung; Bae, Jae Ik [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2011-04-15

    To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45 degree angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.

  4. Novel technique for placement of hemodialysis catheters using a combined open procedure with the Seldinger micropuncture technique.

    Science.gov (United States)

    Maa, J; Gosnell, J E; Chuter, T A M

    2005-03-01

    Percutaneous placement of large-diameter dialysis catheters via the Seldinger technique can be technically challenging in patients with coagulopathy, difficult anatomy, or several previous central line insertions. We describe a method for achieving safer access by combining an open approach to delineate the venous anatomy of the chest wall, with a micropuncture device and smaller diameter guidewire to gain intravascular access to the cephalic vein or its major tributaries. Serial dilation of otherwise unusable vessels can then permit successful and safer hemodialysis catheter insertion in these difficult cases.

  5. Effect of insulin catheter wear-time on subcutaneous adipose tissue blood flow and insulin absorption in humans

    DEFF Research Database (Denmark)

    Clausen, Trine Schnedler; Kaastrup, Peter; Stallknecht, Bente

    2009-01-01

    blood flow (ATBF) and absorption of the rapid-acting insulin analog insulin aspart over a period of 4 days. METHODS: Teflon insulin catheters (Medtronic, Minneapolis, MN) were inserted into the abdominal SAT of 10 healthy men without diabetes (mean +/- SEM age, 23.0 +/- 1.1 years; body mass index, 22...... +/- 3 min on day 0 to 45 +/- 4 min on day 4 (P = 0.019). Neither peak plasma concentration nor area under the curve of insulin aspart changed significantly. CONCLUSIONS: Insertion of a Teflon insulin catheter into the SAT results in increased ATBF and faster absorption of insulin aspart in a period of 4...

  6. Hemodialysis Tunneled Catheter-Related Infections

    Science.gov (United States)

    Miller, Lisa M.; Clark, Edward; Dipchand, Christine; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; MacRae, Jennifer

    2016-01-01

    Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed.

  7. 21 CFR 870.1280 - Steerable catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter. 870.1280 Section 870.1280 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1280 Steerable catheter. (a) Identification. A steerable catheter is...

  8. 21 CFR 882.4100 - Ventricular catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular catheter. 882.4100 Section 882.4100...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4100 Ventricular catheter. (a) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for...

  9. Choice of valve type and poor ventricular catheter placement: Modifiable factors associated with ventriculoperitoneal shunt failure.

    Science.gov (United States)

    Jeremiah, Kealeboga Josephine; Cherry, Catherine Louise; Wan, Kai Rui; Toy, Jennifer Ah; Wolfe, Rory; Danks, Robert Andrew

    2016-05-01

    Ventriculoperitoneal (VP) shunt insertion is a common neurosurgical procedure, essentially unchanged in recent years, with high revision rates. We aimed to identify potentially modifiable associations with shunt failure. One hundred and forty patients who underwent insertion of a VP shunt from 2005-2009 were followed for 5-9years. Age at shunt insertion ranged from 0 to 91years (median 44, 26% hydrocephalus were congenital (26%), tumour-related (25%), post-haemorrhagic (24%) or normal pressure hydrocephalus (19%). Fifty-eight (42%) patients required ⩾1 shunt revision. Of these, 50 (88%) were for proximal catheter blockage. The median time to first revision was 108days. Early post-operative CT scans were available in 105 patients. Using a formal grading system, catheter placement was considered excellent in 49 (47%) but poor (extraventricular) in 13 (12%). On univariate analysis, younger age, poor ventricular catheter placement and use of a non-programmable valve were associated with shunt failure. On logistic regression modelling, the independent associations with VP shunt failure were poor catheter placement (odds ratio [OR] 4.9, 95% confidence interval [CI] 1.3-18.9, p=0.02) and use of a non-programmable valve (OR 0.4, 95% CI 0.2-1.0, p=0.04). In conclusion, poor catheter placement (revision rate 77%) was found to be the strongest predictor of shunt failure, with no difference in revisions between excellent (43%) and moderate (43%) catheter placement. Avoiding poor placement in those with mild or moderate ventriculomegaly may best reduce VP shunt failures. There may also be an influence of valve choice on VP shunt survival.

  10. Changes in the exclusion criteria in a clinical trial about arterial catheters patency

    Directory of Open Access Journals (Sweden)

    Núria Grané Mascarell

    2005-11-01

    Full Text Available Regarding a clinical trial designed to compare the functionality of arterial catheters kept with heparin vs saline solution, a slow rate of case recruiting was detected. In order to improve this rate an analysis of the reasons for non-inclusion was set up. According to the results, amendments to the protocol had to be proposed to improve case inclusion without reducing the quality of the study.Methodology: All not included catheter insertions were registered and analysed regarding the reason of non-inclusion.Results: The more frequent reasons for non including a case in the study were the insertion of the catheter in other ward or department, the issues related with the informed consent (IC and the need of more than 5 attempts to insert the catheter. The remaining reasons were related to hematological issues as well as competition with other trials.Conclusions: The main reasons for not including cases in the trial were subject to be changed by including amendments to the protocol, without affecting neither the trial quality nor the proposed goals. So, four amendments were proposed to the local ethical commission, two of which were accepted and subsequently notified to the Spanish Drug Agency. The phase of cases inclusion is now ending with less delay had the amendments not been presented.

  11. Use of ultrasound to facilitate femoral nerve block with stimulating catheter

    Institute of Scientific and Technical Information of China (English)

    LI Min; XU Ting; HAN Wen-yong; WANG Xue-dong; JIA Dong-lin; GUO Xiang-yang

    2011-01-01

    Background The adjunction of ultrasound to nerve stimulation has been proven to improve single-injection peripheral nerve block quality. However, few reports have been published determining whether ultrasound can facilitate continuous nerve blocks. In this study, we tested the hypothesis that the addition of ultrasound to nerve stimulation facilitates femoral nerve blocks with a stimulating catheter.Methods In this prospective randomized study, patients receiving continuous femoral nerve blocks for total knee replacement were randomly assigned to either the ultrasound guidance combined with stimulating catheter group (USNS group; n=60) or the stimulating catheter alone group (NS group; n=60). The primary end point was the procedure time (defined as the time from first needle contact with the skin until correct catheter placement). The numbers of needle passes and catheter insertions, onset and quality of femoral nerve blocks, postoperative pain score, and early knee function were also recorded.Results The procedure time was significantly less in the USNS group than in the NS group (9.0 (6.0-22.8) minutes vs.13.5 (6.0-35.9) minutes, P=0.024). The numbers of needle passes and catheter insertions were also significantly less in the USNS group. A greater complete block rate was achieved at 30 minutes in the USNS group (63.3% vs. 38.3%;P=0.010). The postoperative pain score, the number of patients who required bolus local anesthetic and intravenous patient-controlled analgesia, and knee flexion on the second postoperative day were not significantly different between the two groups of patients.Conclusions Ultrasound-assisted placement of a stimulating catheter for femoral nerve blocks decreases the time necessary to perform the block compared with just the nerve-stimulating technique. In addition, a more complete blockade is achieved using the ultrasound-assisted technique.

  12. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

    Science.gov (United States)

    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  13. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    Science.gov (United States)

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  14. Chest tube insertion - slideshow

    Science.gov (United States)

    ... presentations/100008.htm Chest tube insertion - series—Normal anatomy To use the sharing features ... pleural space is the space between the inner and outer lining of the lung. It is normally very thin, and lined only ...

  15. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  16. The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX© Catheter

    Directory of Open Access Journals (Sweden)

    Jason Reinglas

    2016-01-01

    Full Text Available Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA. As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics. Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

  17. Contrast-free endoscopic stent insertion in malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection.METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction,unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent,7 to 15 cm long, was finally inserted over the guide wire/guiding catheter by a pusher tube system.RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels,was achieved in all patients.CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.

  18. Proper Angle of Sono-guided Central Venous Line Insertion

    Science.gov (United States)

    Barzegari, Hassan; Forouzan, Arash; Fahimi, Mohammad Ali; Zohrevandi, Behzad; Ghanavati, Mandana

    2016-01-01

    Introduction: 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. Methods: 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. Result: 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. Conclusion: 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. PMID:27299146

  19. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO recommendations “Prevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Aim: The Commission for Hospital Hygiene and Infection Prevention (KRINKO updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt’s hospitals in autumn, 2015.Material and methods: In two non-ICU wards of each of Frankfurt’s , inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model.Results: Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%. In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change.Conclusion: Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two

  20. Benefits of establishing an intravenous team and the standardization of peripheral intravenous catheters.

    Science.gov (United States)

    da Silva, Gislene Aparecida; Priebe, Sheila; Dias, Fábio Nunes

    2010-01-01

    The purpose of this study was to show the importance of a team dedicated to intravenous (IV) insertion and the standardization of peripheral IV catheters in reducing venipuncture attempts, reducing cases of phlebitis, and optimizing costs. The benefits achieved by the team were a decrease in venipuncture attempts, a decrease of phlebitis (from 0.47% to 0.35%), the optimization of the team's time, and a 29.47% reduction in the use of catheters. The study corroborates the IV team's importance in the process of managing nurses' workflow, since it provides important indicators for quality management.

  1. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

    OpenAIRE

    Muhammad Ishaq; Nicki Alexander; David H. T. Scott

    2013-01-01

    We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC) insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. Howeve...

  2. Cytometric Catheter for Neurosurgical Applications

    Energy Technology Data Exchange (ETDEWEB)

    Evans III, Boyd Mccutchen [ORNL; Allison, Stephen W [ORNL; Fillmore, Helen [ORNL; Broaddus, William C [ORNL; Dyer, Rachel L [ORNL; Gillies, George [ORNL

    2010-01-01

    Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

  3. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed El Gharib

    2014-06-01

    Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

  4. A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2006-01-01

    Full Text Available In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300, is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the

  5. Using central venous catheter for suprapubic catheterization in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bilehjani E

    2017-01-01

    Full Text Available Eissa Bilehjani,1 Solmaz Fakhari2 1Department of Cardiovascular Anesthesia, Tabriz University of Medical Sciences, Madani Heart Hospital, 2Department of Anesthesiology, Tabriz University of Medical Sciences, Madani Heart Hospital, Tabriz, Iran Abstract: Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts. Keywords: suprapubic catheterization complication, urethral catheterization, central venous catheter, Seldinger’s technique, cardiac surgery

  6. Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos Prevalencia y motivos de retirada no electiva del catéter de inserción periférica en recién nacidos Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates

    Directory of Open Access Journals (Sweden)

    Priscila Costa

    2012-09-01

    sectional study conducted with 67 newborns admitted at the Neonatal Intensive Care Unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1,671.6g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3% catheters, 13.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspectedinfection, 1.2% accidental dislodgement, 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.

  7. Direct Digital Demultiplexing of Analog TDM Signals for Cable Reduction in Ultrasound Imaging Catheters.

    Science.gov (United States)

    Carpenter, Thomas M; Rashid, M Wasequr; Ghovanloo, Maysam; Cowell, David M J; Freear, Steven; Degertekin, F Levent

    2016-08-01

    In real-time catheter-based 3-D ultrasound imaging applications, gathering data from the transducer arrays is difficult, as there is a restriction on cable count due to the diameter of the catheter. Although area and power hungry multiplexing circuits integrated at the catheter tip are used in some applications, these are unsuitable for use in small sized catheters for applications, such as intracardiac imaging. Furthermore, the length requirement for catheters and limited power available to on-chip cable drivers leads to limited signal strength at the receiver end. In this paper, an alternative approach using analog time-division multiplexing (TDM) is presented, which addresses the cable restrictions of ultrasound catheters. A novel digital demultiplexing technique is also described, which allows for a reduction in the number of analog signal processing stages required. The TDM and digital demultiplexing schemes are demonstrated for an intracardiac imaging system that would operate in the 4- to 11-MHz range. A TDM integrated circuit (IC) with an 8:1 multiplexer is interfaced with a fast analog-to-digital converter (ADC) through a microcoaxial catheter cable bundle, and processed with a field-programmable gate array register-transfer level simulation. Input signals to the TDM IC are recovered with -40-dB crosstalk between the channels on the same microcoax, showing the feasibility of this system for ultrasound imaging applications.

  8. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  9. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home1

    Science.gov (United States)

    Abud, Ana Cristina Freire; Kusumota, Luciana; dos Santos, Manoel Antônio; Rodrigues, Flávia Fernanda Luchetti; Damasceno, Marta Maria Coelho; Zanetti, Maria Lúcia

    2015-01-01

    Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment. PMID:26487141

  10. Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Hahn, Seong Tai [Catholic University of Korea, Diagnostic Radiology, Seoul (Korea)

    2005-06-01

    This study was designed to compare the incidence of mechanical, thrombotic and infective complications in transjugular (IJV) and axillosubclavian (SCV) central venous catheters (CVC) in patients with hematological malignancy. In a prospective observational trial, 131 consecutive patients were classified into two groups: Group A included those with IJV catheter insertions under sonography guidance (n=61) and group B included those with SCV insertions under venography guidance (n=70). After catheter placement, patients were prospectively acquired and recorded to obtain the following data: success rates, total catheter days, and complication episodes per 100 catheter days. All procedures were technically successful. Total catheter days were 7800 (group A) versus 8391(group B). Mechanical complications were observed in three cases from group A and 11 from group B, with an incidence rate of 0.04 per 100 catheter days versus 0.13 (P=0.043), respectively. Two symptomatic thrombotic complications were observed in group B. The number of infective complications was not significantly different between the two groups (P=0.312). There was no difference in infective complication incidence between the two groups. To minimize catheter-related mechanical and thrombotic complications, however, the IJV approach is superior to the SCV approach. (orig.)

  11. WE-G-17A-05: Real-Time Catheter Localization Using An Active MR Tracker for Interstitial Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, W; Damato, A; Viswanathan, A; Cormack, R [Dana Farber Cancer Institute / Brigham and Women' s Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Penzkofer, T; Schmidt, E [Brigham and Women' s Hospital, Boston, MA (United States); Pan, L; Gilson, W [Siemens Corporation, Corporate Technology, Baltimore, MD (United States); Seethamraju, R [Siemens Healthcare, Boston, MA (United States)

    2014-06-15

    Purpose: To develop a novel active MR-tracking system which can provide accurate and rapid localization of brachytherapy catheters, and assess its reliability and spatial accuracy in comparison to standard catheter digitization using MR images. Methods: An active MR tracker for brachytherapy was constructed by adding three printed-circuit micro-coils to the shaft of a commercial metallic stylet. A gel phantom with an embedded framework was built, into which fifteen 14-Gauge catheters were placed, following either with parallel or crossed paths. The tracker was inserted sequentially into each catheter, with MR-tracking running continuously. Tracking was also performed during the tracker's removal from each catheter. Catheter trajectories measured from the insertion and the removal procedures using the same micro-coil were compared, as well as trajectories obtained using different micro-coils. A 3D high-resolution MR image dataset of the phantom was acquired and imported into a treatment planning system (TPS) for catheter digitization. A comparison between MR-tracked positions and positions digitized from MR images by TPS was performed. Results: The MR tracking shows good consistency for varying catheter paths and for all micro-coils (mean difference ∼1.1 mm). The average distance between the MR-tracking trajectory and catheter digitization from the MR images was 1.1 mm. Ambiguity in catheter assignment from images due to crossed paths was resolved by active tracking. When tracking was interleaved with imaging, real-time images were continuously acquired at the instantaneous tip positions and displayed on an external workstation. Conclusion: The active MR tracker may be used to provide an independent measurement of catheter location in the MR environment, potentially eliminating the need for subsequent CT. It may also be used to control realtime imaging of catheter placement. This will enable MR-based brachytherapy planning of interstitial implants without

  12. A COMPARATIVE ANALYSIS OF PERCUTANEOUS AND OPEN SURGICAL TECHNIQUESFOR PERITONEAL CATHETER PLACEMENT.

    LENUS (Irish Health Repository)

    Medani, Samar

    2012-05-01

    BACKGROUND: Peritoneal dialysis (PD) is the preferred available option of renal replacement therapy for a significant number of end-stage kidney disease patients. A major limiting factor to the successful continuation of PD is the long-term viability of the PD catheter (PDC). Bedside percutaneous placement of the PDC is not commonly practiced despite published data encouraging use of this technique. Its advantages include faster recovery and avoidance of general anesthesia.♢ METHODS: We carried out a retrospective analysis of the outcomes of 313 PDC insertions at our center, comparing all percutaneous PDC insertions between July 1998 and April 2010 (group P, n = 151) with all surgical PDC insertions between January 2003 and April 2010 (group S, n = 162).♢ RESULTS: Compared with group P patients, significantly more group S patients had undergone previous abdominal surgery or PDC insertion (41.8% vs 9.3% and 33.3% vs 3.3% respectively, p = 0.00). More exit-site leaks occurred in group P than in group S (20.5% vs 6.8%, p = 0.002). The overall incidence of peritonitis was higher in group S than in group P (1 episode in 19 catheter-months vs 1 episode in 26 catheter-months, p = 0.017), but the groups showed no significant difference in the peritonitis rate within 1 month of catheter insertion (5% in group P vs 7.4% in group S, p =0.4) or in poor initial drainage or secondary drainage failure (9.9% vs 11.7%, p = 0.1, and 7.9% vs 12.3%, p = 0.38, for groups P and S respectively). Technical survival at 3 months was significantly better for group P than for group S (86.6% vs 77%, p = 0.037); at 12 months, it was 77.7% and 68.7% respectively (p = 0.126). No life-threatening complications attributable to the insertion of the PDC occurred in either group.♢ CONCLUSIONS: Our analysis demonstrates further encouraging outcomes of percutaneous PDC placement compared with open surgical placement. However, the members of the percutaneous insertion group were primarily a

  13. Comparing Leaf and Root Insertion

    Directory of Open Access Journals (Sweden)

    Jaco Geldenhuys

    2010-07-01

    Full Text Available We consider two ways of inserting a key into a binary search tree: leaf insertion which is the standard method, and root insertion which involves additional rotations. Although the respective cost of constructing leaf and root insertion binary search trees trees, in terms of comparisons, are the same in the average case, we show that in the worst case the construction of a root insertion binary search tree needs approximately 50% of the number of comparisons required by leaf insertion.

  14. Risk factors for the appearance of central venous catheters colonization

    Directory of Open Access Journals (Sweden)

    Mioljević Vesna

    2007-01-01

    Full Text Available Introduction/Aim. Intravascular device placement (IVD is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI and increased mortality and morbidity. Nosocomial blood infections (NBIs account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs. Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long were analyzed. Based on the insight into medical documentation, patients’ examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52% were sterile while 51 (48% were colonized. The results of our study evidenced that total parenteral nutrition (TPN (p < 0.05, number of catheterization days (p < 0.05, and central venous pressure measurement (p < 0.05 were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter

  15. Radiologic placement of hemodialysis central venous catheters: a practical guide

    Energy Technology Data Exchange (ETDEWEB)

    Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B. [Foothills Hospital, Dept. of Diagnostic Imaging, Calgary, Alberta (Canada)

    2001-04-01

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

  16. The Composite Insertion Electrode

    DEFF Research Database (Denmark)

    Atlung, Sven; Zachau-Christiansen, Birgit; West, Keld;

    1984-01-01

    . The theoretical basis for such electrodes is discussedand, using a simplified model, equations are derived to describe the distribution of potential and current duringdischarge/charge operation. Under the assumption that the insertion compound particles are small enough to ensureequilibrium, and that the local...... electrode potential depends linearly on the degree of insertion, these equations are solvedto obtain analytical expressions for the discharge curve. It is shown that the parameters which determine the dischargebehavior for a given discharge current are simply related to the effective ionic and electronic...

  17. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus.

    Science.gov (United States)

    Ishaq, Muhammad; Alexander, Nicki; Scott, David H T

    2013-04-01

    We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC) insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. However, we recently encountered a situation where the PAC was knotted around the tricuspid valve apparatus and could not be withdrawn. An interventional radiologist was able to unknot the catheter and release it from the tricuspid valve. We reviewed the literature related to this topic. We believe our experience could be of use to others.

  18. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

    Directory of Open Access Journals (Sweden)

    Muhammad Ishaq

    2013-01-01

    Full Text Available We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. However, we recently encountered a situation where the PAC was knotted around the tricuspid valve apparatus and could not be withdrawn. An interventional radiologist was able to unknot the catheter and release it from the tricuspid valve. We reviewed the literature related to this topic. We believe our experience could be of use to others.

  19. Untangling of knotted urethral catheters.

    Science.gov (United States)

    Sambrook, Andrew J; Todd, Alistair

    2007-04-01

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation.

  20. Untangling of knotted urethral catheters

    Energy Technology Data Exchange (ETDEWEB)

    Sambrook, Andrew J. [Aberdeen Royal Infirmary, Department of Radiology, Aberdeen (United Kingdom); Todd, Alistair [Raigmore Hospital, Inverness (United Kingdom)

    2007-04-15

    Intravesical catheter knotting during micturating cystourethrography is a rare but recognized complication of the procedure. We were able to untangle a knot utilizing a fluoroscopically guided vascular guidewire. Following this success, a small study was performed using a model. Various types of guidewires and techniques were tested for different diameters of knots in order to predict the likelihood of success in this type of situation. (orig.)

  1. Flame Length

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — Flame length was modeled using FlamMap, an interagency fire behavior mapping and analysis program that computes potential fire behavior characteristics. The tool...

  2. Inserting the CMS solenoid

    CERN Multimedia

    Maximilien Brice

    2005-01-01

    The huge superconducting solenoid for CMS is inserted into the cryostat barrel. CMS uses the world's largest thin solenoid, in terms of energy stored, and is 12 m long, with a diameter of 6 m and weighing 220 tonnes. When turned on the magnet will produce a field strength of 4 T using superconducting niobium-titanium material at 4.5 K.

  3. Pixel detector insertion

    CERN Multimedia

    CMS

    2015-01-01

    Insertion of the Pixel Tracker, the 66-million-channel device used to pinpoint the vertex of each colliding proton pair, located at the heart of the detector. The geometry of CMS is a cylinder lying on its side (22 meters long and 15 meters high in dia

  4. Implantation of peritoneal catheters by laparotomy: nephrologists obtained similar results to general surgeons

    Directory of Open Access Journals (Sweden)

    Restrepo CA

    2014-10-01

    Full Text Available Cesar A Restrepo, Carlos Alberto Buitrago, Cielo Holguin Division of Nephrology, Department of Health Sciences, Caldas University, Caldas, ColombiaPurpose: To analyze the complications and costs of minilaparotomies performed by a nephrologist (group A compared with conventional laparotomies performed by a surgeon (group B for peritoneal catheter implantation.Setting: Two university hospitals (Santa Sofia and Caldas in Manizales, Caldas, Colombia.Methods: The study included stage 5 chronic kidney disease patients, with indication of renal replacement therapy, who were candidates for peritoneal dialysis and gave informed consent for a peritoneal catheter implant. Minilaparotomies were performed by a nephrologist in a minor surgery room under local anesthesia. Conventional laparotomies were performed by a surgeon in an operating room under general anesthesia.Results: Two nephrologists inserted 157 peritoneal catheters, and seven general surgeons inserted 185 peritoneal catheters. The groups had similar characteristics: the mean age was 55 years, 49.5% were men, and the primary diagnoses were diabetic nephropathy, hypertensive nephropathy, and unknown etiology. The implant was successful for 98.09% of group A and 99.46% of group B. There was no procedure-related mortality. The most frequent complications in the first 30 days postsurgery in group A versus group B, respectively, were: peritonitis (6.37% versus 3.78%, exit-site infection (3.82% versus 2.16%, tunnel infection (0% versus 0.54%, catheter entrapment by omentum (1.27% versus 3.24%, peritoneal effluent spillover (1.91% versus 2.16%, draining failure (4.46% versus 6.49%, hematoma (0% versus 1.08%, catheter migration with kinking (3.18% versus 2.70%, hemoperitoneum (1.27% versus 0%, and hollow viscera accidental puncture (1.91% versus 0.54%. There were no statistically significant differences in the number of complications between groups. In 2013, the cost of a surgeon-implanted peritoneal

  5. Position Control of Motion Compensation Cardiac Catheters

    Science.gov (United States)

    Kesner, Samuel B.; Howe, Robert D.

    2011-01-01

    Robotic catheters have the potential to revolutionize cardiac surgery by enabling minimally invasive structural repairs within the beating heart. This paper presents an actuated catheter system that compensates for the fast motion of cardiac tissue using 3D ultrasound image guidance. We describe the design and operation of the mechanical drive system and catheter module and analyze the catheter performance limitations of friction and backlash in detail. To mitigate these limitations, we propose and evaluate mechanical and control system compensation methods, including inverse and model-based backlash compensation, to improve the system performance. Finally, in vivo results are presented that demonstrate that the catheter can track the cardiac tissue motion with less than 1 mm RMS error. The ultimate goal of this research is to create a fast and dexterous robotic catheter system that can perform surgery on the delicate structures inside of the beating heart. PMID:21874124

  6. Complications of indwelling central venous catheters in pediatric liver transplant recipients.

    Science.gov (United States)

    Cousin, Vladimir L; Wildhaber, Barbara E; Verolet, Charlotte M; Belli, Dominique C; Posfay-Barbe, Klara M; McLin, Valérie A

    2016-09-01

    In pLT recipients, the advantages of ICVCs need to be weighed against the risk of complications. This single-center retrospective study aimed to review ICVC complications in our cohort of pLT recipients. We performed chart reviews of pLT patients having undergone transplant between 01/2000 and 03/2014 and who underwent ICVC placement either before or after LT. We identified 100 ICVC in 85 patients. Overall observation time was 90 470 catheter-days. There was no difference in catheter lifespan between those inserted pre- or post-transplant; 46% of ICVC presented a complication. Most frequent complications were MD and infection. The infection rate was 0.09 per 1000 catheter-days, and MD rate was 0.36 per 1000 catheter-days. Patients having received technical variant grafts were more at risk of complications. To the best of our knowledge, this is the first study examining ICVC complications in pLT recipients. We conclude that ICVC have a high rate of MD. Children receiving technical variants may be more at risk of complications. By removing ICVC in a select number of patients at six months post-insertion, we might avoid as much as 60% of complications.

  7. Management of complications related to central venous catheters in cancer patients: an update.

    Science.gov (United States)

    Linnemann, Birgit

    2014-04-01

    Central venous catheters (CVCs) are important for the treatment of patients with cancer, especially in the perioperative and palliative care settings. These devices not only allow for the administration of chemotherapy, parenteral nutrition, and other intravenous therapies, but they may also improve the patients' quality of life by reducing the need for repeated peripheral venipunctures. Thrombotic and infectious complications are common, especially in the long-term use of CVCs. There are different types of thrombotic complications associated with CVCs, that is, a thrombotic occlusion of the catheter, a mural thrombus at the catheter tip and classical deep vein thrombosis, which occurs most frequently in the upper extremity where the majority of long-term catheters are inserted. Infections are common complications associated with CVCs. Patients with cancer who receive intensive chemotherapy and those patients who undergo hematopoietic stem cell transplantation have a markedly increased risk for insertion site and bloodstream infections. In this review, the epidemiology and risk factors that predispose patients to CVC-related thrombosis and infection are discussed. The diagnostic and therapeutic options according to the published data and the current guidelines are summarized and data for establishing primary and secondary preventative strategies are provided.

  8. A case of misplaced permacath dialysis catheter

    Directory of Open Access Journals (Sweden)

    Mohammed Arshad Ali

    2015-01-01

    Full Text Available Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax, and we recommend the routine use of a fluoroscope for placement of dialysis catheters so as to avoid serious complications.

  9. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5-7 days) central venous access?

    Science.gov (United States)

    Keir, Amy; Giesinger, Regan; Dunn, Michael

    2014-08-01

    In this evidenced-based review, we examine the current available literature to help answer the question 'In neonates requiring long-term central access [patient], does removal of the umbilical venous catheter (UVC) on days 5-7 and replacement with a peripherally inserted central catheter line [intervention] compared with leaving the UVC in situ [comparison] reduce rates of central line-associated bloodstream infections [outcome]?'

  10. Impact of different catheter lock strategies on bacterial colonization of permanent central venous hemodialysis catheters.

    Science.gov (United States)

    Erb, Stefan; Widmer, Andreas F; Tschudin-Sutter, Sarah; Neff, Ursula; Fischer, Manuela; Dickenmann, Michael; Grosse, Philipp

    2013-12-01

    Thirty-nine hemodialysis patients with permanent central venous catheters were analyzed for bacterial catheter colonization comparing different catheter-lock strategies. The closed needleless Tego connector with sodium chloride lock solution was significantly more frequently colonized with bacteria than the standard catheter caps with antimicrobially active citrate lock solution (odds ratio, 0.22 [95% confidence interval, 0.07-0.71]; P = .011).

  11. Tunneled central venous catheter exchange: techniques to improve prevention of air embolism.

    Science.gov (United States)

    Rossi, Umberto G; Torcia, Pierluca; Rigamonti, Paolo; Colombo, Francesca; Giordano, Antonino; Gallieni, Maurizio; Cariati, Maurizio

    2016-01-01

    Malfunctioning tunneled hemodialysis central venous catheters (CVCs), because of thrombotic or infectious complications, are frequently exchanged. During the CVC exchanging procedure, there are several possible technical complications, as in first insertion, including air embolism. Prevention remains the key to the management of air embolism. Herein, we emphasize the technical tricks capable of reducing the risk of air embolism in long-term CVC exchange. In particular, adoption of a 5 to 10 degrees Trendelenburg position, direct puncture of the previous CVC venous lumen for guide-wire insertion, as opposed to guide-wire introduction after cutting the CVC, a light manual compression of the internal jugular vein venotomy site after catheter removal. The Valsalva maneuvre in collaborating patients, valved introducers, and correction of hypovolemia are also useful precautions. Principles of air embolism diagnosis and treatment are also outlined in the article.

  12. 改良塞丁格技术联合血管超声在乳腺癌患者术后化疗经外周静脉置入中心静脉导管置管中的作用%Role of modified Seldinger technique combined with vascular ultrasonography in the placement of peripherally inserted central catheters in patients with breast cancer undergoing postoperative chemotherapy

    Institute of Scientific and Technical Information of China (English)

    夏琛; 卢爱霞; 孙俊伟

    2014-01-01

    目的 探讨改良塞丁格技术联合血管超声在乳腺癌患者术后化疗经外周静脉置入中心静脉导管(PICC)置管中的临床效果.方法 将接受术后化疗乳腺癌患者120例按照随机数字表法分为观察组和对照组各60例,观察组采用改良塞丁格技术联合血管超声PICC置管,对照组采用传统盲穿PICC置管,比较两组患者一次穿刺成功率、一次置管成功率、置管后机械性静脉炎及静脉血栓的发生率.结果 观察组一次穿刺成功率、一次置管成功率、置管后机械性静脉炎发生率分别为91.67%、100%和3.33%,对照组一次穿刺成功率、一次置管成功率、置管后机械性静脉炎发生率分别为76.67%、86.67%和45%,两组比较差异均有统计学意义(P=0.0061,P=0.0434,P<0.0001).观察组置管后静脉血栓发生率为0,对照组置管后静脉血栓发生率为6.67%,两组比较差异无统计学意义(P =0.1187).结论 将改良塞丁格技术联合血管超声PICC置管应用于乳腺癌患者术后化疗置管成功率高,置管后机械性静脉炎发生率低,具有较高的临床应用价值.%Objective To investigate the role of modified Seldinger technique combined with vascular ultrasonography in the placement of peripherally inserted central catheters (PICC) in patients with breast cancer undergoing postoperative chemotherapy.Methods Totally 120 patients with breast cancer undergoing postoperative chemotherapy were equally divided into the observation group and the control group using the table of random number.In the observation group,PICC were placed using the modified Seldinger technique combined with vascular ultrasonography; in the control group,the PICC were placed using the traditional blind puncture technique.The success rate of first puncture,success rate of first placement,and the incidences of mechanical phlebitis and thrombosis were compared between two groups.Results The success rate of first puncture

  13. [Infections associated with the use of indwelling urinary catheters. Infections related to intrauterine devices].

    Science.gov (United States)

    Pigrau, Carlos; Rodríguez-Pardo, M Dolores

    2008-05-01

    Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.

  14. Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks.

    Science.gov (United States)

    Siskind, Eric; Sameyah, Emil; Goncharuk, Edwin; Olsen, Elizabeth M; Feldman, Joshua; Giovinazzo, Katie; Blum, Mark; Tyrell, Richard; Evans, Cory; Kuncewitch, Michael; Alexander, Mohini; Israel, Ezra; Bhaskaran, Madhu; Calderon, Kellie; Jhaveri, Kenar D; Sachdeva, Mala; Bellucci, Alessandro; Mattana, Joseph; Fishbane, Steven; D'Agostino, Catherine; Coppa, Gene; Molmenti, Ernesto

    2013-03-01

    Catheterization of the urinary bladder during kidney transplantation is essential. The optimal time to remove the Foley catheter postoperatively is not universally defined. It is our practice to remove the Foley catheter on postoperative day 1 in live donor kidney transplant recipients who meet our standardized protocol criteria. We believe that early removal of Foley catheters increases patient comfort and mobility, decreases the risk of catheter associated urinary tract infections, and allows for decreased hospital length of stay. The hypothetical risk of early removal of Foley catheters would be the increased risk of urine leak. We reviewed 120 consecutive live donor kidney transplant recipients and found that there was not an increased incidence of urine leaks in patients whose Foley catheters were removed on postoperative day 1.

  15. Removal of Foley Catheters in Live Donor Kidney Transplant Recipients on Postoperative Day 1 Does Not Increase the Incidence of Urine Leaks

    Science.gov (United States)

    Siskind, Eric; Sameyah, Emil; Goncharuk, Edwin; Olsen, Elizabeth M.; Feldman, Joshua; Giovinazzo, Katie; Blum, Mark; Tyrell, Richard; Evans, Cory; Kuncewitch, Michael; Alexander, Mohini; Israel, Ezra; Bhaskaran, Madhu; Calderon, Kellie; Jhaveri, Kenar D.; Sachdeva, Mala; Bellucci, Alessandro; Mattana, Joseph; Fishbane, Steven; D'Agostino, Catherine; Coppa, Gene; Molmenti, Ernesto

    2013-01-01

    Catheterization of the urinary bladder during kidney transplantation is essential. The optimal time to remove the Foley catheter postoperatively is not universally defined. It is our practice to remove the Foley catheter on postoperative day 1 in live donor kidney transplant recipients who meet our standardized protocol criteria. We believe that early removal of Foley catheters increases patient comfort and mobility, decreases the risk of catheter associated urinary tract infections, and allows for decreased hospital length of stay. The hypothetical risk of early removal of Foley catheters would be the increased risk of urine leak. We reviewed 120 consecutive live donor kidney transplant recipients and found that there was not an increased incidence of urine leaks in patients whose Foley catheters were removed on postoperative day 1. PMID:24436583

  16. A new modified technique of laparoscopic needle catheter jejunostomy: a 2-year follow-up study

    Directory of Open Access Journals (Sweden)

    Ye P

    2016-01-01

    Full Text Available Peng Ye, Liping Zeng, Fenghao Sun, Zhou An, Zhoubin Li, Jian Hu Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: The aim of this study was to establish a modified technique for performing laparoscopic needle catheter jejunostomy. Methods: From May 2011 to October 2013, laparoscopic needle catheter jejunostomy was performed in 21 patients with esophageal cancer. During the procedure, jejunal inflation was performed via a percutaneous 20-gauge intravenous catheter to facilitate the subsequent puncture of the jejunal wall by the catheter needle. The success rate, procedure time, complications, and short-term outcomes were evaluated. Results: All laparoscopic needle catheter jejunostomies were technically successful, with no perioperative mortality or conversion to a laparotomy. The operation required a mean time of 51.4±14.2 (range 27–80 minutes, and operative bleeding range was 5–20 mL. There was one reoperation required for one patient on postoperative day 5, because the feeding tube was accidentally pulled out during sleep, by patient himself, and the second laparoscopic jejunostomy for this patient was performed successfully. One patient had puncture site pain and was successfully treated with oral analgesics. Other complications, such as gastrointestinal bleeding, intestinal perforation, intestinal obstruction, tube dysfunction, pericatheter leakage, and infection at the skin insertion site, were not observed. The 30-day mortality rate was 4.8% (one out of 21, which was not attributed to the procedure. Enteral nutrition was gradually administered 24–48 hours after operation. Conclusion: The novel modified technique of laparoscopic needle catheter jejunostomy is a technically feasible, with a high technical success rate and low complication rate. Its specific advantage is simplicity and safety, and this modified approach can be

  17. MICROBIAL FLORA AND RISK FACTORS ASSOCIATED WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS

    Directory of Open Access Journals (Sweden)

    Ravi Prakash

    2015-05-01

    Full Text Available INTRODUCTION: Catheter associated Urinary Tract Infection (UTI represent the most common type of nosocomial infection and is a major health concern due to its complications and frequent recurrence. Among the nosocomial infections UTI contributes a major part. About 80% of nosocomial UTI are associated with using indwelling urinary catheters and most of them are asymptomatic. Only 5% of them develop s symptomatic UTI which leads to development of complications like bacteremia & pyelonephritis. MATERIALS AND METHODS: In th e present study a random collection of 100 urine samples from different clinical “groups ˮ like surgery, urology, AMCU, Ob stetrics & Gynecology patients with indwelling urinary catheter of different durations of catheter stay. Organisms isolated in culture, biochemical c haracterization, and antibiotic susceptibility was done. RESULTS: Among the samples tested 41/100 (41% showed culture positivity. within them surgery patients were 40.90% (18/41 , Urology accounted for, 71.42 % (20/28, in AMCU patients 20% (2/10, with more than 3 days of duration of catheter stay and in Obs & Gyn department showed 0 culture positivity. The predominant organism isolated is pseudomonas aeruginosa (34.2%, followed by Escherichia coli (22%, enterococci (12.19%, Klebsiella (12.19% and Ca ndida 19.5%. Among GNB 90% showed ESBL production, 10% ß - lactam inhibitors resistance, 90% quinolones resistant, 50% resistant to amikacin, 100% to gentamycin was o bserved. CONCLUSION: Incidence of bacteriuria in patients with indwelling urinary catheters is 41 %. Onset of bacteriuria is as early as on 3 rd day of catheterization, and gradually increases with duration of stay, technique of insertion and daily catheter care done. Pseudomonas aeruginosa and Escherichia coli are common organisms isolated. Use o f prophylactic antibiotics without doing culture, and antibiotic susceptibility testing leads to development of drug resistant organisms. So, active

  18. Optimum coil insertion speed of various coils in brain aneurysm embolization in vitro.

    Science.gov (United States)

    Konishi, Yoshifumi; Takeuchi, Masataka; Fukasaku, Kazuaki

    2016-10-01

    A coil must comprise material with shape memory to perform optimal coil embolization. To achieve this, the alloy characteristics of the coil (hardness, shape, and thickness) must be understood. In this experiment, a catheter was fixed in the bright position and the movement of the coil was observed under a constant rate of insertion; the optimal insertion rate during clinical use was investigated. The first coil insertion speed was evaluated using simulated aneurysms in an in vivo arterial model. The results showed that the insertion force relates to the deployment shape of the coil, that the feedback through the force indicator using sound is very effective, and that the recorder is useful for analysis of coil embolization. The inserted coils during aneurysm embolization were able to wind uniformly within the aneurysm due to a variety of factors (guiding or micro-catheter position and kick-back phenomenon such as delivery wire). Optimal speed is achieved with proper coil design, which allows the coil to be inserted into the aneurysm. The shape and size of the aneurysm can help determine the necessary size and design of the coil that should be used during the optimal speed range. Aneurysm wall and coil characteristics are considered, along with the friction state of the coil (hardness, shape, and thickness), leading to improvements in safety during the insertion procedure at optimum speed.

  19. Central venous infusion port inserted via high versus low jugular venous approaches: Retrospective comparison of outcome and complications

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)], E-mail: hpark@dreamwiz.com; Kim, Young Il; Lee, Sang Hyun; Kim, Jung Im; Seo, Hyobin; Lee, Sang Min; Lee, Youkyung; Lim, Min Kyung [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Park, Young Suk [Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Purpose: To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches. Materials and methods: The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n = 7), operation scar (n = 6), radiation scar (n = 5), failure of low jugular vein puncture (n = 2), and abnormal course of right subclavian artery (n = 1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port. Results: The procedure-related complications were all minor (n = 14, 8.6%) in both groups; hematoma (n = 4, 2.8% in low jugular puncture group and n = 1, 4.8% in high jugular puncture group, p = 0.6295), air embolism (n = 2, 1.4% in low jugular puncture group and n = 0 in high jugular puncture group, p = 0.5842) and minor bleeding (n = 5, 3.5% in low jugular vein puncture group and n = 2, 9.5% in high jugular vein puncture group, p = 0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p = 0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p = 0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p = 0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p = 0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein

  20. 新生儿中心静脉导管相关性感染的预防%Prevention of central venous catheter-related infections in neonates

    Institute of Scientific and Technical Information of China (English)

    王欣宁

    2010-01-01

    Central venous catheters are indispensable in modern-day medical practice in neonatal intensive care units.Infection is the most frequent serious complication during these catheter-inserted days.Several strategies to prevent catheter-related infections are disputed all over the world.Studies have shown that some measures played a role in reducing the infection rate,which include maximal sterile barrier precautions,chlorhexidine preparation for skin antisepsis,routine replacement of catheter site dressings and connection sets,time-limited catheter insert,removal catheter after infected,antibiotic locked catheters and so on.%中心静脉导管是新生儿重症监护室常用的静脉通道,而感染是中心静脉导管置管术严重的并发症,各国的新生儿中心都在积极研究各种预防措施,但其有效性仍有争议.研究表明,严格无菌操作、洗必泰皮肤消毒剂、周期性更换辅料及导管连接装置、限期拔管、感染后及时拔管、抗生素封闭导管等措施在降低感染率方面有一定的作用.

  1. Large-deflection statics analysis of active cardiac catheters through co-rotational modelling.

    Science.gov (United States)

    Peng Qi; Chen Qiu; Mehndiratta, Aadarsh; I-Ming Chen; Haoyong Yu

    2016-08-01

    This paper presents a co-rotational concept for large-deflection formulation of cardiac catheters. Using this approach, the catheter is first discretized with a number of equal length beam elements and nodes, and the rigid body motions of an individual beam element are separated from its deformations. Therefore, it is adequate for modelling arbitrarily large deflections of a catheter with linear elastic analysis at the local element level. A novel design of active cardiac catheter of 9 Fr in diameter at the beginning of the paper is proposed, which is based on the contra-rotating double helix patterns and is improved from the previous prototypes. The modelling section is followed by MATLAB simulations of various deflections when the catheter is exerted different types of loads. This proves the feasibility of the presented modelling approach. To the best knowledge of the authors, it is the first to utilize this methodology for large-deflection static analysis of the catheter, which will enable more accurate control of robot-assisted cardiac catheterization procedures. Future work would include further experimental validations.

  2. Fast, automatic, and accurate catheter reconstruction in HDR brachytherapy using an electromagnetic 3D tracking system

    Energy Technology Data Exchange (ETDEWEB)

    Poulin, Eric; Racine, Emmanuel; Beaulieu, Luc, E-mail: Luc.Beaulieu@phy.ulaval.ca [Département de physique, de génie physique et d’optique et Centre de recherche sur le cancer de l’Université Laval, Université Laval, Québec, Québec G1V 0A6, Canada and Département de radio-oncologie et Axe Oncologie du Centre de recherche du CHU de Québec, CHU de Québec, 11 Côte du Palais, Québec, Québec G1R 2J6 (Canada); Binnekamp, Dirk [Integrated Clinical Solutions and Marketing, Philips Healthcare, Veenpluis 4-6, Best 5680 DA (Netherlands)

    2015-03-15

    Purpose: In high dose rate brachytherapy (HDR-B), current catheter reconstruction protocols are relatively slow and error prone. The purpose of this technical note is to evaluate the accuracy and the robustness of an electromagnetic (EM) tracking system for automated and real-time catheter reconstruction. Methods: For this preclinical study, a total of ten catheters were inserted in gelatin phantoms with different trajectories. Catheters were reconstructed using a 18G biopsy needle, used as an EM stylet and equipped with a miniaturized sensor, and the second generation Aurora{sup ®} Planar Field Generator from Northern Digital Inc. The Aurora EM system provides position and orientation value with precisions of 0.7 mm and 0.2°, respectively. Phantoms were also scanned using a μCT (GE Healthcare) and Philips Big Bore clinical computed tomography (CT) system with a spatial resolution of 89 μm and 2 mm, respectively. Reconstructions using the EM stylet were compared to μCT and CT. To assess the robustness of the EM reconstruction, five catheters were reconstructed twice and compared. Results: Reconstruction time for one catheter was 10 s, leading to a total reconstruction time inferior to 3 min for a typical 17-catheter implant. When compared to the μCT, the mean EM tip identification error was 0.69 ± 0.29 mm while the CT error was 1.08 ± 0.67 mm. The mean 3D distance error was found to be 0.66 ± 0.33 mm and 1.08 ± 0.72 mm for the EM and CT, respectively. EM 3D catheter trajectories were found to be more accurate. A maximum difference of less than 0.6 mm was found between successive EM reconstructions. Conclusions: The EM reconstruction was found to be more accurate and precise than the conventional methods used for catheter reconstruction in HDR-B. This approach can be applied to any type of catheters and applicators.

  3. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    Science.gov (United States)

    Ataman Hatipoğlu, Ciğdem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci

  4. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2013-06-01

    Full Text Available OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles' insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. RESULTS: In 54.2% of the knees the insertion' shape was concave; in most pieces (41.6% the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm2; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm2 and it was 41.54 ± 9.75 mm2 for the posteromedial bundle. CONCLUSIONS: The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.

  5. Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report

    Directory of Open Access Journals (Sweden)

    Gruenbaum Shaun E

    2012-04-01

    Full Text Available Abstract Introduction The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has been shown to successfully facilitate difficult intubations when other methods have failed. The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has a fixed length of 56 cm, and it has been suggested in the literature that it may be too short for safe use in patients who are tall. Case presentation We present the case of a 32-year-old, 180 cm tall Caucasian woman with a predicted difficult airway who presented to our facility for an emergency cesarean section. After several failed intubation attempts via direct laryngoscopy, an airway was established with a laryngeal mask airway. After delivery of a healthy baby, our patient's condition necessitated tracheal intubation. A fiber-optic bronchoscope loaded with an Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was passed through the laryngeal mask airway into the trachea until just above the carina, but was too short to safely allow for the passage of an endotracheal tube. Conclusions We present a novel technique in which the Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was replaced with a longer (100 cm exchange catheter, over which an endotracheal tube was passed successfully into the trachea.

  6. Alumina ceramic as a biomaterial for use in afterloading radiation catheters for hyperthermia.

    Science.gov (United States)

    Ferraro, F T; Salcman, M; Broadwell, R D; Sewchand, W; Neuberth, G

    1989-08-01

    A major technical challenge to the use of interstitial hyperthermia in malignant brain tumors is the production of a well-defined, uniform hyperthermal field. In theory, A 915-MHz microwave antenna should allow fewer antennas to be used and cause less mechanical brain damage; however, standard radiation afterloading catheters require antennas to be 12 cm long; this is clearly impractical for intracranial use. Since alumina ceramic (Al2O3) catheters permit short microwave antennas (3-5 cm in length) to function properly in neural tissue, it is important to test the biocompatibility of alumina for use in combined interstitial microwave hyperthermia and brachytherapy. A 5-mm length of alumina catheter was implanted into the brains of 15 white rats. The animals were killed at 3, 7, 14, 28, and 56 days. Histological examination revealed only minor mechanical damage and no encapsulation until 1 month; even then, the glial wall was only a few cell layers thick. Five animals received implants and were killed at similar intervals for x-ray microanalysis with the scanning electron microscope. No migration of aluminum into the brain was detected when compared with two control animals that did not receive implants and an alumina blank. Although we measured 50% attenuation of the radiation from iridium-192 sources in alumina catheters as compared with conventional ones, alumina catheters can still be used for interstitial radiation by increasing either the activity of the seeds or the duration of treatment.

  7. Soft thrombus formation in radiofrequency catheter ablation

    NARCIS (Netherlands)

    Demolin, JM; Eick, OJ; Munch, K; Koullick, E; Nakagawa, H; Wittkampf, FHM

    2002-01-01

    During RF catheter ablation, local temperature elevation can result in coagulum formation on the ablation electrode, resulting in impedance rise. A recent study has also demonstrated the formation of a so-called soft thrombus during experimental ablations. This deposit poorly adhered to the catheter

  8. Catheter ablation of parahisian premature ventricular complex.

    Science.gov (United States)

    Kim, Jun; Kim, Jeong Su; Park, Yong Hyun; Kim, June Hong; Chun, Kook Jin

    2011-12-01

    Catheter ablation is performed in selected patients with a symptomatic premature ventricular complex (PVC) or PVC-induced cardiomyopathy. Ablation of PVC from the His region has a high risk of inducing a complete atrioventricular block. Here we report successful catheter ablation of a parahisian PVC in a 63-year-old man.

  9. Urethral catheters: can we reduce use?

    NARCIS (Netherlands)

    Broek, P.J. van den; Wille, J.C.; Benthem, B.H.B. van; Perenboom, R.J.M.; Akker-van Marle, M.E. van den; Nielen, A.M.A.

    2011-01-01

    Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. The efficacy of an intervention programme to improve adherence to recommenda

  10. Automated Pointing of Cardiac Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Brattain, Laura J; Howe, Robert D

    2013-12-31

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

  11. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis;

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  12. Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula

    Directory of Open Access Journals (Sweden)

    Joshi Anish

    2008-01-01

    Full Text Available Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV catheterization using Seldinger′s technique. In group A, central venous catheterization was done under electrocardiography (ECG guidance. In group B, the catheter was inserted blindly using Peres′ formula of "height (in cm/10". The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.

  13. Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ho Cheol; Shin, Tae Beom; Park, Mee Jung; Kim, Ji Eun; Choi, Hye Young; Bae, Kyung Soo; Choi, Dae Seob; Na, Jae Boem; Jeong, Seong Hoon [Gyeongsang National University Hospital, College of Medicine, Jinju (Korea, Republic of)

    2011-02-15

    We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess. From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated. 15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5- 27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved. Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure

  14. Central Venous Catheter-Related Hydrothorax

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    Se Hun Kim

    2015-11-01

    Full Text Available This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

  15. Central venous catheters: detection of catheter complications and therapeutical options; Zentralvenoese Katheter: Diagnostik von Komplikationen und therapeutische Optionen

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Beck, A. [Universitaetsmedizin Charite, Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes-Kliniken, Friedrichshain und Am Urban, Berlin (Germany). Radiologie; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg (Germany). Radiologie

    2008-06-15

    For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary.

  16. A Retrospective Study of Preferable Alternative Route to Right Internal Jugular Vein for Placing Tunneled Dialysis Catheters: Right External Jugular Vein versus Left Internal Jugular Vein.

    Directory of Open Access Journals (Sweden)

    Pei Wang

    Full Text Available Right internal jugular vein (IJV is a preferred access route for tunneled (cuffed dialysis catheters (TDCs, and both right external jugular vein (EJV and left IJV are alternative routes for patients in case the right IJV isn't available for TDC placement. This retrospective study aimed to determine if a disparity exists between the two alternative routes in hemodialysis patients in terms of outcomes of TDCs.49 hemodialysis patients who required TDCs through right EJV (n = 21 or left IJV (n = 28 as long-term vascular access were included in this study. The primary end point was cumulative catheter patency. Secondary end points include primary catheter patency, proportion of patients that never required urokinase and incidence of catheter-related bloodstream infections (CRBSI.A total of 20,870 catheter-days were evaluated and the median was 384 (interquartile range, 262-605 catheter-days. Fewer catheters were removed in the right EJV group than in the left IJV group (P = 0.007. Mean cumulative catheter patency was higher in the right EJV group compared with the left IJV group (P = 0.031. There was no significant difference between the two groups in the incidence of CRBSI, primary catheter patency or proportion of patients that never required urokinase use. Total indwell time of antecedent catheters was identified as an independent risk factor for cumulative catheter patency by Cox regression hazards test with an HR of 2.212 (95% CI, 1.363-3.588; p = 0.001.Right EJV might be superior to left IJV as an alternative insertion route for TDC placement in hemodialysis patients whose right IJVs are unavailable.

  17. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

    Directory of Open Access Journals (Sweden)

    Yazmin Yaacob

    2013-01-01

    Full Text Available Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%, followed by catheter-related infection (9/161; 5.6%. Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8% chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  18. Early dislodgement of Indwelling Pleural Catheter (IPC): a balancing act.

    Science.gov (United States)

    Tung, Alvin Hon Man; Ngai, Jenny Chun Li; Ng, Susanna So Shan; Ko, Fanny Wai San; Hui, David Shu-Cheong

    2014-03-01

    A 63-year-old nonsmoker with right malignant pleural effusion derived symptomatic benefit following drainage of his effusion. Following insertion of indwelling pleural catheter (IPC), 1.3 L of blood-stained fluid was drained into underwater sealed bottle (Atrium®), but the IPC dislodged 26 h after continuous connection. We believe that the weight of the drainage bottle (including the un-emptied fluid) and the prolonged connection time contributed to this uncommon event reported in the literature. There was no recurrence when his second IPC was connected to a drainage bag which was emptied at every 500 mL, capped at 2 h each time. An anchoring stitch should also be considered when drainage devices heavier than the manufacturer bottles are used to drain IPC.

  19. Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Hwa Rim Kang

    2015-08-01

    Full Text Available Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

  20. Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

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    Cláudio Penido Campos Júnior

    2010-04-01

    Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.

  1. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

    Science.gov (United States)

    Sebastian, Raul; Ghanem, Omar; Diroma, Frank; Milner, Stephen M; Gerold, Kevin B; Price, Leigh A

    2015-05-01

    Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients.

  2. ENDOSCOPIC GROMMET INSERTION OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thiagarajan

    2012-03-01

    Full Text Available Grommet insertion the commonest surgical procedure next only to circumcision is usually performed using an operating microscope 1. Authors have been using 4 mm 0 degree nasalendoscopes to perform this procedure during the last 5 years. This is a report of their experience in using endoscope inlieu of microscope in performing this surgery. This study makes a comparative analysis of Endoscopic Grommet insertion viz a viz Microscopic Grommet insertion. For this comparative analysis one year (2009 data base of Government Stanley Medical College Chennai India was used. This study reveals that Endoscopic Grommet insertion compared favorably with Microscopic Grommet insertion in all aspects with certain obvious advantages.

  3. Evaluation of an intervention program to prevent hospital-acquired catheter-associated urinary tract infections in an ICU in a rural Egypt hospital

    Directory of Open Access Journals (Sweden)

    Amine, Amira Ezzat Khamis

    2014-08-01

    Full Text Available [english] Aim: Catheter associated urinary tract infections (CAUTI are the most common hospital-acquired infection in ICUs. The aim of this study was to estimate the effectiveness of an intervention program by implementing urinary catheter bundle elements to reduce the CAUTI frequency in an ICU. Methods: The intervention study was conducted over a period of onths. During a pre-intervention phase, the base line catheter associated CAUTI incidence rates were determined and compared with the incidence rates during the post-intervention phase. The compliance of health care staff with urinary catheter bundle elements was also measured. The implemented CAUTI prevention bundle consisted of hand hygiene, wearing personal protective equipment, use of disposable gloves, cleansing of urethral meatus prior to catheter insertion using sterile saline, assessment of catheter need, aseptic urine sampling technique, and correct draining bag positioning.Results: During the study period, 55 out of 77 patients were diagnosed with a CAUTI. The mean CAUTI incidence rate for the pre-intervention period was 90.12/1,000 catheter days and for the post intervention phase 65.69/1,000 catheter days. The CAUTIs rate was inversely proportional to insertion bundle elements and maintenance bundle elements compliance rate. This negative relationship was statistically significant only with maintenance bundle elements (p=0.042 (r=–0.828. The compliance rate of the ICU nurses to the bundle elements was raised to 100% during the last 2 months of the post intervention phase.Conclusion: Increased compliance to recommended catheter associated urinary tract infections preventive practices reduced the incidence of CAUTI in an ICU unit. It is simple and effective and is recommended as a part of patient safety culture.

  4. [The operative cystoscope with joystick control mechanism of flexible tools inserted into the urinary bladder and the ureter].

    Science.gov (United States)

    Komiakov, B K; Topuzov, M É; Zubarev, V A; Stetsik, O V

    2014-01-01

    The authors developed an operative cystoscope with joystick control mechanism of ureter catheters and other flexible tools. This construction allowed control of flexible tools inserted into the bladder and the ureter in various directions, thus providing a necessary observation of the operative field at endoscopic operations on the bladder and ureter. This was one of the factors, which determined the operation success.

  5. Use of the Seldinger type movement over a J-shaped stylet for left ventricular vent insertion.

    Science.gov (United States)

    Sanders, Lucas H A; Chen, Weiwen; Schönberger, Jacques P A M; Shehatha, Jaffar; Newman, Mark A J

    2009-12-01

    Access through the right superior pulmonary vein is a commonly used route for left ventricular vent insertion. Complex reshaping of the stylet and vent into a certain position or external guidance do not guarantee successful placement. In this article we describe a modified technique where the stylet sets up the position to allow consistent atraumatic advancement of the catheter across the mitral valve.

  6. Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs.

    Directory of Open Access Journals (Sweden)

    Md Abu Choudhury

    Full Text Available Skin bacteria at peripheral intravenous catheter (PIVC insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs. Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001. Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%, Pseudomonas spp., (10% and Acinetobacter spp. (10% were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

  7. Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs.

    Science.gov (United States)

    Choudhury, Md Abu; Marsh, Nicole; Banu, Shahera; Paterson, David L; Rickard, Claire M; McMillan, David J

    2016-01-01

    Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, pskin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

  8. Radiologic placement of tunneled central venous catheter

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tae; Yang, Po Song; Yang, Dong Hunn; Kim, Ki Tae; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Yun, Eun Joo [Korea Veterans Hospital, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemic patients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency with a injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian vein was punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through a subcutaneous tunnel in the anterior chest wall. Catheter placements were successful in all patients. The mean procedure time was 17.2minutes, mean fluooscopy time was 1.3minutes, mean number of punctures was 1.4, and mean volume of injhected contrast media was 43.5cc. Only two of all leukemic patients developed mild hematomas at the puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax. But late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter in one (3%). The occluded catheter was successfully recanalized with Urokinase infusion. Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, and useful for patients requiring long-term venous access.

  9. [Updating enteral feeding by catheter].

    Science.gov (United States)

    Rodríguez, T; Planas, M

    2005-12-01

    Intestinal nutrition can be administered orally or by means of a catheter; the latter method is the focus of this article. The authors' objective is to provide up-to-date information in a succinct manner about the enteral feeding technique. The authors hope health professionals know the advantages as well as the inconveniences of the latest intestinal nutrition advances regarding access ways and the means to administer these. Intestinal nutrition formulas will not be dealt with in this article. However, a health professional should know that there is a wide variety of diets available depending on the complexity of macronutrients included in a diet, the quantity of proteins in a mixture, and that these are designed, in addition to feeding, to treat the specific pathological process a patient suffers from, such as diabetes of cancer.

  10. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system

    It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  11. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  12. Percutaneous catheter dilatation of carotid stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Mathias, K.; Mittermayer, C.; Ensinger, H.; Neff, W.

    1980-09-01

    Thirty-one carotid artery stenoses were produced in thirty dogs by three different techniques. Twenty-three of these could be cured by transfemoral percutaneous catheter dilatation. High grade tight stenoses may present resistance which cannot be overcome by the catheter. Histological examination of the dilated vessels showed circumscribed changes in the vessel wall, with destruction of elastic membranes. From our experience of catheter dilatation of pelvic and lower limb arteries and of renal arteries, we consider it feasible to use this technique in selected patients with carotid stenosis.

  13. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  14. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    Directory of Open Access Journals (Sweden)

    Thomas B. McGregor

    2016-01-01

    Full Text Available We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  15. Retained Urethral Catheter Secondary to Placement in Proximal Ureter.

    Science.gov (United States)

    McGregor, Thomas B; Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  16. Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

    DEFF Research Database (Denmark)

    Larsen, M.K.; Thomsen, T.R.; Moser, C.;

    2008-01-01

    ABSTRACT: BACKGROUND: Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. METHODS: In this study traditional semiquantitative...... culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ...... observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. CONCLUSION: The results show that diagnosis based on molecular methods improves the detection of microorganisms involved in central catheter-related infections. The importance...

  17. Insertion of short transmembrane helices by the Sec61 translocon.

    Science.gov (United States)

    Jaud, Simon; Fernández-Vidal, Mónica; Nilsson, Ingmarie; Meindl-Beinker, Nadja M; Hübner, Nadja C; Tobias, Douglas J; von Heijne, Gunnar; White, Stephen H

    2009-07-14

    The insertion efficiency of transmembrane (TM) helices by the Sec61 translocon depends on helix amino acid composition, the positions of the amino acids within the helix, and helix length. We have used an in vitro expression system to examine systematically the insertion efficiency of short polyleucine segments (L(n), n = 4 ... 12) flanked at either end by 4-residue sequences of the form XXPX-L(n)-XPXX with X = G, N, D, or K. Except for X = K, insertion efficiency (p) is snorkeling) and by partial unfolding.

  18. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    1991-01-01

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  19. A Survey of Invasive Catheter Practices in US Burn Centers

    Science.gov (United States)

    2012-12-01

    central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters . J Burn Care Res 2006;27:713–18. ...741 Central venous catheters (CVCs) and arterial catheters (ACs) provide essential access for critically injured patients. Practices surrounding...consisted of 23 questions related to spe- cific practices in placement and maintenance of central venous catheters (CVCs), arte- rial catheters ,

  20. Incidence and risk factors for central venous catheter-related thrombosis in hematological patients.

    Science.gov (United States)

    Joks, Monika; Czyż, Anna; Popławski, Dariusz; Komarnicki, Mieczysław

    2014-01-01

    Catheter-related thrombosis (CRT) is a serious complication in hematological patients, but the risk factors for its occurrence are not well established. The study objectives were to estimate the incidence of CRT and to identify the risk factors for developing CRT in hematological patients. In a prospective setting, 104 consecutive patients with 200 insertions of central venous catheters were enrolled into the study. The patients were screened for CRT by compression Doppler ultrasound every 10-14 days. Additionally, ultrasonography was performed in the case of clinical symptoms suggesting CRT. Over the course of 6,098 catheter days of follow-up, the incidence of CRT was 13.5 %. In 18/27 cases (66.6 %), radiological evidence of CRT was preceded by clinical symptoms. However, in 9/27 (33.3 %), CRT was clinically asymptomatic. The median times to symptomatic and asymptomatic CRT were 17 (range 1-49) and 8 (range 1-16) catheter days, respectively. In univariate analysis, the risk factors for CRT were exit-site infection (ESI) (P risk of CRT. The results of our study provide information regarding the characteristic features of the patients who are at high risk of thrombosis, for whom Doppler ultrasound screening should be considered.

  1. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias.

    Science.gov (United States)

    Aagaard, Philip; Natale, Andrea; Briceno, David; Nakagawa, Hiroshi; Mohanty, Sanghamitra; Gianni, Carola; Burkhardt, J David; DI Biase, Luigi

    2016-03-01

    VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.

  2. Predicting the optimal depth of left-sided central venous catheters in children.

    Science.gov (United States)

    Kim, H; Jeong, C-H; Byon, H-J; Shin, H K; Yun, T J; Lee, J-H; Park, Y-H; Kim, J-T

    2013-10-01

    The aim of this study was to predict the optimal depth for insertion of a left-sided central venous catheter in children. Using 3D chest computed tomography angiography, we measured the distance from a point where the internal jugular vein is at the superior border of the clavicle, and from a point where the subclavian vein is inferior to the anterior border of the clavicle, to the junction of the superior vena cava and the right atrium in 257 children. Linear regression analysis revealed that the distances correlated with age, weight and height. Simple formulae for the depth of a central venous catheter via the left internal jugular vein (0.07 × height (cm)) and the left subclavian vein (0.08 × height (cm)) were developed to predict placement of the central venous catheter tip at the junction of the superior vena cava with the right atrium. Using these fomulae, the proportion of catheter tips predicted to be correctly located was 98.5% (95% CI 96.8-100%) and 94.0% (95% CI 90.8-97.3%), respectively.

  3. Injection of gadolinium contrast through pediatric central venous catheters: a safety study

    Energy Technology Data Exchange (ETDEWEB)

    Moriarty, John M.; Ramos, Yanerys; Finn, J.P. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Kung, Geoffrey L. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); Moghaddam, Abbas N. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Amirkabir University of Technology (Tehran Polytechnic), Department of Biomedical Engineering, Tehran (Iran, Islamic Republic of); Ennis, Daniel B. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); University of California, Biomedical Physics Interdepartmental Program, Los Angeles, CA (United States)

    2012-09-15

    Catheter rupture during CT angiography has prompted policies prohibiting the use of electronic injectors with peripherally inserted central venous catheters (PICCs) not only for CT but also for MRI. Consequently, many institutions mandate hand injection for MR angiography, limiting precision of infusion rates and durations of delivery. To determine whether electronic injection of gadolinium-based contrast media through a range of small-caliber, single-lumen PICCs would be safe without risk of catheter rupture over the range of clinical protocols and determine whether programmed flow rates and volumes were realized when using PICCs for contrast delivery. Experiments were performed and recorded using the Medrad Spectris Solaris EP MR Injection System. PICC sizes, contrast media and flow rates were based on common institutional protocols. No catheters were damaged during any experiments. Mean difference between programmed and delivered volume was 0.07 {+-} 0.10 mL for all experiments. Reduced flow rates and prolonged injection durations were observed when the injector's pressure-limiting algorithm was triggered, only in protocols outside the clinical range. PICCs commonly used in children can withstand in vitro power injection of gadolinium-based contrast media at protocols significantly above clinical levels. (orig.)

  4. Pulmonary artery catheter complications: report on a case of a knot accident and literature review

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    Lopes Marcelo Cruz

    2004-01-01

    Full Text Available A particular event concerning a Swan-Ganz catheter complication is reported. A 41-year-old woman was admitted at the emergency room of our hospital with massive gastrointestinal bleeding. A total gastrectomy was performed. During the postoperative period in the intensive care unit , the patient maintained hemodynamic instability. Invasive hemodynamic monitoring with a pulmonary artery catheter was then indicated. During the maneuvers to insert the catheter, a true knot formation was identified at the level of the superior vena cava. Several maneuvers by radiological endovascular invasive techniques allowed removal of the catheter. The authors describe the details of this procedure and provide comments regarding the various techniques that were employed in overcoming this event. A comprehensive review of evidence regarding the benefits and risks of pulmonary artery catheterization was performed. The consensus statement regarding the indications, utilization, and management of the pulmonary artery catheterization that were issued by a consensus conference held in 1996 are also discussed in detail.

  5. Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

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    Sandra Maria Sampaio Enes

    2016-04-01

    Full Text Available Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%, phlebitis was the most frequent complication (31.1%. The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%, in 20G catheter (39.3%, inserted in the dorsal hand vein arc (36.9 %, with mean time of usage of 68.4 hours. The type of infusion (p=0.044 and the presence of chronic disease (p=0.005 and infection (p=0.007 affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

  6. Intraurethral Catheter: Alternative Management for Urinary Retention in Patients With Benign Prostatic Hypertrophy

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    Sulabha Punekar

    1995-01-01

    Full Text Available A polyurethane intraurethral catheter (IUC was used in 27 patients with benign prostatic hypertrophy who were unfit for surgery, or were awaiting surgery. All of them had previously had a periurethral catheter inserted. The IUC was inserted with a cystoscope under fluoroscopic control. Spontaneous voiding through the IUC resumed in 25 patients (93% in the immediate postprocedure period. At the end of 6 months follow-up, the peak flow rates and the residual volumes estimated in 22 patients were satisfactory. Immediate complications included incontinence due to distal displacement in 2 patients and hematuria in one patient; long-term complications included mild encrustation of the IUC in 2 patients and calculus formation on the IUC in 1 patient. None of the patients had clinically significant urinary tract infection. The presence of the IUC did not compromise the subsequent transurethral resection of the prostate gland. We recommend the use of an IUC for up to 6 months in patients with urinary retention who are awaiting surgery or are unfit for surgery as an alternative to an indwelling urethral catheter.

  7. Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    ... Submit Button Frequently Asked Questions about Catheter-associated Urinary Tract Infections Recommend on Facebook Tweet Share Compartir What is ... an incision above the pubis. What is a urinary tract infection? A urinary tract infection (UTI) is an infection ...

  8. Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters; Clinical and radiological perspective from a tertiary centre in Oman

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    Rana S. Hamid

    2015-11-01

    Full Text Available Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs at the Sultan Qaboos University Hospital (SQUH, Muscat, Oman. Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis were collected. Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2% and 93 were male (57.8%. The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%. A total of 203 procedures were technically successful (99.5%. The right internal jugular vein was the most common site of catheter placement (74.9%. Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%. No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%; of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7% and catheter-related infection in 29 cases (22.0%. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature.

  9. Confirmation of endovenous placement of central catheter using the ultrasonographic "bubble test"

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    Ajit S Baviskar

    2015-01-01

    Full Text Available Insertion of central venous catheter (CVC is the most common procedure to be performed in Intensive Care Units. Addition of ultrasonographic guidance to this procedure, which was initially performed blindly, has improved safety of this procedure. Confirmation of endovenous placement of CVC though, is tricky, as methods for confirmation are either operator dependent, time-consuming or not available at bedside. Prospective observational study was carried out to study feasibility of use of sonobubble test to confirm the presence of CVC within central vein. After insertion of CVC in the internal jugular, subclavian or axillary vein, a 10 ml bolus of shaken saline microbubble is injected through port of CVC, and opacification of right atrium is observed in xiphoid view on ultrasonography. The Sonobubble test was helpful for dynamic confirmation of endovenous placement of CVC and prevented complications such as arterial puncture and cannulation. We recommend its use following CVC insertion.

  10. Impedance calculation for ferrite inserts

    Energy Technology Data Exchange (ETDEWEB)

    Breitzmann, S.C.; Lee, S.Y.; /Indiana U.; Ng, K.Y.; /Fermilab

    2005-01-01

    Passive ferrite inserts were used to compensate the space charge impedance in high intensity space charge dominated accelerators. They study the narrowband longitudinal impedance of these ferrite inserts. they find that the shunt impedance and the quality factor for ferrite inserts are inversely proportional to the imaginary part of the permeability of ferrite materials. They also provide a recipe for attaining a truly passive space charge impedance compensation and avoiding narrowband microwave instabilities.

  11. Definition of Metrics to Evaluate Cochlear Array Insertion Forces Performed with Forceps, Insertion Tool, or Motorized Tool in Temporal Bone Specimens

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    Yann Nguyen

    2014-01-01

    Full Text Available Introduction. In order to achieve a minimal trauma to the inner ear structures during array insertion, it would be suitable to control insertion forces. The aim of this work was to compare the insertion forces of an array insertion into anatomical specimens with three different insertion techniques: with forceps, with a commercial tool, and with a motorized tool. Materials and Methods. Temporal bones have been mounted on a 6-axis force sensor to record insertion forces. Each temporal bone has been inserted, with a lateral wall electrode array, in random order, with each of the 3 techniques. Results. Forceps manual and commercial tool insertions generated multiple jerks during whole length insertion related to fits and starts. On the contrary, insertion force with the motorized tool only rose at the end of the insertion. Overall force momentum was 1.16 ± 0.505 N (mean ± SD, n=10, 1.337 ± 0.408 N (n=8, and 1.573 ± 0.764 N (n=8 for manual insertion with forceps and commercial and motorized tools, respectively. Conclusion. Considering force momentum, no difference between the three techniques was observed. Nevertheless, a more predictable force profile could be observed with the motorized tool with a smoother rise of insertion forces.

  12. Thermistor guided radiofrequency ablation of atrial insertion sites in patients with accessory pathways.

    Science.gov (United States)

    Tracy, C M; Moore, H J; Solomon, A J; Rodak, D J; Fletcher, R D

    1995-11-01

    Radiofrequency ablation has gained acceptance in the treatment of patients with symptomatic Wolff-Parkinson-White syndrome. The purpose of this study was to characterize the relation between temperature and other electroconductive parameters in patients undergoing atrial insertion accessory pathway ablation utilizing a thermistor equipped catheter. The mean temperature and power at sites of atrial insertion ablation are lower than has been previously associated with creation of radiofrequency lesions in the ventricle. While high cavitary blood flow in the atrium may result in cooling, the thinner atrial tissue may require less energy to achieve adequate heating than ventricular myocardium.

  13. Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai

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    K Chopdekar

    2011-01-01

    Full Text Available Blood stream infections related to central venous catheterization are one of the major device-associated infections reported. Patients admitted in critical care units requiring central venous catheterization and presenting with signs of septicemia during catheterization period were investigated for catheter-related blood stream infections (CRBSI. The CRBSI rate was 9.26 per 1000 catheter days in general with highest rate in neonatal intensive care unit (27.02/1000 days. Site of insertion of catheter and duration of catheterization did not show the influence on the CRBSI rate. Coagulase-negative Staphylococci were the predominant cause. Mortality of 33% was observed in patients with CRBSI. Since central venous catheters are increasingly being used in the critical care, regular surveillance for infection associated them are essential.

  14. Survival and complications of peritoneal dialysis catheters: introducing a laparoscopic method under local anesthesia

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    Chaman R

    2008-10-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Chronic peritoneal dialysis is a safe method for the treatment of end-stage renal failure. Worldwide, patients on chronic peritoneal dialysis constititute approximately 15% of the total number of patients on dialysis. In Iran, very few people have access to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This lack of access is primarily due to the high occurrence of mechanical complications. Improving catheterization procedures is an important way to extend the use of peritoneal dialysis in Iran. Thus, a prospective study was implemented to evaluate the outcome of a new laparoscopic technique for the insertion of peritoneal dialysis catheters under local anesthesia."n"n Methods: A total of 115 catheters (two-cuff, swan-necked, coiled were inserted into the peritoneal cavity of 109 patients with end-stage chronic renal failure during a 16-month period. The method of insertion was a two-port laparoscopic technique with local anesthesia and sedation. All patients were followed for 12 to 28 months. We prospectively evaluated mechanical and infectious complications and survival rates of the catheters."n"n Results: The average age of the patients was 51

  15. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

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    Diana Yuan Yng Chiu

    2015-01-01

    Full Text Available Three-dimensional (3D echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice.

  16. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

    Science.gov (United States)

    Chiu, Diana Yuan Yng; Green, Darren; Kalra, Philip A.; Abidin, Nik

    2015-01-01

    Three-dimensional (3D) echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice. PMID:26688761

  17. Multicenter study in monitoring central venous catheters complications in hematologic patiennts

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    Carmen García Gabás

    2013-05-01

    Full Text Available Most hematological patients suffer a significant venous damage related to different administrated intravenous therapy, being necessary to place central venous catheters (CVC. CVC is associated with various complications. The most common catheter-related complications are occlusion and infection. To avoid such of them, the development of protocols for insertion and care are needed, as well as recording and following up complications. To this end, we propose a cross-sectional carried out during 13 months whose main goal is to know the incidence of CVC- related complications (mainly occlusion and infection in hematological patients.Population included all the =14 ages patients admitted to different hematological units at Ramon y Cajal and Gregorio Marañón hospitals in Madrid and who signed informed consent. Socio-demographic, clinical characteristics and complications were entered into a log which included a pursuit of care protocol.

  18. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients

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    Moini Majid

    2009-01-01

    Full Text Available To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD, we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (p< 0.05. In conclusion, our results showed that the external jugular vein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

  19. Effectiveness of a Drill-assisted Intraosseous Catheter versus Manual Intraosseous Catheter by Resident Physicians in a Swine Model

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    Hafner, John William

    2013-11-01

    Full Text Available Introduction: Our objective was to compare the effectiveness, speed, and complication rate of the traditional manually placed intraosseous (IO catheter to a mechanical drill-assisted IO catheter by emergency medicine (EM resident physicians in a training environment. Methods: Twenty-one EM residents participated in a randomized prospective crossover experiment placing 2 intraosseous needles (Cook® Intraosseous Needle, Cook Medical, Bloomington, IN; and EZ-IO® Infusion System, Vidacare, San Antonio, TX. IO needles were placed in anesthetized mixed breed swine (mass range: 25 kg to 27.2 kg. The order of IO placement and puncture location (proximal tibia or distal femur were randomly assigned. IO placement time was recorded from skin puncture until the operator felt they had achieved successful placement. We used 3 verification criteria: aspiration of marrow blood, easy infusion of 10 mL saline mixed with methylene blue, and lack of stained soft tissue extravasation. Successful placement was defined as meeting 2 out of the 3 predetermined criteria. We surveyed participants regarding previous IO experience, device preferences, and comfort levels using multiple choice, Likert scale, and visual analog scale (VAS questions. IO completion times, VAS, and mean Likert scales were compared using Student’s t-test and success rates were compared using Fisher’s exact test with p<0.05 considered significant.Results: Drill-assisted IO needle placement was faster than manually placed IO needle placement (3.66 vs. 33.57 seconds; p=0.01. Success rates were 100% with the drill-assisted IO needle and 76.2% with the manual IO needle (p=0.04. The most common complication of the manual IO insertion was a bent needle (33.3% of attempts. Participants surveyed preferred the drill-assisted IO insertion more than the manual IO insertion (p<0.0001 and felt the drill-assisted IO was easier to place (p<0.0001.Conclusion: In an experimental swine model, drill-assisted IO

  20. Toxic catheters and urethral strictures: A concern about types of catheters used in resource-poor countries

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    A.A. Popoola

    2012-12-01

    Full Text Available Various reports in the literature have confirmed urethral toxicity caused by the use of catheters, mostly latex catheters and their coated versions, resulting in long-segment urethral strictures or strictures located in multiple areas of the urethra. Most catheters used in resource-poor countries, such as Nigeria, are latex catheters with various coatings, such as silicone. The reasons for the widespread use of these potentially toxic catheters are mainly non-availability and/or the high cost of less toxic catheters. We report three cases of urethral strictures following the use of siliconized latex catheters in order to highlight the potential urethral toxicity associated with the use of latex catheters and to draw the authorities’ attention to the need to regulate the types of catheters used in the country.

  1. Reduction of Urinary Tract Infections Caused By Urethral Catheter through the Implementation of Hydrophobic Coating and Geometrical Modifications

    Science.gov (United States)

    Gare, Aya

    2013-11-01

    Catheter-Associated Urinary Tract Infection (CAUTI) is the most common nosocomial infection in the U.S. healthcare system. The obstruction of urine caused by confined air bubbles result in the development of urinary back-flow and stagnation, wherein microbial pathogens could multiply rapidly and colonization within catheters become commonplace. Infections can be prevented by aseptic insertion and the maintenance of a closed drainage system, keeping high infection control standards, and preventing back-flow from the catheter bag. The goal of this study is to assess the effectiveness of a simple, low cost, modification that may be implemented into current catheter designs to reduce the incidence of CAUTI. Using the principle of transmission of fluid-pressure and the Young-Laplace equation for capillary pressure difference, this research focuses on improving the liquid flow in the presence of confined bubbles to prevent stagnation and reflux of bacteria-ridden urine into the body. Preliminary experiments are performed on a variety of tubes with hydrophobic-coating the interior, as well as geometrically modifying the tubes. Proof-of-Concept Prototype tubes are used to represent the drainage system of the catheter structure.

  2. [Long-term development of Permacath Quinton catheters used as a vascular access route for extra-renal detoxification].

    Science.gov (United States)

    Dupont, D; Morinière, P; Pourchez, T; el Esper, N; Fournier, A

    1994-01-01

    Between July 1984 and July 1991, we have inserted surgically 147 Permcath Quinton catheters in 126 uremic patients for the following reasons: group I: necessity of hemodialysis without vascular access for acute (group Ia: 44 patients) or chronic renal failure (group Ib: 11 patients); group II: difficulty of creation or loss of vascular access (group II: 45 patients); group III: hemodialysis for patients with short life expectation or contraindications for vascular access on their limbs (group III: 26 patients). The duration of use (+/- SD and range) were respectively for each group: 1.6 +/- 2 (0-10); 3.4 +/- 2.8 (1-11); 7.4 +/- 11 (0-50); 6.7 +/- 8.7 (0.1-34.5) months. Seventeen patients (group IV) coming from groups Ib and II preferred to go on with the use of their catheter for 10.5 +/- 13.5 (0.1-50) months rather than to use their arteriovenous fistula. The complications observed on whole population were: 11 septicemia responsible of 2 deaths, 9 cutaneous local infections, 28 total obstructions of the catheter, 17 partial obstructions with insufficient flow; 10 destructions of the catheter. In conclusion the Permcath Quinton catheter is an adequate long term vascular access for hemodialysis. It is well tolerated since it is preferred to the usual arteriovenous fistula by many patients who have both. The incidence of infection is low. However, obstruction (partial ou total) is frequent (29%), necessitating local fibrinolytic treatment.

  3. Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

    Science.gov (United States)

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

    2016-05-01

    To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P Puncture point using gelatin sponge, The local maintenance costs of the catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (Ppuncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

  4. Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter.

    Science.gov (United States)

    Tan, Lee A; Kasliwal, Manish K; Moftakhar, Roham; Munoz, Lorenzo F

    2014-09-01

    Small-bowel ischemia and necrosis due to knotting of the peritoneal catheter is an extremely rare complication related to a ventriculoperitoneal shunt (VPS). A 3-month-old girl, with a history of Chiari II malformation and myelomeningocele (MM) after undergoing right occipital VPS insertion and MM repair at birth, presented to the emergency department with a high-grade fever. Examination of a CSF sample obtained via shunt tap raised suspicion for the presence of infection. Antibiotic therapy was initiated, and subsequently the VPS was removed and an external ventricular drain was placed. Intraoperatively, as attempts at pulling the distal catheter from the scalp incision were met with resistance, the distal catheter was cut and left in the abdomen while the remainder of the shunt system was successfully removed. While the patient was awaiting definitive shunt revision surgery to replace the VPS, she developed abdominal distension due to small-bowel obstruction. An emergency exploratory laparotomy revealed a knot in the distal catheter looping around and strangulating the distal ileum, causing small-bowel ischemia and necrosis in addition to the obstruction. A small-bowel resection with ileostomy was performed, with subsequent placement of ventriculoatrial shunt for treatment of hydrocephalus. The authors report this exceedingly rare clinical scenario to highlight the fact that any retained distal catheter must be carefully managed with immediate abdominal exploration to remove the distal catheter to avoid bowel necrosis as pulling of a knotted peritoneal catheter may strangulate the bowel and cause ischemia, with significant clinical morbidity and possible mortality.

  5. Percutaneous catheter drainage of thoracic fluid: the usefulness and safety of bedside trocar placement under ultrasound guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon [Seoul Medical Center, Seoul (Korea, Republic of)

    2006-07-15

    The author wanted to evaluate the usefulness and safety of the trocar technique for US-guided bedside catheter placement into thoracic fluid collections, and this technique has generally been reserved for the larger or superficial fluid collections. 42 drainage procedures were performed in 38 patients at the bedside. The patients were positioned supine or semi-upright. A drainage catheter system with a stylet and cannula assembly was used and all of the catheters were inserted using the trocar technique. The procedures consisted of drainage of empyema (n=14), malignant effusion (n=13), lung abscess (n=3), massive transudate (n=8), hemothorax (n=2) and chest wall hematoma (n=2). The clinical results were classified as successful (complete and partially successful), failure or undetermined. The medical records and images were retrospectively reviewed to evaluate the success rate, the complications and the procedure time. Technical success was achieved in all of the 42 procedures. With using the trocar technique, all the catheters were placed into even the small collections without significant complications. Drainage was successful in 36 (85.7%) of the 42 procedures. The average volume of thoracic fluid that was aspirated manually at the time of catheter placement was 420 mL (range: 35 to 1470 mL). The procedure time was less than 10 minutes from US-localization to complete catheter placement in all of the procedures. The trocar technique under US guidance can be an efficient and safe alternative to the Seldinger or guide-wire exchange technique for bedside catheter placement in the critically ill or hemodynamically unstable patients.

  6. Pharmacologically induced erect penile length and stretched penile length are both good predictors of post-inflatable prosthesis penile length.

    Science.gov (United States)

    Osterberg, E C; Maganty, A; Ramasamy, R; Eid, J F

    2014-01-01

    Inflatable penile prosthesis (IPP) remains the gold standard for the surgical treatment of refractory erectile dysfunction; however, current literature to aid surgeons on how best to counsel patients on their postoperative inflated penile length is lacking. The aim of this study was to identify preoperative parameters that could better predict postoperative penile length following insertion of an IPP. Twenty men were enrolled in a prospective study examining penile lengths before and after IPP surgery. Patients with Peyronie's disease were excluded from this analysis. Baseline preoperative characteristics, including body mass index, history of hypertension, diabetes, Sexual Health Inventory for Men scores and/or prior radical prostatectomy were recorded. All patients underwent implantation with a three-piece inflatable Coloplast penile prosthesis. We compared stretched penile length to pharmacologically induced erect lengths. Postoperatively, we measured inflated penile lengths at 6 weeks and assessed patients' perception of penile size at 12 weeks. The median (±interquartile range) stretched penile length and pharmacologically induced erect penile length was 15 (±3) and 14.25 (±2) cm, respectively (P=0.5). Median post-prosthesis penile length (13.5±2.13 cm) was smaller than preoperative pharmacologically induced length (P=0.02) and preoperative stretched penile length (P=0.01). The majority of patients (70%) had a decrease in penile length (median loss 0.5±1.5 cm); however, this loss was perceptible by 43% of men. Stretched penile length and pharmacologically induced erect penile length were equally good predictors of postoperative inflated length (Spearman's correlation 0.8 and 0.9, respectively). Pharmacologically induced erect penile length and stretched penile lengths are equal predictors of post-prosthesis penile length. The majority of men will experience some decrease in penile length following prosthesis implantation; however <50% report a

  7. Application of new balloon catheters in the treatment of congenital heart defects

    Science.gov (United States)

    Fiszer, Roland; Szkutnik, Małgorzata; Smerdziński, Sebastian; Chodór, Beata; Białkowski, Jacek

    2016-01-01

    Introduction Balloon angioplasty (BAP) and aortic or pulmonary balloon valvuloplasty (BAV, BPV) are well-established treatment options in congenital heart defects. Recently, significant technological progress has been made and new catheters have been implemented in clinical practice. Aim To analyze the results of BAP, BAV and BPV with the new balloon catheter Valver and its second generation Valver II, which the company Balton (Poland) launched and developed. These catheters have not been clinically evaluated yet. Material and methods We performed 64 interventions with Valver I and Valver II. With Valver I the following procedures were performed: 17 BPV (including 9 in tetralogy of Fallot – TOF), 10 BAV and 27 BAP in coarctations of the aorta (CoA) – including 9 native and 18 after surgery. With Valver II ten interventions were done – 3 BPV, 2 pulmonary supravalvular BAP (after switch operations), 2 BAP of recoarctations and 3 other BAP. Age of the patients ranged from a few days to 40 years. Results All procedures were completed successfully, without rupture of any balloon catheters. The pressure gradient drop was statistically significant in all groups: BPV in isolated pulmonary valvular stenosis 28.1 mm Hg (mean), BPV in TOF 18.7 mm Hg, BAV 32.8 mm Hg, BAP in native CoA 15.4 mm Hg and in recoarctations 18.6 mm Hg. In 3 cases during rapid deflation of Valver I, wrinkles of the balloons made it impossible to insert the whole balloon into the vascular sheath (all were removed surgically from the groin). No such complication occured with Valver II. Conclusions Valver balloon catheters are an effective treatment modality in different valvular and vascular stenoses. PMID:27625686

  8. EM-navigated catheter placement for gynecologic brachytherapy: an accuracy study

    Science.gov (United States)

    Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

    2014-03-01

    Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and /or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

  9. Fast vision-based catheter 3D reconstruction

    Science.gov (United States)

    Moradi Dalvand, Mohsen; Nahavandi, Saeid; Howe, Robert D.

    2016-07-01

    Continuum robots offer better maneuverability and inherent compliance and are well-suited for surgical applications as catheters, where gentle interaction with the environment is desired. However, sensing their shape and tip position is a challenge as traditional sensors can not be employed in the way they are in rigid robotic manipulators. In this paper, a high speed vision-based shape sensing algorithm for real-time 3D reconstruction of continuum robots based on the views of two arbitrary positioned cameras is presented. The algorithm is based on the closed-form analytical solution of the reconstruction of quadratic curves in 3D space from two arbitrary perspective projections. High-speed image processing algorithms are developed for the segmentation and feature extraction from the images. The proposed algorithms are experimentally validated for accuracy by measuring the tip position, length and bending and orientation angles for known circular and elliptical catheter shaped tubes. Sensitivity analysis is also carried out to evaluate the robustness of the algorithm. Experimental results demonstrate good accuracy (maximum errors of  ±0.6 mm and  ±0.5 deg), performance (200 Hz), and robustness (maximum absolute error of 1.74 mm, 3.64 deg for the added noises) of the proposed high speed algorithms.

  10. 血透患者中心静脉置管感染原因分析及护理对策%Cause analysis and nursing countermeasures of central venous catheter infection in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    饶龙华

    2016-01-01

    Objective:To explore the causes and nursing countermeasures of central venous catheter infection in hemodialysis patients.Methods:95 patients with central venous catheter were selected.The clinical data were retrospectively analyzed.Results:The causes of central venous catheter infection in hemodialysis patients included the duration of catheter insertion,the location of the catheter,and the underlying diseases of the patients.Conclusion:Under the premise of not affecting the treatment effect, shortening the duration of catheter insertion,selecting subclavia venae catheter can reduce the risk of infection in hemodialysis patients.%目的:探讨血透患者中心静脉置管感染原因及护理对策。方法:收治中心静脉置管患者95例,回顾性分析其临床资料。结果:血透患者中心静脉置管感染原因包括置管时间、置管部位及患者基础疾病等。结论:在不影响治疗的前提下,缩短置管时间,选择锁骨下静脉置管,能降低血透患者的感染概率。

  11. Percutaneous catheter drainage of intrapulmonary fluid collection

    Energy Technology Data Exchange (ETDEWEB)

    Park, E. D.; Kim, H. J.; Choi, P. Y.; Jung, S. H. [Gyeongsang National University Hospital, Chinju (Korea, Republic of)

    1994-01-15

    With the success of percutaneous abdominal abscess drainage, attention is now being focused on the use of similar techniques in the thorax. We studied to evaluate the effect of percutaneous drainage in parenchymal fluid collections in the lungs. We performed percutaneous drainage of abscesses and other parenchymal fluid collections of the lungs in 15 patients. All of the procedures were performed under the fluoroscopic guidance with an 18-gauge Seldinger needle and coaxial technique with a 8-10F drainage catheter. Among 10 patients with lung abscess, 8 patients improved by percutaneous catheter drainage. In one patient, drainage was failed by the accidental withdrawal of the catheter before complete drainage. One patient died of sepsis 5 hours after the procedure. Among three patients with complicated bulla, successful drainage was done in two patients, but in the remaining patient, the procedure was failed. In one patient with intrapulmonary bronchogenic cyst, the drainage was not successful due to the thick internal contents. In one patient with traumatic hematoma, after the drainage of old blood clots, the signs of infection disappeared. Overally, of 14 patients excluding one who died, 11 patients improved with percutaneous catheter drainage and three patients did not. There were no major complications during and after the procedure. We conclude that percutaneous catheter drainage is effective and safe procedure for the treatment of parenchymal fluid collections of the lung in patients unresponsive to the medical treatment.

  12. Risk factors for development of complication following peripherally inserted central

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    Hakan Aydın

    2014-03-01

    Full Text Available Objectives: Peripherally inserted central venous catheters (PICCs are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia Methods: ‘Central Venous Catheterization Forms’ filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009 and March 2013 in the operating room of Uludag University Medical Faculty Hospital were retrospectively analysed. Results: A total of 1174 procedures were evaluated. The most preferred vein for the first attempt was the right basilic vein (32.7%. Difficulty (more than two attempts with the PICC procedure was correlated with the patient’s age (p30 kg/m² (p<0.05, resident with less than 4 years of training (p=0.001, number of PICC attempts ≥2 (p<0.001, more than one resident involved in the catheterization procedure (p<0.001 and previous failed PICC procedures (p<0.001. Conclusion: We conclude that catheterization should be performed under the surveillance of a staff keeping in mind the risks of complications. In the case of failure following 2 attempts, the procedure should be handed over to a more experienced staff member. J Clin Exp Invest 2014; 5 (1: 29-35

  13. Development of Needle Insertion Manipulator for Central Venous Catheterization

    Science.gov (United States)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  14. Analysis of ureteral length in adult cadavers

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    Hugo F. F. Novaes

    2013-04-01

    Full Text Available Introduction In some occasions, correlations between human structures can help planning surgical intra-abdominal interventions. The previous determination of ureteral length helps pre-operatory planning of surgeries, reduces costs of auxiliary exams, the correct choice of double-J catheter with low morbidity and fewer symptoms, and an adequate adhesion to treatment. Objective To evaluate ureteral length in adult cadavers and to analyze its correlation with anthropometric measures. Materials and Methods: From April 2009 to January 2012 we determined ureteral length of adult cadavers submitted to necropsy and obtained the following measures: height, distance from shoulder to wrist, elbow-wrist, xiphoid appendix-umbilicus, umbilicus-pubis, xiphoid appendix-pubis and between iliac spines. We analyzed the correlations between ureteral length and those anthropometric measures. Results We dissected 115 ureters from 115 adult corpses from April 2009 to January 2012. Median ureteral length didn't vary between sexes or according to height. It was observed no correlation among ureteral length and all considered anthropometric measures in all analyzed subgroups and in general population. There were no significant differences between right and left ureteral measures. Conclusions There is no difference of ureteral length in relation to height or gender (male or female. There is no significant correlation among ureteral length and the considered anthropometric measures.

  15. Toward automated cochlear implant insertion using tubular manipulators

    Science.gov (United States)

    Granna, Josephine; Rau, Thomas S.; Nguyen, Thien-Dang; Lenarz, Thomas; Majdani, Omid; Burgner-Kahrs, Jessica

    2016-03-01

    During manual cochlear implant electrode insertion the surgeon is at risk to damage the intracochlear fine-structure, as the electrode array is inserted through a small opening in the cochlea blindly with little force-feedback. This paper addresses a novel concept for cochlear electrode insertion using tubular manipulators to reduce risks of causing trauma during insertion and to automate the insertion process. We propose a tubular manipulator incorporated into the electrode array composed of an inner wire within a tube, both elastic and helically shaped. It is our vision to use this manipulator to actuate the initially straight electrode array during insertion into the cochlea by actuation of the wire and tube, i.e. translation and slight axial rotation. In this paper, we evaluate the geometry of the human cochlea in 22 patient datasets in order to derive design requirements for the manipulator. We propose an optimization algorithm to automatically determine the tube set parameters (curvature, torsion, diameter, length) for an ideal final position within the cochlea. To prove our concept, we demonstrate that insertion can be realized in a follow-the-leader fashion for 19 out of 22 cochleas. This is possible with only 4 different tube/wire sets.

  16. Length of urethra in the Indian adult male population

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    Venkatesh Krishnamoorthy

    2012-01-01

    Full Text Available Objective: The urethral length has not been measured in the Indian population. Even the international literature in this arena is very sparse. This paper is an attempt to develop a simple anatomical database for urethral length. Materials and Methods: Between January 2010 and April 2011, the urethral lengths of 422 adult male patients who required catheterization as part of regular treatment at our hospital, were recorded after obtaining consent from the patients and from the scientific and ethics review boards of the institution. Patients with history of prostatic or urethral abnormalities were excluded. The balloon of a sterile Foley′s catheter was inflated using 10 cc of saline. The length from the junction of the balloon to the ′Y′ junction of the Foley was measured. The catheter was then passed into the bladder and re-inflated to same volume. The penis was gently straightened and the length of the catheter outside the penis was measured till the premarked point at the ′Y′ junction. Subtracting this from the original length gave the length of the urethra. Results: The mean length of the urethra was 17.55 + 1.42 cm with a range between 14 and 22.5 cm. Conclusions: Literature in which the length of the normal adult male urethra is recorded for a significant sample size is very scarce. Our data adds to basic anatomic information of the male urethra specific to the Indian population. Statistical Methods: Descriptive statistical analysis was performed. The non-linear regression analysis was employed to find the normative values of urethral length according to age class.

  17. Microbiocidal effects of various taurolidine containing catheter lock solutions

    NARCIS (Netherlands)

    Olthof, E.D.; Nijland, R van; Gulich, A.F.; Wanten, G.J.A.

    2015-01-01

    BACKGROUND & AIMS: We have recently shown that a catheter lock solution containing taurolidine dramatically decreases catheter-related bloodstream infections (CRBSI) in patients on home parenteral nutrition (HPN) when compared to heparin. Since several taurolidine formulations are commercially avail

  18. A novel method for salvage of malfunctioning peritoneal dialysis catheter

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    Ali Akbar Beig

    2014-01-01

    Conclusions: Comparing the advantages and disadvantages of this method to the previous laparoscopically repaired catheter, we concluded that this new method is efficient, and is a suitable way for malfunctioning PD catheter salvage.

  19. Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation

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    Jin-yi Li

    2017-01-01

    Full Text Available A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT. Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB by transthoracic echocardiography (TTE. Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT.

  20. Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation

    Science.gov (United States)

    Li, Jin-yi; Jiang, Jing-bo; He, Yan; Luo, Jian-chun

    2017-01-01

    A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT). Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB) by transthoracic echocardiography (TTE). Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT.

  1. Prevention of catheter-related Pseudomonas aeruginosa infection by levofloxacin-impregnated catheters in vitro and in vivo

    Institute of Scientific and Technical Information of China (English)

    Yan Ping; Liu Wei; Kong Jinliang; Wu Hong; Chen Yiqiang

    2014-01-01

    Background Implanted medical catheter-related infections are increasing,hence a need for developing catheter polymers bonded to antimicrobials.We evaluated preventive effects of levofloxacin-impregnated catheters in catheterrelated Psuedomonas aeruginosa (strain PAO1) infection.Methods Drug release from levofloxacin-impregnated catheters was measured in vitro.Levofloxacin-impregnated catheters and polyvinyl chloride (PVC) catheters were immersed in 5 ml 50% Luria Bertani medium containing 108 CFU/ml Pseudomonas aeruginosa then incubated for 6,12,24 or 48 hours at 37℃ when bacteria adhering to the catheters and bacteria in the growth culture medium were determined.Impregnated and PVC catheters were singly implanted subcutaneously in mice,50 μl (107CFU) of PAO1 was injected into catheters.After the first and fifth days challenge,bacterial counts on implanted catheters and in surrounding tissues were determined microbiologically.Bacterial colonization and biofilm formation on implanted catheters were assessed by scanning electron microscopy.Results Drug release from levofloxacin-impregnated catheters was rapid.Levofloxacin-impregnated catheters had significantly fewer bacteria compared to PVC in vitro.After first and fifth day of challenge,no or significantly fewer bacteria adhered to impregnated catheters or in surrounding tissues compared to PVC.Scanning electron microscopical images after first day displayed from none to significantly fewer bacteria adhering to impregnated implanted catheters,compared to bacteria and microcolonies adhering to PVC catheters.After the fifth day,no bacteria were found on impregnated catheters,compared to clusters surrounding mucus-like substance and coral-shaped biofilms with polymorphonuclear leukocyte on PVC catheters.After the first day of challenge,secretion occurred in all implanted catheters with surrounding tissues mildly hyperaemic and swollen.After the fifth day,minute secretions inside impregnated catheters and no

  2. Effect of insertion speed on tissue response and insertion mechanics of a chronically implanted silicon-based neural probe.

    Science.gov (United States)

    Welkenhuysen, M; Andrei, A; Ameye, L; Eberle, W; Nuttin, B

    2011-11-01

    In this study, the effect of insertion speed on long-term tissue response and insertion mechanics was investigated. A dummy silicon parylene-coated probe was used in this context and implanted in the rat brain at 10 μm/s (n = 6) or 100 μm/s (n = 6) to a depth of 9 mm. The insertion mechanics were assessed by the dimpling distance, and the force at the point of penetration, at the end of the insertion phase, and after a 3-min rest period in the brain. After 6 weeks, the tissue response was evaluated by estimating the amount of gliosis, inflammation, and neuronal cell loss with immunohistochemistry. No difference in dimpling, penetration force, or the force after a 3-min rest period in the brain was observed. However, the force at the end of the insertion phase was significantly higher when inserting the probes at 100 μm/s compared to 10 μm/s. Furthermore, an expected tissue response was seen with an increase of glial and microglial reactivity around the probe. This reaction was similar along the entire length of the probe. However, evidence for a neuronal kill zone was observed only in the most superficial part of the implant. In this region, the lesion size was also greatest. Comparison of the tissue response between insertion speeds showed no differences.

  3. Corynebacterium diphtheriae as an emerging pathogen in nephrostomy catheter-related infection: evaluation of traits associated with bacterial virulence.

    Science.gov (United States)

    Gomes, Débora L R; Martins, Carlos A S; Faria, Lúcia M D; Santos, Louisy S; Santos, Cintia S; Sabbadini, Priscila S; Souza, Mônica C; Alves, Gabriela B; Rosa, Ana C P; Nagao, Prescilla E; Pereira, Gabriela A; Hirata, Raphael; Mattos-Guaraldi, Ana L

    2009-11-01

    Corynebacterium diphtheriae still represents a global medical challenge, particularly due to the significant number of individuals susceptible to diphtheria and the emergence of non-toxigenic strains as the causative agents of invasive infections. In this study, we characterized the clinical and microbiological features of what we believe to be the first case of C. diphtheriae infection of a percutaneous nephrostomy catheter insertion site in an elderly patient with a fatal bladder cancer. Moreover, we demonstrated the potential role of adherence, biofilm formation and fibrin deposition traits in C. diphtheriae from the catheter-related infection. Non-toxigenic C. diphtheriae isolated from the purulent discharge (named strain BR-CAT5003748) was identified by the API Coryne system (code 1 010 324) and a multiplex PCR for detection of dtxR and tox genes. Strain BR-CAT5003748 showed resistance to oxacillin, ceftazidime and ciprofloxacin. In experiments performed in vitro, the catheter isolate was classified as moderately hydrophobic and as moderately adherent to polystyrene surfaces. Glass provided a more effective surface for biofilm formation than polystyrene. Micro-organisms adhered to (>1.5 x 10(6) c.f.u.) and multiplied on surfaces of polyurethane catheters. Microcolony formation (a hallmark of biofilm formation) and amorphous accretions were observed by scanning electron microscopy on both external and luminal catheter surfaces. Micro-organisms yielded simultaneous expression of localized adherence-like and aggregative-like (LAL/AAL) adherence patterns to HEp-2 cells. Interestingly, the coagulase tube test resulted in the formation of a thin layer of fibrin embedded in rabbit plasma by the non-toxigenic BR-CAT5003748 strain. In conclusion, C. diphtheriae should be recognized as a potential cause of catheter-related infections in at-risk populations such as elderly and cancer patients. LAL/AAL strains may be associated with virulence traits that enable C

  4. Proper Angle of Sono-guided Central Venous Line Insertion; a Brief Report

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    Hassan Barzegari

    2016-04-01

    Full Text Available Introduction: 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. Methods: 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. Result: 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. Conclusion: 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. 

  5. Urinary catheterization diary – A useful tool in tracking causes of non-deflating Foley catheter

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    C.O. Okorie

    2015-06-01

    Conclusions: Most urinary catheters marketed in developing countries are unidentifiable after unpacking. A catheterization diary is a useful tool for solving catheter-related problems, and its application in health-care facilities should be encouraged. Companies marketing Foley catheters should print the catheter name on both the catheter packaging and on the catheter itself.

  6. Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters.

    Science.gov (United States)

    Efthymiou, Christopher Andrew; Masudi, Tahir; Thorpe, James Andrew Charles; Papagiannopoulos, Kostas

    2009-12-01

    Malignant pleural effusions in the presence of trapped lung remain notoriously difficult to treat. Various methods exist ranging from minimally invasive procedures including repeated needle thoracocentesis to the need for a formal surgical procedure such as placement of a pleuroperitoneal shunt and even thoracotomy and decortication. Controversy exists as to what is the optimum treatment for this condition. Any planned treatment should balance the therapeutic benefit provided against convalesce for a disease with a limited life expectancy. Patients should not spend a significant proportion of their remaining life span recovering from palliative procedures. In a series of patients with malignant pleural effusion the medial survival time was 20 weeks, with 30 days and 1 year mortality rates of 12.8% and 83.6%, respectively. We describe our five-year experience with the use of indwelling PleurX catheters in patients with malignant pleural effusions in the presence of confirmed trapped lung on radiological or VATS investigation. Patient health related quality of life was investigated by telephone questionnaire. The parameters analysed were symptomatic relief, mobility and ease of management following insertion. One hundred and sixteen patients underwent PleurX catheter insertion by a single operator, 48 questionnaires were completed. Of the 48 cases analysed, improvement in all three quality of life indices was recorded following catheter insertion. Ease of mobility was recorded as moderately satisfied and very satisfied in 50% and 15% of patients, respectively. Symptomatic improvement was found to have been increased with 42% and 6% of patients responding to moderately satisfied and very satisfied, respectively. Ease of management was recorded as 'slightly satisfied' and moderately satisfied in 50% and 33% of patients, respectively, demonstrating a high satisfaction index in patients with chronic progressively debilitating malignancies. Complications were either

  7. Central Solenoid Insert Technical Specification

    Energy Technology Data Exchange (ETDEWEB)

    Martovetsky, Nicolai N [ORNL; Smirnov, Alexandre [ORNL

    2011-09-01

    The US ITER Project Office (USIPO) is responsible for the ITER central solenoid (CS) contribution to the ITER project. The Central Solenoid Insert (CSI) project will allow ITER validation the appropriate lengths of the conductors to be used in the full-scale CS coils under relevant conditions. The ITER Program plans to build and test a CSI to verify the performance of the CS conductor. The CSI is a one-layer solenoid with an inner diameter of 1.48 m and a height of 4.45 m between electric terminal ends. The coil weight with the terminals is approximately 820 kg without insulation. The major goal of the CSI is to measure the temperature margin of the CS under the ITER direct current (DC) operating conditions, including determining sensitivity to load cycles. Performance of the joints, ramp rate sensitivity, and stability against thermal or electromagnetic disturbances, electrical insulation, losses, and instrumentation are addressed separately and therefore are not major goals in this project. However, losses and joint performance will be tested during the CSI testing campaign. The USIPO will build the CSI that will be tested at the Central Solenoid Model Coil (CSMC) Test Facility at the Japan Atomic Energy Agency (JAEA), Naka, Japan. The industrial vendors (the Suppliers) will report to the USIPO (the Company). All approvals to proceed will be issued by the Company, which in some cases, as specified in this document, will also require the approval of the ITER Organization. Responsibilities and obligations will be covered by respective contracts between the USIPO, called Company interchangeably, and the industrial Prime Contractors, called Suppliers. Different stages of work may be performed by more than one Prime Contractor, as described in this specification. Technical requirements of the contract between the Company and the Prime Contractor will be covered by the Fabrication Specifications developed by the Prime Contractor based on this document and approved by

  8. Effectiveness of 10% povidone-iodine drying time before Peripheral Intravascular Catheter insertion: preliminary results from an explorative quasi-experimental study Eficacia del tiempo de secado de la yodopovidona al 10% antes de la inserción de catéter venoso periférico: resultados preliminares de un estudio exploratorio casi-experimental Eficácia de iodopovidona a 10% de acordo com tempo de secagem antes da inserção do cateter intravenoso periférico: resultados preliminares de um estudo exploratório quasi-experimental

    Directory of Open Access Journals (Sweden)

    Alvisa Palese

    2013-02-01

    Full Text Available AIM: to investigate the effectiveness of 10% povidone-iodine after a 30-second or 2-minute drying time on microbial count reduction at the point of a Peripheral Intravascular Catheter (PIC insertion. A quasi-experimental design was adopted. In total, 53 patients were enrolled, 25 were exposed to a 2-m drying time and 28 to a 30-s drying time. From the preliminary results of this study, no differences in the occurrence of contamination have emerged between patients receiving 30-s and 2-m drying time for 10% povidone-iodine solutions.OBJETIVO: para investigar la eficacia de una solución yodopovidona al 10% tras tiempo de secado de 30 segundos o 2 minutos en la reducción del contaje microbiano en el local de inserción del Catéter Venoso Periférico, fue adoptado un diseño casi-experimental. Al total, fueron incluidos 53 pacientes, 25 expuestos a 2 min. de secado y 28 a 30 segundos. Con base en los resultados preliminares, no se encontraron diferencias en la ocurrencia de contaminaciones entre pacientes sometidos a un tiempo de secado de 30 s. o de 2 min tras desinfección con solución de yodopovidona al 10%.OBJETIVO: investigar a eficácia da solução iodopovidona a 10% sobre a redução da contagem microbiana no ponto de inserção do Cateter Venoso Periférico após tempo de secagem de 30s ou 2 min. MÉTODO: desenho quase-experimental. Foram incluídos 53 pacientes no estudo: 25 foram expostos a 2min de secagem e 28 foram expostos a 30s de secagem. RESULTADOS: Os resultados preliminares não apresentaram diferenças na ocorrência de contaminação entre os pacientes que foram submetidos a 30s ou 2min de secagem após desinfecção com solução de iodopovidona a 10%.

  9. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home

    Directory of Open Access Journals (Sweden)

    Ana Cristina Freire Abud

    2015-10-01

    Full Text Available Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance.Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01. The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015.Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment.

  10. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fiberoptic oximeter catheter. 870.1230 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1230 Fiberoptic oximeter catheter. (a) Identification. A fiberoptic oximeter catheter is a device used to estimate the...

  11. Gas turbine vane cooling air insert

    Energy Technology Data Exchange (ETDEWEB)

    North, W.E.; Hultgren, K.G.; Dishman, C.D.; Van Heusden, G.S.

    1992-09-08

    This patent describes a gas turbine. It comprises turbine vanes, each of the vanes supplied with cooling air and having: an airfoil portion forming a first cavity having an insert disposed therein for directing the flow of the cooling air, the insert having first and second insert ends; a shroud portion from which the airfoil portion extends, the insert attached to the shroud portion at the first insert end; an insert extension extending through a portion of the insert and extending beyond the first insert end, the insert extension and the insert forming an annular gap therebetween separating the insert from the insert extension; a plate covering at least a portion of the shroud, the plate having a first hole formed therein through which the insert extension extends; and at least a first seal extending between the insert extension and the insert, and sealing the annular gap therebetween. This patent also describes a method of making a gas turbine. It comprises welding a first tubular insert adjacent its first end to a vane outer shroud; partially inserting a second tubular insert into the first tubular member and attaching the second tubular insert thereto; placing a plate having a hole formed therein on the outer shroud so that the hole surrounds the second tubular insert; and attaching the second tubular insert to the plate by placing a first seal between the first and second tubular inserts and attaching the first seal to each of the first and second tubular inserts, and placing a second seal between the second tubular insert and the plate and welding the second seal to the second tubular insert and the plate.

  12. Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Cantasdemir, M. E-mail: cantas1@yahoo.com; Kara, B.; Cebi, D.; Selcuk, N.D.; Numan, F

    2003-10-01

    AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD.

  13. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Christine Hohl Moinat

    2014-01-01

    Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

  14. Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections

    Directory of Open Access Journals (Sweden)

    Jonas Marschall

    2013-01-01

    Full Text Available BACKGROUND: Enterococci are an important cause of central venous catheter (CVC-associated bloodstream infections (CA-BSI. It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.

  15. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter.

    Science.gov (United States)

    Chuang, Ming-Tsung; Wu, Ding-Kwo; Chang, Cheng-Ang; Shih, Ming-Chen Paul; Ou-Yang, Fu; Chuang, Chien-Han; Tsai, Yi-Fan; Hsu, Jui-Sheng

    2011-11-01

    The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

  16. [Femoral venous catheter: an unusual complication].

    Science.gov (United States)

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  17. Best practices in urinary catheter care.

    Science.gov (United States)

    Herter, Rebecca; Kazer, Meredith Wallace

    2010-06-01

    Urinary catheterization is a common healthcare intervention used to manage urinary dysfunction that poses serious associated risks and complications. This article discusses methods of urinary catheterization and their indications, catheter-associated complications, and assessment and management strategies that home healthcare practitioners can employ to ensure best patient outcomes and minimize complications.

  18. Complications after placement of peritoneal catheter

    Directory of Open Access Journals (Sweden)

    Đurđević-Mirković Tatjana

    2011-01-01

    Full Text Available Introduction. Peritoneal dialysis is one of the modalities used for treatment of end-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis and renal transplantation. Owing to the rich vascularization of the peritoneum, it is used in the processes of osmosis and diffusion, enabling the removal of uremic material from the body. The procedure includes introduction of peritoneal fluid via the peritoneal catheter. Complications. The catheter is placed through the anterior abdominal wall with its tip positioned in the small pelvis. There are several techniques for catheter placement considered minimally invasive, which, however, may be associated with various complications. These complications can be divided into mechanical (catheter dysfunction, cuff protrusion, hernia, dialysate leaks, visceral perforation and infectious (early peritonitis, exit site or tunnel infection, surgical wounds. In most cases, such complications are rare and can be successfully managed using conservative therapy; however, in some situations severe complications can endanger the life of the patient. On-time recognition of complications, particularly in patients at risk, is of paramount importance for an effective treatment. The development of complications can increase the morbidity and the chance of treatment failure, and therefore transfer to haemodialysis. Conclusion. The preoperative evaluation and determination of the risk factors as well as the early recognition and adequate management of complications are essential in their prevention.

  19. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

    Directory of Open Access Journals (Sweden)

    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  20. Urethral catheters: can we reduce use?

    Directory of Open Access Journals (Sweden)

    van den Akker-van Marle M Elske

    2011-05-01

    Full Text Available Abstract Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13 and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13, decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96, but increased significantly in intensive care (IC and coronary care (CC units (OR 1.48; 95% CI 1.01 - 2.17. The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16 and neurology (ratio 0.97; 95% CI 0.80 - 1.18 and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96 and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90. The percentage of correct indications on the day of inclusion increased from 50 to 67% (p Conclusion Targeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or

  1. The effect of insertion angle on orthodontic mini-screw torque

    Directory of Open Access Journals (Sweden)

    Seyed Hamid Raji

    2014-01-01

    Full Text Available Background: Primary stability is an important factor for the clinical success of orthodontic mini-screws. The present study made an attempt to evaluate the effect of insertion angle changes on the maximum insertion and removal torque of orthodontic mini-screws. Materials and Methods: In this experimental study, 72 mini-screws (Dual Top Anchor System, Jeil, 1.6 mm diameter, 8 mm length were used. They were randomly divided into four equal groups and inserted in poly-carbonate plates with 3 mm thickness. Then, their maximum insertion torque (MIT and maximum removal torque (MRT were recorded using a digital torque tester/screwdriver. Each group had a different insertion angle (90°, 75°, 60° and 45°. The data were analyzed by SPSS software (version 18 using one-way ANOVA and post-hoc Tukey′s tests. The level of significance was set at 0.05. Results: The maximum MIT was observed in 45° insertion angle (14.84 Ncm and the minimum MIT was reported in 75° insertion angle (12.66 Ncm. The maximum MRT was observed in 45° insertion angle (23.21 Ncm and the minimum MRT was reported in the 90° insertion angle (17.43 Ncm. Conclusion: Oblique insertion of the mini-screws results in higher insertion and removal torques and probably more primary stability compared to the vertical insertion.

  2. The pericardial reflection and the tip of the central venous catheter - topographical analysis in stillborn babies

    Energy Technology Data Exchange (ETDEWEB)

    Eifinger, Frank; Vierzig, Anne; Roth, Bernhard [University Children' s Hospital, Department of Pediatric Critical Care Medicine and Neonatology, Cologne (Germany); Scaal, Martin [University of Cologne, Institute of Anatomy II, Cologne (Germany); Koerber, Friederike [University of Cologne, Department of Radiology, Cologne (Germany)

    2016-10-15

    Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium. To investigate the level of the superior pericardial reflection in stillborn babies. We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium. Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5). The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space. (orig.)

  3. Effectiveness of percutaneous catheter drainage for tuberculous iliopsoas abscess associated with tuberculous spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kue Hee; Kim, Yun Hwan [Korea Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the efficacy of percutaneous catheter drainage of tuberculous abscess associated with tuberculous spondylitis. In twelve patients (male: female=1:2; mean age, 37.3 years) tuberculous abscess was diagnosed, and was treated by percutaneous abscess drainage(PAD). All patients had either a psoas or iliopsoas abscess and in two, a paravertebral abscess was also present. Four had bilateral lesions, one, a unilateral lesion, and one, paravertebral abscesses and bilateral psoas. The size of abscesses ranged from 4x5x12cm to 6x9x30cm;four were septated and all were lobulated. Using an 8.5-14F catheter, 17 of 18 abscesses were percutaneously drained; Ultrasound guidance was used in 12 cases, and CT guidance in five. The volume of drainage mater ranged from 150 to 1200 cc(mean, 600cc), and the duration of catheter insertion was 6-48 (mean, 17.4) days. In no patient did significant complications arise during or after drainage, and in all cases, follow-up studies using ultrasound, CT or MRI were performed. The duration of follow-up ranged from 3 to 35 (mean, 15.4) months; during this time, no recurrence was noted. Chemotherapy alone is sufficient for treating a small tuberculous psoas or iliopsoas abscess, but for a large abscess, adjuvant drainage is necessary.

  4. An assembly-type master-slave catheter and guidewire driving system for vascular intervention.

    Science.gov (United States)

    Cha, Hyo-Jeong; Yi, Byung-Ju; Won, Jong Yun

    2017-01-01

    Current vascular intervention inevitably exposes a large amount of X-ray to both an operator and a patient during the procedure. The purpose of this study is to propose a new catheter driving system which assists the operator in aspects of less X-ray exposure and convenient user interface. For this, an assembly-type 4-degree-of-freedom master-slave system was designed and tested to verify the efficiency. First, current vascular intervention procedures are analyzed to develop a new robotic procedure that enables us to use conventional vascular intervention devices such as catheter and guidewire which are commercially available in the market. Some parts of the slave robot which contact the devices were designed to be easily assembled and dissembled from the main body of the slave robot for sterilization. A master robot is compactly designed to conduct insertion and rotational motion and is able to switch from the guidewire driving mode to the catheter driving mode or vice versa. A phantom resembling the human arteries was developed, and the master-slave robotic system is tested using the phantom. The contact force of the guidewire tip according to the shape of the arteries is measured and reflected to the user through the master robot during the phantom experiment. This system can drastically reduce radiation exposure by replacing human effort by a robotic system for high radiation exposure procedures. Also, benefits of the proposed robot system are low cost by employing currently available devices and easy human interface.

  5. Repositioning of malpositioned or flipped central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Thalhammer, A.; Jacobi, V.; Balzer, J.; Vogl, T.J. [Institute for Diagnostic and Interventional Radiology, Central Radiology Clinic, J.W. Goethe University, Frankfurt am Main (Germany)

    2002-03-01

    Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation. (orig.)

  6. Drug transport in HEMA conjunctival inserts containing precipitated drug particles.

    Science.gov (United States)

    Gupta, Chhavi; Chauhan, Anuj

    2010-07-01

    This paper focuses on exploring the mechanism of cyclosporine A transport in hydroxyethyl methacrylate (HEMA) rods to develop conjunctival inserts for extended ocular delivery. Cylindrical conjunctival HEMA inserts were prepared by thermal polymerization in presence of drug at high loadings to create rods containing particles of drug dispersed in the matrix. The drug release rates were measured to explore the effect of length, drug loading, crosslinking, and mixing in the release medium. Also microstructure of the inserts was characterized by SEM imaging. The inserts release the drug for a period of about a month at therapeutic rates. The rates of drug release are zero order and independent of drug loading and crosslinking for certain period of time. These effects were shown to arise due to a mass-transfer boundary layer in the fluid and a mathematical model was developed by coupling mass transfer in the insert with that in the boundary layer in the surrounding fluid. The model with diffusivity in the insert and boundary layer thickness as parameters fits the experimental data and explains all trends in release kinetics. The fitted diffusivity is about twice that obtained by direct measurements, which agreed well with the value obtained by using the Brinkman's equation but only after accounting for drug binding to the polymer.

  7. Use of Permcath (Quinton) catheter in uraemic patients in whom the creation of conventional vascular access for haemodialysis is difficult.

    Science.gov (United States)

    Pourchez, T; Morinière, P; Fournier, A; Pietri, J

    1989-01-01

    During the last 4 years, the Permcath Quinton double-lumen silicone catheter was inserted into the internal jugular vein of 57 uraemic patients with difficulty for creating conventional vascular access for haemodialysis. In 4 patients, with definitive contraindication of conventional vascular access, this catheter still permits haemodialysis after a duration of 8-25 months. In 25 further patients with terminal uraemia, but poor vein system, it allowed the maturation of an arteriovenous fistula after 2-14 months of use. In 17 patients already on chronic haemodialysis, but who lost abruptly their vascular access (15 grafts and 2 arteriovenous fistulae), it allowed a new arteriovenous fistula to mature in 16 cases after a mean duration of 7.3 +/- months. In 5 patients with short life expectancy because of neoplasia, it allowed to dialyse them until their death which occurred after 6.5 +/- 2.2 months. In 6 patients with acute renal failure and haemostasis problems, it allowed to perform not only dialysis, but also plasmapheresis in 3 and parenteral nutrition in 3 other cases. The complications were the following: sepsis (n = 3); episodes of hypocoagulability due to inadvertent injection of heparin stored in the lumen (n = 2), thrombosis of the lumen (n = 3), and insufficient flow (n = 6). In no case these complications prevented continuation of haemodialysis. The catheter had to be removed in 2 cases because of septis and in 1 case because of insufficient flow. In 3 cases the catheter had to be replaced because of thrombosis and in 1 case because of laceration. These complication rates are, however, fewer than those reported in the literature for arteriovenous shunts or rigid subclavian and femoral catheters. The Permcath catheter seems, therefore to be the method of choice for immediated vascular access in patients in whom the creation of conventional vascular access is difficult.

  8. Gene Insertion Patterns and Sites

    Science.gov (United States)

    Vain, Philippe; Thole, Vera

    During the past 25 years, the molecular analysis of transgene insertion patterns and sites in plants has greatly contributed to our understanding of the mechanisms underlying transgene integration, expression, and stability in the nuclear genome. Molecular characterization is also an essential step in the safety assessment of genetically modified crops. This chapter describes the standard experimental procedures used to analyze transgene insertion patterns and loci in cereals and grasses transformed using Agrobacterium tumefaciens or direct transfer of DNA. Methods and protocols enabling the determination of the number and configuration of transgenic loci via a combination of inheritance studies, polymerase chain reaction, and Southern analyses are presented. The complete characterization of transgenic inserts in plants is, however, a holistic process relying on a wide variety of experimental approaches. In this chapter, these additional approaches are not detailed but references to relevant bibliographic records are provided.

  9. Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T. [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey); Akhan, Okan, E-mail: akhano@tr.net [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey)

    2011-11-15

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

  10. Risk factors for central venous ca